Avera Health Plans

As an essential component of the Avera Health integrated delivery plan, Avera Health Plans (ahp) provides coverage and conducts other activities that increase the Health of the community in its service area. Ahp conducts substantially all of its activities within the service area of Avera Health but does conduct a small portion beyond the Avera Health service area to fulfill its mission of making a positive impact in the communities it serves by ensuring adequate rural Health care is available. Ahp provides Health insurance coverage to an underserved population including elderly and low income, high risk and medically underserved persons. Of the 80,000 total members served in 2022, 10,182 of these members were medicare supplement members and approximately 40% consists of individuals or employees of small groups. Approximately 21,200 members are individuals and more than 90.9% of the Health care exchange enrollees in the individual category were eligible to receive an advance premium tax credit, which means they were below 400% of the federal poverty limit. Avera Health Plans is further distinguished from the for-profit Plans by its participation in the federal Health insurance exchange/marketplace. Ahp has affordable, community-rated premiums which are market competitive, and they do not cover ahp's costs including claims and administrative expenses. Net medical and pharmacy claims expense resulted in a medical income ratio (mir) average of 93% for 2022. Significant financial support by Avera Health (501(c)(3)) allows ahp to remain financially viable.ahp also sponsors Health education open forums, open houses, and webinars that are open to the public.