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Capital Journal: Wrapper

Nov 14, 6:22 PM EST

Health care open enrollment begins Saturday

PIERRE, S.D. (AP) -- South Dakotans can begin shopping for insurance through the federal health exchange on Saturday as it enters its second year.

Though last year's open enrollment window was widely considered a disaster because of technical problems with the federal website,, insurance companies and advocates anticipate Obamacare's second year will run much more smoothly for consumers.

More than 13,000 South Dakotans signed up for individual private insurance through the federal exchange in last year's open enrollment period, according to official data released in April.

Experts advise South Dakotans - even those who are satisfied with the coverage they purchased last year - to browse the marketplace website and update their personal and financial information to make sure their income, tax credit status or public program eligibility hasn't shifted since last year.

Some things to know about the upcoming enrollment period:


Consumers looking to enroll in private individual coverage can start shopping on Saturday. Kim Jones, a statewide navigator coordinator for the South Dakota Community Action Partnership, said consumers should use the new "window shopping" tool on to get a rough determination for subsidy eligibility and plan costs. Once a consumer has decided on a product, she said they can set up an account with the federal exchange to get a final assistance determination. Consumers can enroll in coverage online, over the telephone - translators are available - or by completing a paper application. In-person assisters can also help consumers through the process.

Consumers who enrolled in coverage last year but do nothing this year will be re-enrolled in the same plan automatically if it's still available. If not, they'll be automatically enrolled in a similar plan, but experts say that consumers should go back through the system to look at their options and update their information.


To make the enrollment process go smoothly, Jones advised having ready a pay stub that details income and lists an employer identification number; Social Security number; addresses; birthdays and phone numbers and any immigration documents.


There are various levels of federal assistance or public programs available to consumers looking to get insured, and there are several tiers of plans available. The levels of plans are denoted by metal level. Low-premium "bronze" plans typically have high deductibles, while high-premium "platinum plans" typically have lower deductibles. Subsidies are available for consumers between 100 percent and 400 percent of the federal poverty level. Members of federally recognized Indian tribes can also be eligible for additional cost assistance. South Dakota didn't opt in to the federal expansion of Medicaid, a government health program for low-income people. The more stringent program here is available to some individuals and families including children, pregnant women and the disabled.

Consumers can also purchase coverage from insurers who offer individual plans off the exchange, but they won't be eligible for federal assistance.


Observers agree that consumers will likely face a much improved experience navigating this time around. Jones said the site's performance has been steadily improving since last year and she's hopeful enrollment will be much less bumpy this time around. Debra Muller, chief administrative officer of Avera Health Plans, said she's not as worried as she was ahead of last October's enrollment opening. Last year she advised consumers not to start shopping immediately.


The open enrollment period runs from Nov. 15 to Feb. 15, and consumers looking to avoid a federal penalty must purchase insurance during that time period. Consumers looking to secure coverage for Jan. 1, 2015 must purchase it by Dec. 15. Public program enrollment is open at any time. Certain life changes, like a marriage or a job loss, open up the ability to enroll in the marketplace outside of the designated window.

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