Where You Get Health Insurance
Depends on Your Job, Family, and Income.
Marketplace
The Health Insurance Marketplace is where people and families can shop for and sign up for health plans. Many people can get help paying for their plan to make it cost less. You can sign up during open enrollment (starting November 1 each year) or if you’ve had a big life change.
Medicaid
Medicaid is a federal- and state-funded health insurance program. You don’t have to pay premiums or enrollment fees. You don’t have to pay copayments, coinsurance, or deductibles for services. You can apply for Medicaid anytime.
You can see if you qualify at HealthCare.gov yourself. But you don’t have to do it alone. Certified application counselors at your local health center offer free help for questions or enrollment assistance.
Common Insurance Words and What They Mean
Each health plan has different costs you pay, like copays and other out-of-pocket costs for care.
Premium
This is the amount you pay every month to keep your health insurance.
Copayment (Copay)
This is a set amount of money you pay each time you get medical care or a prescription. The copay is typically paid at the time of service.
Deductible
The amount you pay for health care services before your health insurance begins to pay.
Out-of-Pocket Maximum
Everything* you pay for services—your deductible, copays, and coinsurance—get’s counted under your out-of-pocket expenses. Once you reach the out-of-pocket maximum, insurance usually begins to pay more costs and your coinsurance starts. *Your monthly premium costs are not counted as an out-of-pocket expense.
Coinsurance
A percentage you pay for services after you meet your deductible. Example: Your coinsurance amount may be 20%. If your doctor visit costs $100 and you have already met your deductible, you would pay $20 (which is 20% of $100). Insurance would pay the rest.
Know Your Health Insurance Network
Your provider network is a list of doctors and hospitals that work with your health plan. Doctors or hospitals in your network are called “in network” and usually cost less. Doctors or hospitals not in your network are “out of network” and usually cost more.
Sioux Falls
196 E 6th Street, Suite 200
Sioux Falls, SD 57104
605-275-2423
Bismarck
216 N 2nd Street, Suite 104
Bismarck, ND 58501
701-221-9824
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