U.S. Senator Tim Johnson

Passage of the health reform law more than three years ago began a fundamental transition of our health care system. While many provisions are yet to be implemented, the law has already made great strides in improving access to quality, affordable health care for folks in South Dakota.

As this process continues forward, I want to ensure that all South Dakotans understand their rights and responsibilities, as well as what benefits and resources are available.  Below you will find information on where we are and where we are going, along with links to additional materials and useful tools to ensure you are equipped to make the best decisions for you and your family. 

Where we are today…

Since September 2010, individuals have benefited from consumer protections in the health reform law that improve care, protect choice and reduce costs while ending insurance industry abuse and giving South Dakota families control of their care.  

• Children can no longer be denied insurance coverage because of a pre-existing condition.

• Children are allowed to remain on their parents’ plans until the age of 26.

• Insurance companies are prohibited from dropping your coverage when you get sick.

• Insurance companies are prohibited from placing lifetime caps on health care benefits. 

• Insurance companies must ensure greater value to consumers by spending at least 80 percent of premium dollars on health care and quality improvements or provide a rebate to consumers.

• Insurance premium rate increases are now subject to review in every state, improving transparency and public accountability.

• Seniors on Medicare will benefit from free preventive services and the gradual closure of the Medicare Part D Drug Benefit "Donut Hole," which will be eliminated by 2020.

• Select small businesses with less than 25 full-time equivalent employees are currently eligible to receive a tax credit to help cover the cost of providing their employees with health insurance. 

You can learn more about patient’s rights and protections and additional key features of the law here.

Beginning in 2014...

• Health Insurance Marketplaces will provide private health coverage options for the uninsured, self-employed, or those not offered coverage through their employer.  These portals will enable people to compare and purchase private health insurance plans at competitive prices. Enrollment in the Marketplace plans begins on October 1, 2013, with coverage beginning January 1, 2014.

• For those obtaining coverage through the Marketplace, premium assistance tax credits will be available on a sliding scale based on income to make this coverage more affordable.

• Employers with 50 or more full-time equivalent employees will be required to offer affordable health coverage or face paying a penalty.

• Small employers with fewer than 50 full-time equivalent employees are exempt from the requirement to offer coverage, although they will continue to be eligible for tax credits to help offset the cost should they choose to do so. Small employers will also be able to shop for coverage options through the Small Business Health Options Program (SHOP), designed to simplify and standardize the process of selecting coverage.

• Individuals will be required take responsibility for their own health needs and maintain basic health insurance coverage or pay to help offset the costs to our system of caring for the uninsured, whose ranks they are joining.  Certain individuals are exempt from this requirement.

• All Americans will be protected from insurance denials based on pre-existing conditions and annual limits on coverage will be prohibited.

You can review previous and upcoming milestones in health reform implementation at the following links:

http://www.healthcare.gov/law/timeline/index.html

http://healthreform.kff.org/timeline.aspx?source=QL

• HealthCare.gov - I encourage you to visit this website often as the October 1, 2013, open enrollment period approaches. This online resource enables you to take health care into your own hands, explore insurance coverage options and learn how health reform impacts you. 

• State Assistance - The State of South Dakota has resources available to assist consumers with immediate health insurance questions and can help individuals take advantage of some of the new protections and benefits under the health reform law. Please review the Consumer Help section on HealthCare.gov for further information.

• Navigators, Certified Application Counselors (CACs), and Insurance Agents and Brokers - In addition to some other groups, these assisters will be available during the enrollment period to help consumers with the application and enrollment process for coverage in the new marketplaces and to help determine eligibility for available premium and cost-sharing subsidies to make coverage more affordable. 

• Call Center and Online Support – Beginning in early fall, a national 1-800 contact number and an online enrollment and assistance center will be available for all Americans.

Please monitor HealthCare.gov for updated information on these resources. 

I remain committed to ensuring health reform delivers improvements for South Dakotans of all ages, and that includes providing accurate information about the health reform measure as our nation makes the transition in the months and years to come.