How To Choose Your Affordable Care Act Plan

All You Need To Know About ACA

Healthcare continues to become more expensive every year. While some employers offer health insurance plans, most Americans lack access to affordable healthcare coverage. The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, was created to provide millions of uninsured Americans access to quality healthcare at lower costs.

The ACA offers Americans the choice between private insurance companies and government-run programs like Medicaid and Medicare. Private insurers can sell their policies through state exchanges or directly to individuals. These options can give consumers better choices and prices, but they can also limit access to services depending on where you live.

Our trusted Rapid Valley health insurance agents will help you choose an affordable care act plan by following the recommendations below. 

All You Need To Know About Affordable Care Act

The ACA: What Is It? Who Needs Insurance & Why?

The Affordable Care Act (ACA) was approved by the US Congress in 2010. Its goal is to lower healthcare expenses while improving the affordability and quality of health insurance for all Americans. Americans can either keep their current plan during Open Enrollment, which runs from November 1, 2015, through January 31, 2016, or they can look for a new one. 

A penalty must be paid when filing annual taxes by those who fail to enlist in a health insurance plan or have a coverage gap.

ACA Plans Similarities

All ACA plans are required to provide ten essential benefits. These 10 vital advantages include things like:

  • Emergency assistance
  • Hospitalization
  • Non-hospital services
  • Newborn and maternity care
  • Services for substance use disorders, behavioral health, and mental illness
  • Drugs on Prescription
  • Services for rehabilitation and habilitation
  • Testing services
  • Services for children, such as dental and vision care
  • Services for chronic disease management and prevention

Before the ACA’s essential health benefits, millions of Americans lacked coverage for pregnancy, drug rehab, mental health services, or prescription medications. 

According to our Colonial Pine Hills health insurance agents, you must purchase an ACA plan to enjoy the benefits. But bear in mind that insurance providers are free to decide how to pay for these advantages. This implies that you might still be required to satisfy a deductible and make co-payments, etc. So always double-check the plan’s specifics!

Government subsidies are also available for all ACA plans. You cannot apply for subsidies if you purchase a non-ACA-compliant plan. Even if you select an ACA plan, you might not still qualify for them. 

ACA Metallic Levels

Every Obamacare plan available on the federal exchange and other marketplaces has a metallic level name that identifies the proportion of healthcare costs that you and your insurance provider will cover. Regardless of the coverage, all plans include the same basic services, including maternity, mental health, preventive dental treatment for children, etc.

Bronze Plans: Bronze Plans require you to pay 40% through deductibles, copays, and coinsurance, and they cover 60% of the covered medical costs up to the plan’s out-of-pocket maximum. Bronze plans often have the highest out-of-pocket costs but the lowest monthly premiums.

Silver Plans: Up to the plan’s out-of-pocket maximum, Silver Plans pay 70% of covered medical costs; the remaining 30% is your responsibility. Our South Dakota health insurance agents claim that silver plans are the only metallic-level plans where Americans may be eligible for cost-sharing discounts and subsidies based on income.

Gold Plans: Up to the plan’s out-of-pocket maximum, the Gold Plans cover 80% of approved medical costs while you cover 20%.

Platinum Plans: They cover 90% of approved medical costs up to the out-of-pocket maximum allowed by the plan, with a 10% copayment from you.

What Is The Cost Of An EPO Plan?

The terms and conditions of each individual EPO plan will vary, so consult with your health insurance agency to learn more about what specific plans and coverage are available to you.

How To Pick An Insurance Level

Consider a few variables while deciding which level would be ideal for you or your family’s needs. You should think about:

  • How frequently do you visit the hospital or doctor?
  • If you require care regularly, frequently, or infrequently just a few times a year
  • medicines you take
  • Whether your medical professional or facility is covered by the proposed plan.

ACA Plans Based On The Organizations

Health insurance plans under the Affordable Care Act, or ACA, fall into four primary categories:

  • Preferred Provider Organization Plans, or PPOs
  • Point-of-Service Plans, or POSs
  • Health maintenance organization plans, or HMOs
  • Exclusive Provider Organization Plans, or EPOs

When selecting any of these ACA plans, take into account different factors like your budget, where you reside, and the type of healthcare you require.

Our Rapid Valley health insurance agents can help you find the right plan for your budget. All you need is to follow some basic steps and that’s it!

Finding A Reliable South Dakota Health Insurance Plan

Obtaining health insurance in South Dakota can be a tricky and frustrating process. Budgeting for it can be challenging because there are many factors to consider. At South Dakota Health Insurance, we are ready to help. Our experts will gladly assist you in locating what you require with a top-rated care service.

To learn more about our services and how we can help, feel free to contact us through our website! 


South Dakota Health Insurance
5040 Saturn Dr,
Rapid City, SD 57703

Tel: 605-653-3824