South Dakota uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual and family dental plans.
Not all insurers who offer medical plans through the South Dakota exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $43 to $65 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in South Dakota in 2022 was $49.98.
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
The pediatric stand-alone dental plans available on the South Dakota marketplace do comply with the ACA’s coverage rules for children’s dental. For consumers, this means out-of-pocket costs for pediatric dental care can not exceed $375 per child in 2023 (or $750 for all the children on a family’s plan), and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.
The South Dakota benchmark plan does include coverage for both basic and major dental services for children.
In 2023, one insurer offers stand-alone individual/family dental coverage through the health insurance marketplace in South Dakota. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are a variety of dental insurers that sell stand-alone dental policies directly to consumers in the Mount Rushmore State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the South Dakota Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In South Dakota, there are also various dental discount plans available. Dental discount plans are not insurance, but they can offer discounted prices on care at participating dentists. Learn about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in South Dakota are eligible for some dental services up to an annual limit of $1,000. Dental services for Medicaid eligible adults include preventive, crowns, root canals and dentures. Children eligible for Medicaid in South Dakota also receive these dental benefits with no annual cap.
South Dakota’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
