South Dakota Health Insurance Guide

Health Insurance Overview in South Dakota

South Dakota expanded Medicaid in 2023 following voter approval of Amendment D in 2022 — one of the most recent states to expand. South Dakota uses the federal HealthCare.gov marketplace. The state's small population and rural character mean marketplace options are limited in many areas.

Average Health Insurance Costs in South Dakota

Marketplace Enrollment in South Dakota

South Dakota residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in South Dakota

Medicaid in South Dakota

South Dakota Medicaid expanded in July 2023 following voter approval in 2022. Adults with incomes up to 138% of the federal poverty level are eligible.

Children's Health Insurance (CHIP) in South Dakota

Children's Health Insurance Program (CHIP) covers children in families with incomes up to 200% of the federal poverty level.

What Makes South Dakota Unique

South Dakota voters approved Medicaid expansion in November 2022 with 56% of the vote, over the objections of the governor and most of the legislature. The state implemented expansion in July 2023, covering approximately 42,000 previously uninsured South Dakotans. South Dakota's tribal communities — particularly on the Pine Ridge and Rosebud reservations — see significant benefits from the expansion.

ACA Subsidies: What South Dakota Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

South Dakota’s Marketplace for 2027: Insurers, Rates, and Dates

South Dakota residents enroll through HealthCare.gov. Full-price premiums rose about 6.4% on average for 2026, before subsidies. 3 insurers sold plans for 2026. Proposed 2027 changes average about 10.4% before subsidies.

About 51,000 people enrolled for 2026. About 83% received premium tax credits, and the average net premium after credits was about $118 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in South Dakota

South Dakota expanded Medicaid by constitutional amendment, effective July 2023. Its three insurers — Avera, Sanford Health Plan, and Wellmark Blue Cross — return for 2027, and South Dakota’s 2026 full-price increase (about 6.4%) was among the smallest in the country.

Tips for Choosing Health Insurance in South Dakota

South Dakota residents who were previously uninsured should check eligibility for Medicaid following the 2023 expansion. Rural South Dakota residents may have very limited marketplace options. ACA subsidies are available for incomes 100-400% of the federal poverty level. Tribal members may have additional coverage options through Indian Health Service.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.

Frequently Asked Questions

How many insurers sell marketplace plans in South Dakota?

Three insurers sold South Dakota marketplace plans for 2026, with proposed 2027 changes averaging about 10.4% before subsidies.

When is open enrollment in South Dakota for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do South Dakota marketplace enrollees pay after subsidies?

In 2026 about 83% of South Dakota enrollees received premium tax credits, and the average net premium was about $118 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.