Haris Ashley
South Dakota residents have a range of health insurance providers to choose from, including national and regional carriers. The state uses the federally run HealthCare.gov exchange platform for residents to purchase its ACA Marketplace plans. The average cost of health insurance in South Dakota is $690 per month, but most people pay much less as they qualify for discounts or subsidies. The cost of health insurance in South Dakota is generally lower than the national average, and the state consistently ranks among the lowest average monthly premiums for individual health plans.
| Characteristics | Values |
|---|---|
| Health Insurance Marketplace | South Dakota uses the federally run HealthCare.gov exchange platform for residents to purchase ACA Marketplace plans. |
| Average Cost | $690 per month at full price, or $92 per month after discounts/subsidies. |
| Medicaid Expansion | Took effect in South Dakota in mid-2023, due to a ballot measure that voters approved in the 2022 election. |
| Eligibility for Medicaid | Adults, ages 19 to 64, meeting income limits and other general eligibility requirements (with or without private health insurance) may be eligible for FREE or low-cost South Dakota Medicaid. |
| Medicare | Available for individuals over the age of 65 or those with certain disabilities. |
| Premium Subsidies | In 2024, nearly 96% of enrollees through the South Dakota Marketplace qualified for premium subsidies, averaging about $611/month. |
| Cost-Sharing Reductions | People with household incomes up to 250% of the federal poverty level qualify for CSR, resulting in lower deductibles and out-of-pocket expenses for Silver plans. |
| Special Enrollment Period | Outside of the federal open enrollment period, a special enrollment period is available for qualifying life events, such as losing employer-sponsored health coverage or getting married. |
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What You'll Learn
Medicaid expansion in South Dakota
South Dakota has expanded Medicaid to cover individuals with incomes up to 138% of the federal poverty level, or $21,597 for an individual in 2025. This expansion took effect on July 1, 2023, after a ballot measure was approved by voters in the 2022 election. The expansion is expected to provide health coverage to an additional 40,000 low-income individuals in the state by 2025.
South Dakota uses the federally run HealthCare.gov exchange platform for residents to purchase health insurance plans, including Medicaid. During the open enrollment period for 2024 coverage, 96% of enrollees through the South Dakota Marketplace qualified for premium subsidies, which lowered the average monthly cost to $111.
In 2024, voters approved a work requirement for Medicaid eligibility, which could be authorized by the state legislature and the federal government. This requires enrollees to work 80 hours per month and report the details to the state to maintain their coverage. However, some supporters of the original constitutional amendment that expanded Medicaid have stated they will fight any attempt to add restrictions, including work requirements.
The expansion of Medicaid in South Dakota is expected to bring in nearly $1.35 billion in additional federal funding over the next five years. However, there are concerns about potential cuts to federal Medicaid funding, which could impact the state's budget. Despite this, some conservative lawmakers have stated their opposition to any cuts to Medicaid, and it may be difficult for Republicans in Congress to push through such cuts.
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Eligibility for South Dakota Medicaid
South Dakota uses the federally run HealthCare.gov exchange platform for residents to purchase ACA Marketplace plans. The ACA's Medicaid expansion took effect in South Dakota in mid-2023, following a ballot measure approved by voters in the 2022 election. This expansion aimed to provide health coverage to low-income individuals and families, allowing states to extend their Medicaid eligibility criteria to cover individuals with incomes up to 138% of the federal poverty level.
In South Dakota, adults under 65 with incomes up to 138% of the poverty level are eligible for Medicaid. This change took effect in July 2023, and as a result, individuals who were previously eligible for premium subsidies in the South Dakota Marketplace are now eligible for Medicaid instead. In 2024, voters approved a ballot measure allowing the state to impose a work requirement for this population, if permitted by the federal government. A typical work requirement would mandate that Medicaid expansion enrollees work 80 hours per month and report these details to the state to maintain eligibility.
Pregnant women with household incomes up to 133% of the federal poverty level are eligible for Medicaid. Children with household incomes up to 204% of the federal poverty level are eligible for CHIP, while parents with dependent children are eligible with incomes up to 58% of the federal poverty level. Additionally, South Dakota Medicaid provides coverage for seniors and individuals with disabilities, helping to pay for the costs of long-term care in their homes, communities, and medical facilities.
It is important to note that the cost of health insurance in South Dakota can vary depending on factors such as age, health status, and the level of coverage required. Therefore, it is recommended to compare quotes from multiple providers and consider factors beyond cost, such as benefits, provider networks, and customer service.
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Average health insurance costs in South Dakota
The cost of health insurance in South Dakota is generally lower than the national average. The state consistently ranks among the lowest average monthly premiums for individual health plans. However, the cost of insurance depends on several factors, such as age, health status, and the level of coverage required.
For instance, older people pay more for coverage than younger people. A 60-year-old in South Dakota will pay more than twice as much as a 40-year-old for the same level of coverage. Similarly, the more you earn, the less discount you can get. The size of the discount, or subsidy, depends on your household income.
On average, health insurance costs $92 per month in South Dakota for people who qualify for discounts. About one-third of South Dakota residents with marketplace coverage pay less than $10 per month after discounts. To qualify for health insurance subsidies, a single person needs to earn less than $60,240 per year (roughly $124,800 for a family of four).
Catastrophic health plans cost $388 per month on average in South Dakota. Silver plans, which offer a good middle ground between Gold and Bronze plans, cost $469 per month on average. Gold plans have the highest monthly costs but cover most of your bill when you go to hospital. Bronze plans have cheap monthly rates but higher costs for care.
South Dakota residents can purchase health insurance from the federal exchange or a private insurer during open enrollment. The state uses the federally run HealthCare.gov exchange platform for residents to purchase ACA Marketplace plans. Three insurers offer health plans through the South Dakota exchange/Marketplace.
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Health insurance providers in South Dakota
South Dakota uses the federally run exchange for individual market plans, allowing residents to purchase health insurance through HealthCare.gov. This platform provides access to health insurance products offered by three private insurers with varying coverage areas. The cost of health insurance in South Dakota is generally lower than the national average, and the state consistently ranks among the lowest for average monthly premiums.
During the open enrollment period for 2024 coverage, 96% of enrollees through the South Dakota Marketplace qualified for premium subsidies, with an average subsidy of $611 per month. People with a household income of up to 250% of the federal poverty level may also qualify for cost-sharing reductions, which lower deductibles and out-of-pocket expenses for Silver plans.
Medicaid expansion took effect in South Dakota in mid-2023, and as a result, people with incomes between 100% and 138% of the poverty level are now eligible for Medicaid instead of premium subsidies in the Marketplace. This expansion was due to a ballot measure approved by voters in the 2022 election.
Some of the major providers offering individual and family health plans in South Dakota include Avera Health and UnitedHealthcare. UnitedHealthcare offers a range of health insurance plans for individuals, families, and seniors, including Medicare and Medicaid plans. They also provide supplemental plans, such as dental insurance, accident insurance, and critical illness insurance.
Wellmark also offers health insurance plans in South Dakota, and residents can access important resources and information by registering on their website.
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Medicare options in South Dakota
Medicare is a federal health insurance program designed for individuals over the age of 65 or those with certain disabilities. In South Dakota, eligible residents have a range of Medicare options to choose from, including:
Original Medicare (Parts A and B)
Original Medicare includes Medicare Part A (hospital coverage) and Medicare Part B (medical/physician coverage). It is provided directly by the federal government. Original Medicare does not cover vision and dental benefits, and it can leave beneficiaries with significant out-of-pocket expenses. However, you can add a Medigap plan from a private insurer to supplement your Original Medicare plan.
Medicare Advantage (Part C)
Medicare Advantage plans include all the benefits of Medicare Parts A and B, but with different out-of-pocket costs. These plans often include additional benefits such as dental, vision, and prescription drug coverage. However, provider networks may be limited, and out-of-pocket costs are often higher than with Original Medicare plus a Medigap plan. As of September 2024, 71,971 Medicare beneficiaries in South Dakota were enrolled in Medicare Advantage plans, lower than the national average.
Medicare Prescription Drug Plans (Part D)
Medicare Part D covers prescription medication. You can enroll in Part D along with Original Medicare, and some Medicare Advantage plans also include Part D. The cost of Part D plans can vary depending on your location and income level.
Medicare Supplement (Medigap) plans
Medigap plans can help cover out-of-pocket costs not covered by Original Medicare, such as deductibles, coinsurance, and copays. Medigap plans are available from private insurers, and there are 10 standardized plans offered nationwide.
It's important to note that Medicare eligibility and costs can vary based on individual circumstances, and South Dakota residents can seek guidance from resources like the Senior Health Information and Insurance Education (SHIINE) program to help navigate their Medicare options.
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