We know health insurance can be expensive, but we also know how critical it is for people to receive the proper medical care. Because let’s face it, medical care is even more expensive.
Prior to my position as Chief Medical Officer, I was a doctor for eight years in O’Neill, Neb., and I know how important access to care is. We’re not just talking about setting a broken leg, but the year-to-year preventive care that helps you maintain your health.
That’s why back in 2010 when the Affordable Care Act was voted into law, we decided to participate in healthcare.gov when it went into place in 2013. The heart of our mission at Avera, and Avera Health Plans, is to help the people and the communities in which we serve – providing more affordable health insurance options is a natural fit.
Avera Health Plans has been the No. 1 choice in South Dakota three of the past four years and now covers 89 percent of the individual marketplace in the state. Even as other companies have decided to leave healthcare.gov, Avera Health Plans has decided to stay, because that’s just what we do: we provide care and services to people who need it.
Healthcare.gov, also known as the Marketplace, allows people who don’t have insurance through an employer to enroll for health insurance during a set timeframe. This year, you can start looking and even enroll in a new plan for 2017 coverage as of Oct. 1 directly with Avera Health Plans. However, it will not be possible to apply for additional savings with healthcare.gov until open enrollment begins Nov. 1, 2016 – Jan. 31, 2017.
The added benefit for healthcare.gov is that people can also apply for more cost reductions in their monthly premiums and out-of-pocket expenses if they meet certain income requirements. And a surprising amount of people do – 86 percent of South Dakota consumers this year qualified for an average tax credit of $228 per month through the Marketplace, according the U.S. Department of Health and Human Services.
You’ve probably heard your premiums are going up this year, and I know that’s a hardship. But I also want point out some of the good that’s come out of the ACA.
You no longer can be denied coverage due to your health status, or pay higher rates due to age or chronic conditions.
You’re also guaranteed coverage for 10 essential benefits:
- Ambulatory patient services
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Even better, many of preventive services, your annual checkup, mammography and other screenings can now be done at no cost to you.
In South Dakota, the ACA means more people in the state are insured today: 21,393 South Dakotans enrolled for coverage in 2016 through healthcare.gov. It has been significant for young adults – 41 percent of enrollees are under the age of 35.
• 47 percent of all South Dakota enrollees obtained coverage for $100 or less after applicable tax credits.
• 211,000 South Dakotans with private health insurance, through healthcare.gov or an employer, gained preventive service with no cost-sharing.
Just think of that. More than 200,000 people in South Dakota can now see their doctor for an annual checkup or screening at no cost to them. Some of these people may not have seen a provider in years because they couldn’t afford to.
That is why we are on healthcare.gov. Because people should be able to afford preventive care, medications and other health services for themselves and their families.
That’s just our mission: to make a positive impact in the lives and health of persons and communities.
Sources: healthinsurance.org, U.S. Department of Human Services
About the writer: Preston Renshaw, MD, is the Chief Medical Officer at Avera Health Plans. He spent the previous eight years as a family medicine physician in O’Neill, Neb.