Medicaid Expansion: Can I Use Medicaid to Satisfy the Health Insurance Requirement in South Dakota?
One way to satisfy the Obamacare requirement that you have health insurance is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in South Dakota's Medicaid program, you do not have to sign up for another insurance plan.
South Dakota Has Not Expanded Medicaid
The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid. Because South Dakota has not yet to chosen to expand Medicaid eligibility, you may have fewer options for health coverage than people in states where Medicaid is growing.
Do You Qualify for Medicaid?
Each state has its own rules for Medicaid eligibility. Whether you qualify depends on your income level and other factors. To find out whether you are eligible for Medicaid under South Dakota's existing rules, contact the South Dakota Medicaid office. You can also find out whether you qualify when you apply for health insurance at HealthCare.gov.
If you don’t qualify, your health insurance options depend on which of the following situations apply to you:
You earn at least 100% of the federal poverty level. If you earn more than about $12,060 a year as a single person or about $24,600 for a family of four, you can purchase a private health insurance plan at HealthCare.gov. Those who earn between 100% and 400% of the federal poverty level will qualify for cost-saving subsidies based on income and family size.
You earn less than 100% of the federal poverty level but don't qualify for Medicaid. If you earn less than about $12,060 a year as a single person or about $24,600 for a family of four -- but you don't qualify for Medicaid in South Dakota -- you can purchase health insurance at HealthCare.gov, but you will not be eligible for cost-saving subsidies. You will have to pay full price for your health insurance plan. If this sounds unfair, you’re right. Read on for more information about why this coverage gap exists.
The Medicaid Donut Hole: What It Is & What You Can Do About It
In states that choose not to expand Medicaid eligibility, there's a donut hole for those who earn too much to qualify for Medicaid but not enough to qualify for cost-saving subsidies under Obamacare.
The Affordable Care Act was written on the assumption that Medicaid would be expanded to cover all Americans who earn less than 133% of the federal poverty level, and that it would be much easier to qualify for the program than it is now. That's why the law doesn't provide subsidies for those with very low incomes.
For people who live in states that choose not to expand Medicaid, if you earn less than 100% of the federal poverty level but still don't qualify for Medicaid, you may fall into the gap where no subsidies are available.
A handful of states are still considering whether or not to expand Medicaid, so stay tuned to see if the rules change in South Dakota. Meanwhile, if you cannot afford health insurance, you may at least be able to avoid the Obamacare penalty for being uncovered.
You May Be Able to Avoid a Tax Penalty
Under the Affordable Care Act, if you don’t have qualifying health care coverage, you must pay a fee. However, if you live in a state that isn't expanding Medicaid and you happen to fall into the donut hole described above, you won't have to pay the fee.
If you qualify for this exemption, you can claim it by visiting HealthCare.gov.
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