How to Choose a Plan

When you’re shopping for health insurance, there’s a lot to consider. Count on us to give you a hand when you’re searching for the right plan – and later whenever you need help navigating your health care and insurance coverage.

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Enroll in 4 Steps

  1. Compare our health insurance plans, and get a convenient online quote.
  2. Get your questions answered with our resources on this page for choosing a plan (including if you qualify for financial assistance). Contact us if you need help.
  3. Know when you can sign up – during open enrollment season or a special enrollment period.
  4. Make sure you have all the necessary details for your application – and sign up online or with one of our agents.

Compare Plans

You have various plan options to fit your coverage needs and budget. See more on our health plans page and review the resources below to help you decide.

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Need help deciding? Check out our infographic to learn more.

Co-Pay Plan

  • Lower deductible plan
  • Fixed co-pays for medical services such as clinic and urgent care visits, and deductibles and coinsurance for services such as surgery and hospitalizations
  • Payment amounts vary based on the plan type

When to choose? Consider a lower deductible plan if you know you will have significant health care expenses and want assurance you’ll have less out-of-pocket costs for services.

High-Deductible Plan

  • Requires you to pay the full cost of health services and prescription drugs – except for covered preventive services – until you meet the deductible/out-of-pocket maximum specified in your plan
  • Covers all eligible health care expenses once the deductible/out-of-pocket maximum is met
  • With some plans, can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money that’s tax-free

When to choose? Consider this plan if you’re generally healthy and don’t expect significant health care expenses.

Key Terms

Need help understanding health insurance terms? We can help. (You can also see more terms in the uniform glossary.)

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Premium

Your premium is the amount you pay monthly for your health insurance coverage. Premiums do not figure into the out-of-pocket maximum.

Out-of-Pocket

Your out-of-pocket costs include expenses (such as deductibles, co-pays and coinsurance) for services that are not reimbursed by insurance. The out-of-pocket maximum is the most you pay for covered services in a plan year. After you’ve reached your out-of-pocket maximum, Avera Health Plans pays 100% of the costs for covered benefits.

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Co-Pay

Co-pay is the fixed amount you pay for a covered health care service, such as a clinic or urgent care visit. Your co-pay can vary by the type of service – or whether you see a primary care doctor or a specialist.

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Deductible

Deductible is the amount you would pay for health care services before your health insurance plan begins to pay. Some costs will be covered before you have to pay your full deductible.

Coinsurance

Coinsurance is a percentage you’ll pay for covered health services after you met your deductible but before you reach your maximum out-of-pocket. For example, insurance pays 80% and you pay 20%.

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In-Network/Participating Provider

This is a health care facility, practitioner or provider with a signed agreement with Avera Health Plans to provide services to members.

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Primary Care Provider

The first health care provider you should contact for treatment, primary care providers are typically family practice and internal medicine providers, OB-GYN providers and pediatricians.

Read 5 Reasons why you need a primary care provider

Preventive Service

Preventive services are provided at no cost to you when delivered by an in-network provider. These include yearly checkups with your primary care provider or family doctor, preventive screenings and many immunizations.

Covered preventive services (in English) (pdf) | Servicios preventivos cubiertos (en Español) (pdf)

Read Health Insurance Perks

Cost Savings

There are key ways to save with your health insurance:

  • Financial assistance you may qualify for
  • How you use your plan, such as the many perks, benefits and built-in savings (like free wellness visits and other preventive services).

Make the Most of Your Benefits

It’s important to know how your own behaviors and what services you use can affect your health care costs now and in the future.

5 WAYS TO SAVE WITH INSURANCE (PDF)

Tax Credits & Financial Assistance

Did you know? 90% of people who apply for health insurance from the Federal Marketplace receive financial assistance? Of those people, 75% pay $50 or less per month!

Our on-exchange health care plans sold through the Federal Marketplace (Healthcare.gov) include potential tax credits. Get an estimate of savings based on your household size and income.

SAVINGS CALCULATOR

Savings: What to Know

  • In South Dakota if you are making less than $100,000 a year, supporting three dependents and are self-employed, you could quality for tax credits.
  • You can apply tax credits to help reduce your monthly premium on any "metal" plan (Gold, Silver, Bronze).
  • Only Silver plans offer tax credits to help with both your monthly premium AND assistance to reduce costs for health care co-pays, deductibles and out-of-pocket maximums.
  • You also may qualify for tax credits and other types of assistance if either apply:
    • Because of COVID-19, you are underemployed, lost your job or are on reduced hours – and you can no longer afford your current health insurance.
    • You’re an American Indian or Native Alaskan.

Questions about qualifying? CONTACT US

In-Network and Prescription Benefits

  • When health care providers and health insurance carriers work together, they will find the best pricing to reimburse you for health care services or procedures.
  • That means you'll pay less for the care you need (which is exactly what you'll enjoy with an Avera plan).
  • Even if you find a lower monthly premium with another health insurance company, you may end up paying more if they don’t have a wide network of providers who understand the benefits of working together – such as those affiliated with Avera Health.

In-Network Providers

See if your practitioner, clinic or hospital participates in our wide network of coverage.

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Prescription Lookup

From preventive prescriptions to those for more advanced treatments, see how they’re covered.

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Tips to Choose a Health Plan

  1. Look beyond the monthly premium.
    Examine your overall costs including free, preventive services, co-pays, coinsurance, deductible and out-of-pocket maximums to see how the overall plan will affect your family finances.

  2. Understand how much you'll pay for a doctor visit.
    Remember, no matter which plan you choose, most preventive services such as screenings are free.

  3. Identify a deductible and out-of-pocket maximum you can afford.
    These are key factors in your overall health care costs.

  4. Find out if your household qualifies for tax credits or other financial assistance.
    Check the savings calculator on Healthcare.gov to learn more.

  5. Choose a plan with a wide network to get the best and most cost-effective care.
    Avera Health Plans members have access to our robust regional network, which includes Avera Health, Monument Health and many other independent providers.

  6. Look for additional perks with your health plan.
    Ask your agent what makes one plan stand out above the others. Because no two people have the same health insurance needs, Avera Health Plans believes you should have choices.


More Enrollment FAQ

How can I can get help with my monthly premium?

You're only a few clicks away from finding out if you qualify to reduce your monthly premiums based on your annual salary and number of people in your household. Check out this chart from Healthcare.gov to find out.

Why should I utilize open enrollment?

Health insurance protects you from unexpected, high medical costs. You also pay less for covered in-network care because of our partnership with providers throughout our dedicated network and the Avera Health system. You receive free preventive care, including wellness exams and vaccines and, depending on your age, preventive screenings like mammography and colon tests.

What plans do you recommend for a 20-something with no dependents?

Find an agent to discover what type of plan works best for you.

For example, you may consider a Bronze plan with affordable co-pays so you know exactly how much you'll pay when you do go to the doctor. Plans with a higher deductible will have lower monthly premiums. Make sure you understand plans that have you pay a co-insurance at the doctor’s office as this will be a percentage – and sometimes this is hard to predict.

How long can I stay on my parents’ insurance?

You can stay on your parents’ plan until you turn 26 years old. If you consider getting a plan on your own, depending on your household size and income, you may qualify for premium tax credits to reduce your monthly premium and/or lower out-of-pocket costs.

If I’m getting married or starting a family, what should I look at for coverage?

Congratulations! This is an exciting time in your life, and you're taking an important step by looking for health coverage. First of all, identify your monthly budget and how much you can afford to pay each month for your premium.

Note: If you have an annual income of less than $96,000 for a family of four, you may be eligible for tax credits and cost reductions. However, if coverage is available through an employer, you may not be eligible for tax credits.

What’s the average price difference of a broken leg with and without insurance?

Without health insurance, non-surgical treatment for broken leg typically costs $2,500 or more for a fracture that requires a cast. X-rays average $210 according to health.costhelper.com. If you need surgical treatment for a broken leg, it will typically cost you $17,000 to $35,000 or more.

If you have health insurance at the time of your visit, the rest will depend on your co-pay and where you are with your year-to-date deductible and annual out-of-pocket cost. (This is where having a low-deductible plan is beneficial.) Yet the cost will be significantly less than without health insurance.

Learn More About Costs With and Without Insurance

Downloadable Guides

Here are more resources to help you make sense of your health insurance options, so you can make the best purchase for you and your family.

Your Guide to Choosing Health Insurance (pdf)

Consumer Insights for Health Insurance (pdf)

Get Started

Get a Quote

Still have questions? Our local team is happy to help make sure you have the right plan for your health care needs and budget.

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You can also call our sales team toll-free at 855-692-8372.

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