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. Navigators offer free help for questions or enrollment assistance.
Navigators
Our trained helpers (called Navigators) can answer your questions, help you select and sign up for a health plan—and explain how to use it to get the most benefits.
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.
Native American? Learn about your health insurance options here.
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.
Do You Have Questions?
Complete the contact form and a Navigator will reach out to you. We’ll answer your questions, show you your options, and help you get enrolled correctly!
For More Info
Penny Kelley
Outreach & Enrollment Services Program Manager
penny@communityhealthcare.net
605.277.8405
Sioux Falls
196 E 6th Street, Suite 200
Sioux Falls, SD 57104
605.275.2423
This page is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,600,000 with 100 percent funded by CMS/HHS. The content are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.