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South Dakota Health Insurance Consumer Guide
This guide was developed to assist you in choosing the right health insurance plan for you and your family. The options found in South Dakota’s ACA Marketplace may be a good choice for many consumers, and we will guide you through the options below.
South Dakota uses the federally run health insurance exchange HealthCare.gov for residents to purchase its ACA Marketplace plans. The Marketplace provides access to health insurance products from private insurers.
The federal government provides financial assistance for insurance through an advance premium tax credit if you buy coverage from the exchange. Depending on your income and other circumstances, you may also get help to lower your monthly insurance premium (the amount you pay to enroll in the coverage) and possibly your out-of-pocket expenses.
Explore our other comprehensive guides to coverage in South Dakota
Dental coverage in South Dakota
Looking to improve your smile? Dental insurance may be a smart addition to your health coverage. Our guide explores dental coverage options in South Dakota.
South Dakota’s Medicaid program
Medicaid expansion took effect in South Dakota on July 1, 2023. The state received federal approval to initiate the expansion, and for the specific benefits package that the newly eligible population is receiving.1 South Dakota's total Medicaid enrollment has grown to more than 130,000 people.2
Medicare coverage and enrollment in South Dakota
As of late 2022, there were 190,708 residents enrolled in Medicare in South Dakota.3 Learn more about Medicare Parts A, B, C and D plans and Medicare Supplement insurance (Medigap) plan availability in South Dakota.
Short-term coverage in South Dakota
As of 2023, there were at least five insurers selling short-term health insurance plans in South Dakota.4
Frequently asked questions about health insurance in South Dakota
Who can buy Marketplace health insurance?
To qualify for health coverage through the South Dakota Marketplace, you must:5
- Live in South Dakota
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in South Dakota?
In South Dakota, the open enrollment period for individual and family health coverage runs from November 1 to January 15.6
If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.5
Outside of open enrollment, you’ll need a qualifying event to enroll or make changes to your coverage. If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.
How do I enroll in a South Dakota Marketplace plan?
To enroll in an ACA Marketplace plan in South Dakota, you can:
- Visit HealthCare.gov to access South Dakota’s health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
- Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.7
You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
How can I find affordable health insurance in South Dakota?
South Dakota uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.
When using the South Dakota Marketplace, about nine out of ten eligible enrollees saved money on 2023 premium payments, amounting to an average savings of $649/month. After subsidies were applied, the average enrollee’s monthly cost was about $85/month.8
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250%of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
Source: CMS.gov9
How many insurers offer Marketplace coverage in South Dakota?
There are three insurers offering health plans through the South Dakota exchange for 2023 coverage.10
- Avera
- Sanford
- Wellmark Blue Cross Blue Shield of South Dakota (new for 2023, after previously exiting the state’s market at the end of 2016).
In most South Dakota counties, at least one insurer is offering health plans for coverage in 2023.11
Are Marketplace health insurance premiums increasing in South Dakota?
The following average rate changes have been requested by South Dakota Marketplace insurers for 2024 coverage:10
South Dakota’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company |
|
|---|---|
| Issuer | Percent Increase |
| Avera | 5.88% |
| Sanford Health Plan | –0.39% |
| Wellmark Blue Cross Blue Shield of SD | 1.03% |
Source: HealthCare.gov10
The South Dakota Division of Insurance doesn’t publicize information about rate filings until regulators have finalized the rates. But unlike some states, regulators in South Dakota do have the authority to reject rate filings that aren’t justified, or to require insurers to make adjustments to proposed rates. For 2023, the rates were approved as filed.
How many people are insured through South Dakota’s Marketplace?
A record high of 47,591 people enrolled in private health coverage through the South Dakota exchange during the open enrollment period for 2023 coverage.12
The surge in enrollment during these years was due in part to the American Rescue Plan (ARP) which made ACA’s premium subsidies more substantial. Under the ARP – now extended by the Inflation Reduction Act – subsidies are more significant and accessible through the end of 2025.13
Source: 2014,14 2015,15 2016,16 2017,17 2018,18 2019,19 2020,20 2021,21 2022,22 2023,13 202423
What health insurance resources are available to South Dakota residents?
HealthCare.gov
800-318-2596
State Exchange Profile: South Dakota
The Henry J. Kaiser Family Foundation overview of South Dakota’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “South Dakota Medicaid Plan” SD.gov, May 23, 2023 ⤶
- “April 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 28, 2023 ⤶
- “Medicare Monthly Enrollment ” CMA.gov, April 2023. ⤶
- “Availability of short-term health insurance in South Dakota” healthinsurance.org, March 8, 2023 ⤶
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov ⤶ ⤶
- “When can you get health insurance?” HealthCare.gov, 2023 ⤶
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023 ⤶
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023 ⤶
- “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
- ”South Dakota Rate Review Submissions” HealthCare.gov, 2023 ⤶ ⤶ ⤶
- 2023 Qualified Health Plans, CMS.gov, Oct. 26. 2022 ⤶
- “Marketplace 2023 Open Enrollment Period Report: Final National Snapshot” CMS.gov, Jan. 25, 2023 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023 ⤶ ⤶
- “ASPE Issue Brief (2014)” ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015 ⤶
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016 ⤶
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017 ⤶
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018 ⤶
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019 ⤶
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020 ⤶
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021 ⤶
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022 ⤶
- “HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶
