Outreach and Enrollment

Rural Health Care, Inc has Outreach and Enrollment Specialists available to assist patient and any consumers with  Health Insurance  Marketplace questions and applications. This is a confidential  free service. Call 605-223-2200 for an appointment or for more information..

The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.

With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.

When you apply in the Health Insurance Marketplace

When you use the Health Insurance Marketplace, you’ll provide some information about your household size and income to find out if you can get lower costs on your monthly premiums for private insurance plans. You’ll learn if you qualify for lower out-of-pocket costs. You’ll see all the health plans available in your area so you can compare them side-by-side and pick the plan that’s right for you.

The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program (CHIP).

Most Americans are eligible to use the Marketplace. Learn more about Marketplace eligibility.

The Health Insurance Marketplace is sometimes known as the health insurance “exchange.”

The individual shared responsibility payment

  • You owe the fee for any month you, your spouse, or your tax dependents don’t have qualifying health coverage (sometimes called “minimum essential coverage”).
  • You pay the fee when you file your federal tax return for the year you don’t have coverage.
  • In some cases, you may qualify for a health coverage exemption from the requirement to have insurance. If you qualify, you won’t have to pay the fee. Learn about health coverage exemptions.

The 2017 fee for not having health insurance

  • For the 2017 plan year, the fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
  • The penalty rises yearly with inflation.

Percentage of income

  • 2.5% of household income
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

Per person

  • $695 per adult
  • $347.50 per child under 18
  • Maximum: $2,085

Exemptions from the payment

Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption.”

You may qualify for an exemption if:

  • You’re uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.

Hardship exemptions

If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a “hardship” exemption:

  1. You were homeless.
  2. You were evicted in the past 6 months or were facing eviction or foreclosure.
  3. You received a shut-off notice from a utility company.
  4. You recently experienced domestic violence.
  5. You recently experienced the death of a close family member.
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
  7. You filed for bankruptcy in the last 6 months.
  8. You had medical expenses you couldn’t pay in the last 24 months.
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
  10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
  11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
  12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
  13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

How to apply for an exemption

If you are applying for an exemption based on: coverage being unaffordable; membership in a health care sharing ministry; membership in a federally-recognized tribe; or being incarcerated:

You have two options–

Note: If you get an exemption because coverage is unaffordable based on your expected income, you may also qualify to buy catastrophic coverage through the Marketplace. This may be more affordable than your other options.

If you’re applying for an exemption based on: membership in a recognized religious sect whose members object to insurance; eligibility for services through an Indian health care provider; or one of the hardships described above:

If your income will be low enough that you will not be required to file taxes:

  • You don’t need to apply for an exemption. This is true even if you file a return in order to get a refund of money withheld from your paycheck. You won’t have to make the shared responsibility payment.

If you have a gap in coverage of less than 3 months, or you are not lawfully present in the U.S.:

  • You don’t need to apply for an exemption. This will be handled when you file your taxes.
Sanford Health Plan
Avera Health Plans

Outreach and Enrollment Privacy Policy

Outreach and Enrollment Specialists at Rural Health Care, Inc are required by federal law and organizational policy to protect patient and consumers personal information. No health information is gathered or requested from consumers in order to complete a Health Insurance Marketplace application. Any financial or personal information shared in the process of health insurance Marketplace applications is not collected, shared or stored. The only information kept on file is the patient/consumer’s name, phone number, address if needed and email if email is the preferred method of communication.

Outreach and Enrollment Specialists are trained and held accountable in ensuring all patient and consumer privacy is protected. Questions or concerns should be directed to Jim Hardwick CEO at 605-223-2200.

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