Home to the our nation’s most bold statement of patriotic artwork, Mount Rushmore, and the geographical center point of the country, South Dakota is full of mountains and small towns. The state is known for its many miles of caves, parks with free-roaming bison, and potato farming. The Sioux nation is also very prevalent in South Dakota, with most towns and sites derived from Lakota terminology, including the Black Hills, and Sioux Falls.
The residents of South Dakota have only a few reputable options for individual health insurance. The best companies in the state include Celtic, Coventry, and UnitedHealthOne. If you have any questions about plans from any of these carriers, feel free to call one of our licensed agents at 888 803 5917 for assistance. To get a quote and compare prices and availability in your area on your own, enter your zip code below.
The health of South Dakota as a whole is mediocre compared to the rest of the US. According to the UnitedHealth Foundation rankings, the state is 23rd for the year 2011. Along with every other state, there is a growing population of obese adults, which has increased from 19 percent to nearly 28 percent of all adult residents over the past decade. There is also one of the highest levels of excessive alcohol intake in the nation in South Dakota. A positive side is that diabetes is not very prevalent among adults, with only a 1.2 percent increase in the last ten years. Also, the air quality is one of the best in the country due to the low population and high natural integrity of the state.
South Dakota does have a low and gradually decreasing smoking population, now slightly over 15 percent of all adults are smokers in the state. In terms of health care, South Dakota is doing decently well. The percentage of individuals without insurance is higher than many other states at 13 percent, and public health funding is also somewhere in the middle meeting sufficient quality. To improve health in the future, wellness programs are offered through health insurance carriers, as well as public programs for those who cannot afford insurance. Utilizing such services as well as getting the proper medical treatment when necessary could help South Dakota residents become more healthy in the future.
Health Insurance Plans
- Celtic Basic plans in South Dakota offer essential health coverage for an affordable rate, with the option of either 70% or 80% coverage after deductible on in-network services. Deductible options for individuals are $2,500, $3,500, $5,000, or $7,500, all of which offer low monthly premiums. Immediate benefits include preventive care for no charge with in-network providers, in addition to your first two visits to a primary care physician or specialist for a $30 copay and generic prescriptions for $15. These plans offer hospital stays, outpatient surgery, emergency care and lab work for an additional deductible per occurrence and coinsurance after deductible.
- CeltiCare Preferred plans provide traditional PPO coverage of either 80% or 100% on in-network hospital care after deductible. Deductibles range from $1,000 to $10,000 for individuals, and double the price for additional dependent members. These plans have an incredibly low rate for physician office visits at $15 for a PCP or specialist, though limited to two per year. Generic prescription drugs are offered for a $10 copay as soon as your plan begins, and brand names are $40 after the separate $500 pharmacy deductible.
- CelticSaver HSA plans are high deductible plans, with deductible options of $2,600 or $5,000 for individuals. These comprehensive plans give members the option of opening a health savings account (HSA) to complement their policy and build tax-advantaged savings. Preventive services are available for no cost through the Celtic PPO network from your plan’s start date, and all other types of care are covered at 80% with $2,600 plans, or 100% with $5,000 plans after deductible. Prescriptions are included in the annual deductible, and covered at the chosen level of coinsurance after it has been met. If you choose to connect an HSA to your plan, you can receive tax deductions on your federal and state taxes, and withdraw funds tax-free.
- HealthGear plans are available in four different types with varying levels of coinsurance. HG A2500 and HG A5000 plans cover 80% of covered services after you have met the deductible, while HG B3500 plans cover 70% and HG C5000 cover 60%. With every type of HealthGear plan, there is a $40 copay for primary care office visits and $60 for specialists, with varying limits on number of visits. Generics are the only prescription option available for a $15 copay, no separate deductible required. Other covered services include various inpatient and outpatient hospital care, home health care, transplants and skilled nursing. For no cost with network providers, preventive care is offered as soon as your plan begins.
- Spectrum plans have a higher level of coverage with a reasonable price. Choose a deductible of $1,500 or $3,500, and receive preventive care with network providers covered in full once your plan becomes effective. Other first-dollar benefits include doctor’s office visits, generic prescriptions, and emergency care for a copay as soon as your plan begins. After a $100 prescription drug deductible, any type of prescription is available for a copay. Qualified major medical services are covered at 90% after deductible with Spectrum plans.
- Torch plans from CoventryOne come in a variety of deductibles, ranging from $1,000 to $5,000, with 80/20 coinsurance after deductible. Benefits available instantly include office services from a specialist or primary care doctor for a copay and preventive care covered in full with network providers. After you meet the deductible, there is 80% coverage on major medical care with in-network providers. There is also a separate prescription deductible of $100 and brand name or non-formulary medications available for a copay.
- TorchLight plans have a higher deductible, ranging from $2,000 to $10,000 for individuals. These plans cover 60% of your health care costs for inpatient and outpatient services once your deductible has been met. When your plan begins, doctor’s office visits are available for a copay, as well as urgent care services. There is a $500 prescription deductible, after which all levels of prescriptions can be purchased for a low copay. Preventive care is no cost when using in-network providers.
- Prism plans have the most comprehensive set of benefits, offering 100% coverage after deductible. Once you have met the deductible amount, which can be $2,500, $3,500 or $5,000, you can see a physician, receive inpatient care, surgery, skilled nursing, home health care, prescription drugs and more for no cost. As soon as your plan starts, you may receive preventive services covered in full within the PPO network. These plans are convenient and easy to use and provide a great number of benefits.
- Copay plans are available in a range of deductibles, from $1,000 to $10,000 for individuals, offering the perks of discounted coverage before deductible. The Copay Select plan gives members more covered services than the Value plan, including all tiers of prescription drugs, and the option of either 70%, 80% or 100% coverage depending on the chosen deductible. Value plans cover 70% of care after deductible, and do not have as many options though they are a more budget-conscious selection. With either plan, you can visit a primary care doctor or specialist for a $35 copay (for the first four visits), and use in-network doctors for preventive care at no cost from the date of effectiveness.
- High Deductible plans come in three types in South Dakota, including Plan 100, Plan 80 and Saver 80. Plan 100 offers coverage in full after deductible when using in network doctors for all types of medical care. Plan 80 also gives members access to a wide selection of benefits, including inpatient and outpatient hospital care, prescription drugs, emergency and urgent care for 20% coinsurance. Saver 80 plans have a limited coverage range, but provide basic major medical care for a low monthly rate and a wide range of deductibles – from $1,000 to $10,000. Each of these plans covers preventive services at 100% with in-network providers.
- Health Savings Account plans give members the option to open a health savings account (HSA) to pay for medical care or build savings, and have several deductibles to choose from. These plans are available with either 70 or 100 percent coverage after deductible on a wide array of medical services, including doctor’s office visits, outpatient surgery, inpatient stays, and prescriptions. Individual deductibles range from $2,500 to $5,000 for individuals for HSA 100 plans, and $1,250 to $5,000 for HSA 70 plans. With the ability to set aside funds specifically for health care costs, HSAs provide greater flexibility and control over medical expenses that results in tax breaks.
Public Health Options
South Dakota offers its residents many services to assist with affording medical care and providing health care services. Uninsured South Dakota individuals and families have several options, including Medicaid, if they cannot pay for a private health insurance plan through one of the companies mentioned above. If an individual has been rejected for health insurance due to their health, they can either be eligible for a Medicaid program, or PCIP if their income is too high. Families with children can enroll their child in CHIP regardless of income if they do not already have insurance. There are other programs offered as well for specific conditions and life stages through Medical Assistance and the Health Department. These include prevention of disease, supplemental food programs, family planning, and general education on how to conduct a healthy, active lifestyle. For a full list of programs, visit the South Dakota Department of Health.
- Medicaid: health insurance programs for low-income or otherwise qualified families and children in South Dakota. To view more information on who qualifies, refer to our Medicaid Eligibility by State article.
- CHIP: Children’s Health Insurance Program for children under age 19 in South Dakota with or without health insurance, from families of varying income levels.
- All Women Count!: screening program providing uninsured or underinsured women between ages 30 and 64 with Pap tests, and mammograms for women 40 – 64.
- South Dakota Family Planning Program: provides a range of medical services to men and women in need of testing, contraceptive services, and medical care surrounding family planning.
Health Insurance Laws
The private health insurance market in South Dakota contains some very important provisions in the way it operates. As each state varies its laws pertaining to pre-existing conditions, South Dakota insurers have their underwriting rules and legal protections as well. In the state, a pre-existing condition can be qualified by any medical treatment for a specific illness or condition received in the year preceding the date of application for health insurance. If identified as an adult with a pre-exisitng condition, the insurance company may deny or accept your application based on severity and cost. If the insurer accepts you for a plan, they have the option of implementing an exclusion period to exempt them from paying for medical care of that condition alone. Exclusion periods are limited to twelve months maximum in South Dakota.
Another option they may exercise is the use of an elimination rider, which would cause the insurance company to never pay for treatment of the specified condition. Despite the injustices faced as a sick person, there is an alternative offered by the state in the Pre-Existing Condition Insurance Plan. PCIPs allow individuals who have been rejected or charged unfairly because of their health to receive medical coverage at a fair rate. These plans were set up by the Affordable Care Act (ACA), and are offered in each state. At this point, it is safe to consider PCIPs as temporary coverage, like COBRA – though much more affordable, as they will no longer exist in 2014.
The ACA has created many new laws for private health insurance companies to abide by, which basically abolishes all mentioned laws that currently stand. As of January 2014, insurers in South Dakota (and the rest of the US) will have to accept any adult for health insurance, despite their health condition or medical records. Subsidized exchanges set up by the state will also be in place to help regulate the quality of care, number of benefits, and rates charged. All individuals will be required to have health insurance on this date if they do not have coverage already, unless their income is low enough to qualify them as an exception.
A current law in place for the sake of protecting insured persons is guaranteed renewability. In each state, insurers are asked by law to offer to renew the same plan for a beneficiary before their term ends. This is a helpful regulation in order to keep people insured and avoid breaks in coverage. Insurance companies are also held by this law to not cancel an individual’s plan if they acquire an illness after they have purchased a plan in good health. As long as the insured party does not engage in any illegal or fraudulent activity in regards to their health policy, guaranteed renewal makes sure they are entitled to the coverage for which they pay.