Written by Katie Minder under the direction and review of Lorna Saboe-Wounded Head.
The Marketplace, or Health Insurance Exchange, is a service operated by the U.S. Department of Health & Human Services that allows people to shop and enroll for health insurance. The Health Insurance Exchange is available for anyone who is not offered health care through a job, Medicare, Medicaid, the Children’s Health Insurance Program, or any other source of qualifying health care (meeting the minimum standard for health care). This person must be living in the United States, be a U.S. citizen (or a lawfully present non-citizen), and not be incarcerated (a person is not incarcerated if they are on probation; parole; house arrest; or in jail or prison pending disposition of charges: not convicted of a crime, but still being held).
A common misconception about the Marketplace/Health Insurance Exchange is that only people with a lower income can utilize this healthcare program. The reality is that it does not matter how much money you make, you can still access a health insurance plan if you meet the requirements. If your income is a little higher, you may have to pay a bit higher premium within reason. It never hurts to check!
Benefits Covered
Marketplace plans cover the 10 essential health benefits, which include the following:
- Ambulatory patient services
- Prescription drug
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Laboratory services
- Rehabilitative and habilitative services and devices
- Preventive and wellness services
- Pediatric services, including oral and vision care (not adult)
- Birth control and breastfeeding
Getting Enrolled
The open enrollment period is November 1st to January 15th. If you enroll by December 15th, your coverage will begin on January 1st. If you enroll by the last day of the open enrollment period, the coverage will begin on February 1st. If you need to enroll or change plans outside the yearly open enrollment period, you must have a life change or income that qualifies for the special enrollment period. Examples of a life change are: job loss, losing health coverage, moving, getting married, having a baby, adopting a child, or having your income drop below a certain amount.
To find out what type of health care plan you qualify for and what the cost will be, you can enter your information in the Marketplace Screening Tool. You will need to enter information about your monthly and annual income, household members, and other identifying information. Once your information is entered, if you are eligible for a premium tax credit, the estimate will show on your screen. This is the amount you can use to lower your monthly premium each month. Click on ‘view plans’. The screening tool will show you which plans you are eligible for and the cost of the premium. Depending on your income, household size, and eligible tax credit, your monthly premium may be zero. Review each plan to determine which one fits your health care needs. Once you have decided, start an application. You will need to create an account if you don’t already have one.
Help Applying for Health Insurance
The Great Plains Tribal Leaders Health Board (GPTLH) Navigator program assists uninsured Native Americans access the Marketplace/Health Insurance Exchange. Navigators collaborate one-on-one with individuals to determine which plan is the best for them and to answer questions about the plans. This program assists Native Americans living in western South Dakota. For more information, please visit the Great Plains HIE Navigator website.
The Community Healthcare Association of the Dakotas (CHAD) is a non-profit membership organization that serves as the primary care association for North Dakota and South Dakota. CHAD prides itself on assisting consumer find high-quality, reliable, affordable health care. There are many locations in North Dakota and South Dakota. For more information, check out the CHAD website.
Additional Resources
- HealthCare.gov, Health Care Marketplace.
- Great Plains Heath Insurance Exchange Navigator Program, Great Plains Tribal Leaders' Health Board.
- CHAD website, Community Healthcare Association of the Dakotas.
This content was presented as a webinar for the Financial Fireside Chats on May 21, 2024.
