South Dakota Health Insurance

The Mount Rushmore State has two insurers offering 2021 health insurance. You can buy plans both on and off the Marketplace. 

South Dakota Health Insurance Overview

South Dakota has more than 886,000 residents—making it one of the least populated states.¹ Just over half of the population get private health insurance through an employer.² A small percentage buy Affordable Care Act (ACA) or Obamacare plans through the Health Insurance Marketplace. Roughly one-third of all residents have government-funded health insurance through Medicare, Medicaid, and the Children’s Health Insurance Program.

South Dakota has not adopted Medicaid expansion under the ACA, which would give coverage to low-income adults without children. As a result, this has left over 40,000 residents in the Medicaid coverage gap. A Medicaid expansion amendment may appear on the November 2022 ballot.

Although more people would have medical benefits if the state expanded Medicaid, South Dakota still has a fairly low uninsured rate. As of 2019, 9.6% of the population lacked health insurance. This figure is just slightly higher than the U.S. uninsured rate average.³

Buying South Dakota Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs 

South Dakotans can buy ACA health insurance for individuals and families. Self-employed entrepreneurs with no employees have the same access. 

ACA health plans come in bronze, silver, gold, and platinum. Each policy pays a percentage of your covered medical expenses ranging from 60% for bronze to 90% for platinum. But for 2021, no South Dakota insurance company offered platinum plans.⁴

The ACA prohibits companies from denying you coverage due to health or a preexisting condition. All metal policies provide 10 essential health benefits, such as prescription drug coverage, hospitalization, and free preventive care. 

South Dakota carriers also offer an alternative to metal plans called catastrophic health insurance. It’s generally available to adults under 30, but older adults experiencing hardship can also enroll. Catastrophic insurance offers similar coverage levels as bronze plans. They also include the same ACA protections and benefits as metal plans. 

South Dakota Health Insurance Marketplace Enrollment

South Dakotans have many options to enroll in ACA plans. Residents can apply through the federal Marketplace at healthcare.gov, directly with an insurance company, or through a licensed agent. 

Open enrollment for 2022 plans begin on November 1, 2021 and ends on January 15, 2022.

Coverage takes effect on January 1, 2022 if you buy a plan by December 15, 2021.

Open enrollment for 2021 plans sold on and off the Marketplace ended on December 15, 2020. Roughly 31,000 residents signed up.⁵ You can still enroll past the deadline if you relocate, get married, or have another qualifying life event.

Health Insurance Companies in South Dakota 

Two South Dakota insurance carriers offer metal plans and catastrophic insurance for 2021. The companies below sell both on and off the Marketplace:⁶

1. Avera Health Plans
2. Sanford Health Plans

According to SERFF Filing Access, both companies have rate reductions in 2022.

South Dakota Health Insurance Costs

Marketplace premiums in South Dakota were higher in 2021. Rates for silver plans have the biggest change, while gold plans took a slight dip. The difference between the lowest-cost silver premium from 2019 to 2021 is about $68. Below are the average monthly rates:

• Average lowest-cost bronze premium: $412 in 2019; $438 in 2020; $454 in 2021
• Average lowest-cost silver premium: $541 in 2019; $588 in 2020; $609 in 2021
• Average lowest-cost gold premium: $632 in 2019; $659 in 2020; $652 in 2021

Before 2021, if you earned between one to four times of the federal poverty level, you were eligible for subsidies to help you pay for any metal plan.

In 2021, the federal government expanded subsidies and removed the income cap for premium tax credits. Instead, you would pay no more than 8.5% of your annual household income on health insurance based on the price of the benchmark plan. The federal government would cover the balance through subsidies.

Help With Marketplace Premiums for Low-Income South Dakotans 

Your monthly premium could be much less than what’s shown above if you qualify as low income. For 2021, you’re considered low income if you earn from $12,880 to $51,520 as a single adult. This amount represents 100% to 400% of the federal poverty level (FPL). 

You qualify for premium tax credits (subsidies) on any Marketplace plan if your income is within this range. The federal government provides subsidies. About 94% of South Dakotans qualified in 2020.⁷ The average amount received was $625 per month in 2021. 

South Dakota Medicaid for Low-Income Adults and Children

Medicaid is jointly funded by the state and federal governments. It provides health, vision, dental, and prescription drug benefits to low-income adults and children. Recipients can get coverage for a low or no monthly cost. 

Medicaid in South Dakota enrolled more than 141,000 low-income residents as of October 2020.⁸ Total Medicaid and CHIP enrollment is over 126,000 as of April 2021.⁹ Others include parents and caretakers with dependent children, pregnant women and newborns, and people 65 and older.

Each group has a maximum income limit to qualify. For instance, parents and caretaker relatives can earn up to $776 a month for a two-person household. The limit increases by around $110 for each additional person. You can view more Medicaid income limits in South Dakota here. 

South Dakota Children’s Health Insurance Program (CHIP)

South Dakota’s CHIP benefits are available to residents under 19 from low-income households. Over 11,000 children are enrolled as of April 2021.¹⁰ Coverage includes dental and vision care, wellness exams, and regular checkups. Both uninsured children and those with private health insurance can enroll. 

Income requirements for these two groups vary. For example, uninsured children from a family of three earning up to $3,825 a month can qualify. Children with insurance from the same family size have a lower income limit of $3,423 per month. 

Medicare for South Dakota Seniors and Younger Adults With Disabilities

Medicare is regulated by the federal government. It’s generally for people 65 and older. But younger adults with disabilities and certain chronic conditions (like kidney failure) can enroll.  

About 177,500 South Dakotans have Medicare, according to the latest 2020 study from Kaiser Family Foundation (KFF). 

Roughly 81% of those beneficiaries get coverage through Original Medicare. It is the traditional program run by the federal government. The remaining beneficiaries are enrolled in an alternative plan called Medicare Advantage. It’s sold by private companies that contract with the government. 

Both options provide coverage for inpatient hospital care (Part A) and outpatient medical services (Part B). Original Medicare also covers some medications, which are typically those provided in a hospital setting. Whereas most Medicare Advantage plans include Part D drug benefits for prescriptions you give yourself. 

Private companies also sell individual Medicare Part D plans, which are typically paired with Original Medicare. According to KFF, roughly 104,000 South Dakotans bought standalone Part D coverage in 2018.¹¹ Original Medicare beneficiaries can also enroll in Medicare Supplement (or Medigap). It helps pay for covered out-of-pocket costs like your Part A coinsurance and Part B copayments. 

Short-Term Health Insurance in South Dakota

South Dakota limits short-term coverage to a maximum of six months. Policies are not renewable.¹² States that default to federal rules can offer coverage for as long as 364 days with renewals for up to 36 months. 

You might consider short-term health insurance if you need coverage for a temporary situation. For example, if you’re waiting for benefits to start a new job or you’re in between jobs. 

Short-term health plans don’t provide comprehensive benefits, which usually make them cheaper than qualified-ACA plans. But unlike ACA plans, short-term plans aren’t required to provide all essential health benefits or cover preexisting conditions. You usually need to answer medical questions to apply. Companies can deny you a policy based on your health. 

Short-term insurance may fit your needs if you’re comfortable with its limitations. Comparing the costs (premiums, deductibles, etc.) and benefits with ACA coverage can help you better decide which is right for you.