Health Insurance 
in Lead, South Dakota

Shopping for insurance can easily become confusing and overwhelming, there are many different types of policies to choose from and it can be difficult to compare apples to apples. But buying health insurance doesn't have to be difficult. American Health Insurance can quickly connect you with the most comprehensive and affordable plans available in your area.

Agents are standing by to answer your questions and make sure you understand all the options available to you. Call today to compare policies and choose a healthcare plan that meets your needs. We work with top insurance carriers so that we can connect you with the right amount of coverage at the right price.

Having a health insurance policy can give you peace of mind knowing that you and your loved ones have financial backing for common or unforeseen medical circumstances. However, choosing a health plan amidst the sea of options can be daunting.

The more you know about the health insurance plans, the better you'll be able to make an informed decision, saving you money. To make your decision easier, American Health Insurance will help connect you with top insurance providers who can unravel the key differences between various options.

Finding the right health plan for you is about understanding what advantages and disadvantages each health insurance policy has and matching it with your needs.

Some of the most important factors that will affect your decision include:

• Monthly premium amount
• Out-of-pocket expenses
• Copayments
• Deductibles
• Emergency and hospital care
• Benefits such as vision and dental plans
• Prescription drug coverage
• Local doctors in the network
• Coverage for pre-existing conditions
• Health insurance coverage during travel

For a health plan to be right for you, it should accommodate your needs. If you rarely visit the doctor, then your plan should reflect that through lower monthly premiums. Similarly, if your medical needs are more constant, then you want to be covered for more, but should expect to pay higher premiums.

Your future expectations, such as upcoming life events, should also be considered. For example, if you're having a baby soon then that should be factored into your decision. Conversely, if you didn't come close to the limits of your last or current plan, you should use that information to guide you in choosing your next health insurance policy.

With the range of health insurance plans available, American Health Insurance ensures that Lead, South Dakota residents will be able to find an ideal plan to fulfill their medical needs while remaining within their budget.

Health care plans available from the Health Insurance Marketplace are organized into four categories: Bronze, Silver, Gold, and Platinum. These categories essentially describe how you are going to share medical costs with your provider. The quality of care, however, remains the same.

There will be differences between one Lead provider and another but the market average for cost-sharing in these four categories are as follows:

• Bronze: You pay 40% and provider pays 60%
• Silver: You pay 30% and provider pays 70%
• Gold: You pay 20% and provider pays 80%
• Platinum: You pay 10% and provider pays 90%

Of course, each metal category comes with different benefits that stretch beyond just cost sharing. To better understand the differences between each of these health plan categories, we will look at a breakdown:

• Bronze: You will get the lowest monthly premiums but with the highest medical costs if the need should arise. With a Bronze plan, you may have to spend thousands before reaching your deductibles, or the point at which your insurance starts to pay. It's a great plan if you want to protect yourself financially for worst-case scenarios, but you will bear the cost of routine care and checkups.
• Silver: You can expect a moderate monthly premium as well as moderate costs for medical care. Deductibles tend to be lower in the Silver plan than the Bronze. Routine medical care is better covered than the Bronze level. If you are eligible for cost-sharing reductions, often referred to as "extra savings" or subsidies, you will have to choose a Silver health plan.
• Gold: A Gold plan has high monthly premiums but with low costs for medical care. The amount you'll have to pay before your insurance starts to pay - your deductibles - tend to be low. The plan has great value for money if you require frequent medical assistance.
• Platinum: With the highest premiums coupled with the lowest cost when you get care, the Platinum plan is ideal if you know that you will need frequent medical care and want most of your costs covered. It also offers the lowest deductibles out of all of the metal categories.

While these tiers can give you a general indication of what you can expect from the various plans on the Marketplace, health insurance policies from different providers will still vary. For example, some may provide free services before meeting your deductible or free preventative care.

Lead, South Dakota health insurance plans are further differentiated by network types. This is also known as the provider network and is essentially a list of health care providers that work with an insurance provider, offering you discounted services. The network types that can be found on the Marketplace include the following:

• Preferred Provider Organization (PPO): This is a network type that allows you to save costs if you use Lead, South Dakota healthcare providers that are within the insurance provider's network. You may still go outside of the network of doctors and specialists without a referral from your primary care physician (PCP). However, going outside of the network will incur expenses.
• Health Maintenance Organizations (HMOs): With an HMO, you will be covered for in-network healthcare services but must get a referral from your PCP before visiting with a specialist. HMOs tend to not provide any cover or limited cover for out-of-network medical services, meaning that you'll likely have to pay the full cost yourself - except in emergencies.
• Point-of-Service (POS) Plans: A POS plan allows for more freedom because both in- and out-of-network care is covered. You'll still need a referral from your PCP before seeing a Lead, South Dakota specialist, as with an HMO. A referral is also required to have cover for out-of-network services and going out-of-network generally costs more than in-network.
• Exclusive Provider Organizations (EPOs): Coverage in this type of network is limited to healthcare providers within the network unless it's an emergency. EPOs tend to have a large network.

Generally speaking, using out-of-network emergency medical services is covered with all network types, although some may require you to pay additional costs.

An Affordable Care Act (ACA) health insurance policy is one that adheres to the regulations and standards from the comprehensive health care reform law that was initially implemented in 2010. It may also be referred to as "Obamacare" or PPACA.

If you use an ACA health plan then you can expect a wide range of quality health care, which is detailed in the section above. ACA plans are sold on the Health Insurance Marketplace - also referred to as the Health Insurance Exchange.

It is possible to get a health plan that doesn't fall under the ACA umbrella. Insurance providers can sell various health plans outside of the Health Insurance Marketplace that can help people with a wider range of health care needs. For example, if you missed Open Enrollment or are between jobs and you are waiting for your benefits at a new job, then short-term insurance - which is non-ACA compliant - can be ideal.

The types of non-ACA policies available vary based on the insurer. For people in Lead, South Dakota the following are three types of common non-ACA policies which American Health Insurance can connect you with:

• Short-Term Insurance: Short-term insurance plans are ideal for people who need cover but have either missed the Open Enrollment period or need cover during a gap in their usual coverage. It can be considered an excellent plan for healthy people that don't expect to require a great deal of medical services.
• Limited Benefit Indemnity Insurance: This plan will generally provide a fixed amount for each medical service required, regardless of the cost of that service. There tends to be no annual deductibles with this type of plan. A limited benefit plan may, for example, pay for primary care but when it comes to other medical needs such as inpatient care, you may have far less coverage.
• Accident and Critical Illness Insurance: With these plans, you will be covered for unexpected illness or injury. It covers sudden events such as a heart attack or unexpected injuries such as from a motor vehicle collision.

There is a host of non-ACA policies that you can choose from in Lead, South Dakota. For healthy people, non-ACA plans can be an ideal solution to save money at the cost of benefits that a healthy person may never use.

The Health Insurance Marketplace, which is where you can find ACA health plans available in Lead, South Dakota, has an Open Enrollment period once a year. During this period, you may buy a new health plan, renew an existing plan, or change your current plan to one that better suits your current and future needs. Some states may extend the open enrollment period, which usually takes place for a few weeks between November and December.

After the Open Enrollment period has elapsed for the year, the only way to apply for Marketplace plans is if you fall within the requirements for a Special Enrollment Period. For example, if you had specific life events happen such as having a baby, getting married, or if you've lost your current health cover, you may be eligible for a Special Enrollment Period.

Furthermore, certain health plans that you can get through your work may have different Open Enrollment Periods than the usual end-of-year period.

Don't worry, Open Enrollment is not the only time that you can buy insurance. If you do not qualify for a Special Enrollment Period and have missed the Open Enrollment Period, or your situation and needs suits it, then you can purchase non-Marketplace insurance such as short-term insurance.

American Health Insurance can connect you with top insurance providers who will help you to find a health plan outside of Open Enrollment in the following ways:

• Through a Lead, South Dakota insurance broker or agent: Insurance agents and brokers can help you to find an ideal health plan that falls outside of the Marketplace. What you pay tends to be unaffected by the use of an agent or broker since they are paid by the insurance company.
• Direct from an insurance company: Alternatively, you can go directly to an insurance provider and browse the insurance products that they have.

Whether through the Marketplace or outside of the Open Enrollment Period, we can help get you and your family a health plan that covers your important medical needs.

Dental and vision coverage is important. If ignored, it's something that is likely going to end up costing you more than monthly premiums would have.

Dental and vision insurance plans can help to offset the cost of dental work, eye exams, glasses, and contact lenses among other things. While the health plan you are considering may have everything you want from affordability to service availability, health plans don't always come with dental and vision coverage.

There are two main ways to go about getting dental and vision coverage. They are as follows:

• Purchase a health plan that includes vision or dental coverage: You may be able to combine both vision and dental plans as a part of your health plan package. Of course, premiums will increase based on the additional benefits of the plan.
• You can also buy a vision or dental plan as a stand-alone product: . It's important to note that some plans on the Marketplace may require that you also purchase a health plan. As a stand-alone service, you will have to pay two separate premiums - one for your health plan and another for your dental or vision plan.

As with health plans that we discussed earlier, dental and vision plans on the marketplace fall into two categories, low and high:

• Low: Simply put, low refers to the level of coverage. You can expect low premiums but also higher deductibles and copayments, meaning that you'll spend less each month on your premiums but will have to pay more when you need vision or dental services.
• High: . This category refers to higher premiums and thus lower deductibles and copayments.

Dental coverage can be especially important for children. As such, it is required that insurers on the Marketplace offer coverage for children, even if you don't have to purchase it. For adults, dental coverage is not considered essential. Many insurance providers offer dental and vision insurance that can be purchased separately from your health insurance, even if you gain your health care benefits through your employer.

Individual health insurance is important. If you are met with a sudden and significant medical bill without insurance, it could be catastrophic for your life and finances. Thankfully, American Health Insurance can connect you with top insurance providers who will help you find solutions including all of the above-mentioned Marketplace options and non-ACA plans.

If you have preexisting conditions that you wish to be covered for, then the ACA plans can provide you cover for your condition and other areas that are important to you such as vision or dental coverage.

If you are healthy with no preexisting conditions, then you may be better off purchasing a non-ACA plan as it can help you save on your monthly premiums by only getting cover for what you need, such as accident insurance.

Providing your family with a health insurance policy that can cover unforeseen and expected medical circumstances can fill you with the confidence that they are looked after.

There are different things to consider when buying insurance for the whole family. For example, children require regular checkups, dental care, and a host of other unexpected issues. These additional needs must be carefully considered before choosing the right plan.

A Bronze tier plan or a plan with a low monthly premium might seem financially sound at the time but with a family there will may be considerable medical care needed. As such, it may be better for you to opt for a plan with higher monthly premiums, such as a Gold level or similar plan. This will help you to avoid higher deductibles, copayments, and out-of-pocket expenses which can be substantial for a whole family.

A family plan may seem expensive, but you should consider what you are getting and look for ways to make the policy more affordable. The following may assist you in this endeavor:

• Lower Cost Per Person: Generally, a family health plan will end up being more affordable than buying individual insurance policies for each family member.
• Premium Tax Credits: You can save even more money if you are eligible for Premium Tax Credits when your household falls within the required bracket (100% to 400% of federal poverty level).
• CHIP Plans: There are further financial aids that can help to offset the cost of family insurance such as the Children's Health Insurance Program (CHIP). It can provide low-cost insurance for families with children if you qualify.

One of the main purposes of the Affordable Care Act is to ensure that health insurance is available to more people, regardless of their financial situation.

As a part of the ACA, you can reduce your cost in the following ways:

• Premium Tax Credit: This is a way that you can save on your monthly premiums. If your household's income is 1 to 4 times the federal poverty level based on your household size, then you may be eligible for cost reductions on your premiums.
• Cost Sharing Reduction (CSR): With CSR, you may be able to lower the amount you have to pay for your copayments, coinsurance, and deductibles. It will also place a cap on your out-of-pocket expenses; once reached, your insurance will cover all of your required services. Only Silver plans are eligible.

Furthermore, if you are healthy and don't expect to have to use medical services often, then you can opt for a Bronze or Silver-tier plan as it can help to reduce your monthly premiums.

Of course, in the event of significant medical needs, your copayments, deductibles, and coinsurance will be higher, and you should therefore carefully consider your situation before deciding on a plan.

One of the main purposes of the Affordable Care Act is to ensure that health insurance is available to more people, regardless of their financial situation.

As a part of the ACA, you can reduce your cost in the following ways:

• Premium Tax Credit: This is a way that you can save on your monthly premiums. If your household's income is 1 to 4 times the federal poverty level based on your household size, then you may be eligible for cost reductions on your premiums.
• Cost Sharing Reduction (CSR): With CSR, you may be able to lower the amount you have to pay for your copayments, coinsurance, and deductibles. It will also place a cap on your out-of-pocket expenses; once reached, your insurance will cover all of your required services. Only Silver plans are eligible.

Furthermore, if you are healthy and don't expect to have to use medical services often, then you can opt for a Bronze or Silver-tier plan as it can help to reduce your monthly premiums.

Of course, in the event of significant medical needs, your copayments, deductibles, and coinsurance will be higher, and you should therefore carefully consider your situation before deciding on a plan.

Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) are similar types of networks. Both types of plans are able to provide you with discounted medical services thanks to their network of healthcare providers in Lead, South Dakota. Insurance providers negotiate with the healthcare providers and essentially pass the savings down to you.

While both plans are similar, there are differences. The differences that an HMO has includes the following:

• HMOs tend to more affordable than PPOs
• You must choose a primary care physician (PCP) from the network of providers
• In order to see a specialist, you will need to first get a referral from your PCP
• Providers outside of the network are not covered by the plan, except in emergencies

The differences that PPOs have compared to HMOs are as follows:

• While PPOs tend to cost more than HMOs, they provide greater flexibility
• You may use out-of-network providers and be covered, but an additional cost will be applied
• You do not have to choose a PCP
• To see a specialist, you do not need to be referred by your PCP - if you have one

Both plans have their own benefits. Generally speaking, PPOs are preferred if you need to have access to a greater range of providers. With an HMO, you can save more because you are taking advantage of the network's discounts.

Below are some of the common questions that you may have with regards to your Lead, South Dakota health insurance policy. It's important to note that each insurance provider is different, and you should refer to your insurer for specific questions:

Getting or changing a Lead, South Dakota health insurance plan can be easy and affordable with American Health Insurance. The more you understand about your options the better informed you will be, allowing you to choose a plan that fits all your medical needs without breaking the bank.

If you're looking for coverage for your family in Lead, South Dakota, American Health Insurance will connect you with top insurance providers who can help you compare options to suit the needs of everyone in your household.

As you shop for a plan for your family, you will want a plan that provides the options to see a variety of different doctors and specialists. If you have, or plan to have, children you will want to make sure that you have a plan that covers every aspect of pregnancy as well as pediatric care. As you grow older your health insurance needs tend to increase.

If you are struggling with health issues now that could potentially get worse in the coming years, you want to double-check and see what Lead specialists are covered by your plan.