13K in SD got health insurance using marketplace
By Dirk Lammers
SIOUX FALLS (AP) — The number of South Dakotans who chose health plans using the new insurance marketplace created by the nation's health care law during open enrollment that ended in March was about two-thirds of a target by the federal government.
A federal report released by the U.S. Department of Health and Human Services on Thursday shows that 13,104 South Dakotans selected a plan during the six-month open enrollment period, although 24,147 residents were eligible. Ninety percent of enrollees will get financial help on their premiums.
The health care law requires nearly every American to have insurance coverage or face a tax penalty of either $95 or 1 percent of income, whichever is higher.
The Obama administration had hoped to enroll 19,000 South Dakota residents by March 31, according to estimates in a Sept. 5 departmental memo to former U.S. Health and Human Services Secretary Kathleen Sebelius. The final figure was 69 percent of that.
Ruth Krystopolski, president of Sanford Health Plan, one of three insurers in the state offering plans in the marketplace, said she thought the administration's original projections were aggressive.
Early problems with the federal system deterred some people from enrolling, and early communication was poor, she said.
"I think parts of the process have gotten easier," Krystopolski said Thursday. "I think there are still some challenges."
Of South Dakota's 13,104 enrollees, 54 percent are female and 46 percent are male. The age breakdown is 9 percent younger than 18, 9 percent 18-25, 21 percent 26-34, 15 percent 35-44, 19 percent 45-54 and 27 percent 55-64. The enrollment figures show that nearly three-quarters enrolled in the plan of medium expense.
South Dakota residents shopping for a plan on the federal website, www.healthcare.gov, have three insurers to choose from: Avera Health Plans, Sanford Health Plan and Dakotacare.
Debra Muller, chief administrative officer for Avera Health Plans, said Avera has had nearly 10,500 applicants during the six-month period and about 90 percent of them will be matched with policies.
Muller anticipates a continued need for education as many new enrollees are unfamiliar with concepts such as deductibles, prior authority and the difference between in-network and out-of-network providers.
"For many of them, it's the first time they've ever sought health insurance," she said.
Dakotacare, owned by the South Dakota State Medical Association, offered 19 individual and two small group plans through the marketplace during the enrollment period.
State residents could also shop directly from insurers. But those who chose that option couldn't get federal subsidies even if they qualified.
Those who missed the March 31 deadline — except under a handful of circumstances — will have to wait until November to sign up for coverage when the new open enrollment period will begin. The benefits under those plans wouldn't kick in until 2015. The three insurers that marketed to South Dakota residents through the federal website intend to participate again during that enrollment period.
Wellmark Blue Cross and Blue Shield, the largest insurer in South Dakota, said in March it may seek to join them.