South Dakota Health Insurance

From the iconic Mount Rushmore to wide-open prairies and scenic national parks, South Dakota remains a unique and welcoming place to call home. Understanding your health insurance options here is essential to protecting both your health and financial future.

As of 2025, the uninsured rate in South Dakota reflects a stable enrollment landscape, despite certain gaps in public coverage. If you’re currently without insurance, here’s what you need to know about securing coverage in the state.

Health Insurance Options in South Dakota

South Dakota offers a variety of health insurance options tailored to its residents’ needs. Your best path to coverage depends on your age, income, job situation, and household size.

Employer-Sponsored Insurance

Many South Dakotans receive health insurance through their workplace. If your employer offers a health plan, it’s often the most affordable and convenient route to coverage.

ACA Marketplace Plans

Individuals and families without employer-based coverage can shop for health plans through the federal Health Insurance Marketplace. These ACA-compliant plans include essential health benefits like preventive care, mental health services, and prescription drugs.

If you meet income qualifications, you may be eligible for financial assistance. Use our ACA Subsidy Calculator to see if you qualify for premium tax credits or cost-sharing reductions.

Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.

ACA Plan Types

ACA Marketplace plans are organized into metal tiers. These determine your balance of monthly premiums versus out-of-pocket costs.

• Bronze: Lower premiums, higher out-of-pocket costs. Ideal for minimal medical usage.
• Silver: Balanced costs. Eligible for cost-sharing reductions if you qualify.
• Gold: Higher monthly premiums but lower costs when receiving care.
• Platinum (if available): Highest premiums, lowest out-of-pocket costs. Best for those who need regular care.

Metal Tier Breakdown:

Short-Term Medical Plans

Short-term medical (STM) plans offer temporary health coverage and can be a practical solution for individuals who are between jobs, recently lost employer coverage, waiting for ACA or Medicare eligibility, or need affordable protection during a coverage gap.

These plans are available in this state and follow federal rules, but they are not regulated by the ACA. That means they can deny coverage based on pre-existing conditions and typically do not include comprehensive benefits like maternity, mental health, or preventive care.

While short-term medical plans are not a substitute for long-term health insurance, they may be ideal in situations where you’re temporarily uninsured—such as after job loss or before new coverage begins—and want short-term protection from unexpected medical events.

STM Plan Enrollment: Unlike ACA-compliant plans, you can enroll in short-term health plans year-round.

Quick Coverage Start: Many short-term plans can begin as soon as the next day after your application is approved.

Medicaid

South Dakota administers Medicaid to provide free or low-cost health coverage for qualifying low-income residents. Medicaid includes benefits like doctor visits, hospital care, mental health, prescriptions, and more.

Note: South Dakota has historically not expanded Medicaid under the ACA, though recent initiatives may affect eligibility in future years.

Children’s Health Insurance Program (CHIP)

CHIP helps children and pregnant women in households that earn too much for Medicaid but need affordable insurance. In South Dakota, CHIP offers benefits such as regular checkups, dental, and vision care.

Student Health Insurance

College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans, making South Dakota student health insurance accessible and flexible for a wide range of needs.

Medicare

Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities. Options include:

• Medicare Advantage (Part C)
  • Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
• Prescription Drug Plans (Part D)
  • Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
• Medicare Supplement (Medigap)
  • Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.

COBRA Coverage

If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily—typically at full cost.

Explore all non-ACA health plans that may fit your needs and lifestyle.

Open Enrollment for 2026 Coverage

November 1, 2025 – January 15, 2026

During this time, you can apply for, renew, or switch ACA Marketplace plans.

Special Enrollment Period (SEP)

You may qualify to enroll outside of Open Enrollment if you experience a Qualifying Life Event (QLE), such as:

• Job loss
• Marriage or divorce
• Birth or adoption of a child
• Relocation
• Major change in income

You typically have 60 days from the event to apply.

Health Insurance Providers in South Dakota

As of 2025, the following insurers offer individual and family health insurance plans in the state through the federal ACA Marketplace:

• Avera Health Plans
• Sanford Health Plans

Plan availability and features may vary by location within the state.

Understanding Health Insurance Costs

When selecting a plan, be sure to understand these common cost terms:

• Premium: Monthly payment to maintain your plan.
• Deductible: What you pay before insurance covers services.
• Copayment (Copay): Fixed amount per visit/service.
• Coinsurance: Shared costs with your insurer after the deductible.
• Out-of-Pocket Maximum: Your yearly cost cap for covered services.
• In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.

Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.

Bottom Line

Health insurance in South Dakota comes with various options—from employer-sponsored plans to ACA marketplace coverage, Medicaid, and Medicare. By staying informed and enrolling during the appropriate periods, you can secure reliable health coverage that meets your needs.

Need help selecting a plan? Use our ACA Subsidy Calculator or consult with a licensed agent to explore the best coverage for your situation.