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 about 837,000 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 20,000 residents in the Medicaid coverage gap.
Although more people would have medical benefits if the state expanded Medicaid, South Dakota still has a fairly low uninsured rate. As of 2018, 9% of the population lack health insurance. This figure is the same uninsured rate as the U.S. 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 2020, no South Dakota insurance company offers 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 2021 plans lasts from November 1, 2020 through December 15, 2020. Coverage takes effect on January 1, 2021.
Open enrollment for 2020 plans sold on and off the Marketplace ended on December 18, 2019. Roughly 29,000 residents signed up.5 You can still enroll past the deadline if you relocate, get married, or have another qualifying life event.
Govt Launches Special Enrollment Period
South Dakota residents who missed open enrollment can still sign up. Due to the coronavirus, the federal government reopened enrollment on the federal Marketplace from February 15, 2021 through August 15, 2021.
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
- Avera Health Plans
- Sanford Health Plans
South Dakota Health Insurance Costs
Marketplace premiums in South Dakota are higher in 2020. Rates for silver plans have the biggest change. The difference between the lowest-cost silver premium from 2019 to 2020 is about $47. Below are the average monthly rates:
- Average lowest-cost bronze premium: $412 in 2019; $438 in 2020
- Average lowest-cost silver premium: $541 in 2019; $588 in 2020
- Average lowest-cost gold premium: $632 in 2019; $659 in 2020
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 2020, you’re considered low income if you earn from $12,760 to $51,040 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 the subsidies. About 93% of South Dakotans qualified in 2019.7 The average amount was $563 per month.
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 93,000 low-income residents as of November 2019.8 Among enrollees, two in seven are children and one in four are individuals with disabilities.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 $775 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. Nearly 16,000 children are enrolled as of November 2019.10 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 $3,783 a month can qualify. Children with insurance from the same family size have a lower income limit of $3,385 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 174,000 South Dakotans have Medicare, according to the latest 2018 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.
