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Health Care Reform:

Health Insurance & Affordable Care Act

South Dakota Health Insurance Marketplace

Plans and Costs continued...

Types of Plans: All insurance plans on the Marketplace are sold by private companies or co-ops. They can offer four types of coverage: bronze, silver, gold, and platinum. These “metal level” plans all cover the same kinds of benefits. The difference is how much they pay on average toward the costs of health care services. Another type of plan is called catastrophic. These have less expensive monthly fees called premiums, but they also offer less coverage. Catastrophic plans are mainly for healthy people under 30.

Plans and Costs continued...

Go to to compare plan costs.

  • Bronze Plan : You pay 40% and the plan pays 60%.
  • Silver Plan: You pay 30% and the plan pays 70%.
  • Gold Plan: You pay 20% and the plan pays 80%.
  • Platinum Plan: You pay 10% and the plan pays 90%.
  • Catastrophic Plan: You pay 100% of a set amount of money called the deductible before the plan's coverage kicks in. Three primary care visits per year and preventive services are covered for free before you meet the deductible.

Within the metal levels are different types of plans, including:

HMO (health maintenance organization): You can only get treated by doctors in the plan's network (except in a medical emergency). You pay the full cost of care if you use a health care provider outside the network. You also need a referral from your primary care doctor before seeing a specialist.

PPO ( preferred provider organization ): You can see doctors and go to a hospital outside of your plan’s network for an additional cost. You generally do not need a referral before seeing a specialist.

POS  (point of service): You can see doctors and go to a hospital outside of your plan’s network at an additional cost. You also need a referral from your primary care doctor to see a specialist.

EPO (exclusive provider organization): You are limited to doctors and hospitals that are part of your plan’s network (except in a medical emergency), but you generally do not need a referral before going to a specialist.

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