South Dakota health insurance

Open enrollment for 2021 coverage in South Dakota runs from November 1 - December 15, 2020. Short-term plans are available year-round with initial plan terms up to six months.

Health insurance in South Dakota

This page is dedicated to helping consumers quickly find health insurance resources in the state of South Dakota. Here, you’ll find information about the many types of health insurance coverage available, including the basics of the South Dakota health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in South Dakota; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of South Dakota health insurance resources for residents.

South Dakota’s health insurance marketplace

The South Dakota health insurance marketplace uses the federally run exchange, so residents enroll through HealthCare.gov.

Read our overview of the South Dakota health insurance marketplace – including news updates and exchange history.

South Dakota open enrollment period and dates

In South Dakota, the open enrollment period for 2021 health plans will run from November 1 – December 15, 2020. Outside of that window, a qualifying event is necessary in order to enroll in an individual market plan (on-exchange or outside the exchange).

Loss of other minimum essential coverage is a qualifying event, so anyone losing coverage amid the COVID-19 pandemic can enroll in a new plan in the individual market, as long as they sign up within 60 days of losing coverage.

South Dakota enrollment in qualified health plans

Thus far, enrollment peaked in the South Dakota health insurance marketplace in 2018, when 29,652 people enrolled. It dropped slightly in 2019, but grew again in 2020, with 29,331 people enrolling during open enrollment.

Read more about open enrollment and premiums in our overview of the South Dakota health insurance marketplace.

Medicaid expansion in South Dakota

South Dakota has not expanded Medicaid under the ACA and has no imminent plans to do so. Instead, South Dakota is seeking federal approval to impose a work requirement in two counties for the existing Medicaid population.

In the dwindling minority of state, like South Dakota, where Medicaid has not yet been expanded, Medicaid coverage is only available based on the pre-ACA eligibility rules. For South Dakota, there’s no Medicaid coverage available for non-disabled childless adults, and parents with dependent children are only eligible if they have a household income that doesn’t exceed 58 percent of poverty.

Total enrollment in Medicaid/CHIP has increased nationwide by an average of 24 percent since 2013 (mostly as a result of the ACA’s expansion of Medicaid), but in South Dakota, it has decreased by 5 percent.

As a result, in 2020, approximately 14,000 South Dakotans remained in the coverage gap with no access to Medicaid or exchange subsidies. Their only option is to pay full price for a private plan, which is not possible for most households with incomes below the poverty level.

But South Dakota Medicaid expansion advocates are working to gather enough signatures to get Medicaid expansion on the 2022 ballot in South Dakota. This is how Medicaid has been expanded in Maine, Utah, Idaho, and Nebraska. Oklahoma voters approved a Medicaid expansion ballot initiative in June 2020, and Missouri voters will have a similar decision to make on their August 4, 2020 primary ballot.

Read more about Medicaid expansion in South Dakota.

Short-term health insurance in South Dakota

Federal regulations changed for short-term health insurance as of 2018, allowing for longer short-term plans. But they are clear in noting that a state can impose stricter guidelines.

So South Dakota’s six-month limit on short-term plans continue to apply unless the state enacts legislation to change it.

Read more about short-term health insurance in South Dakota.

South Dakota and the Affordable Care Act

South Dakota’s U.S. Congressional delegation is comprised entirely of Republicans: John Thune and Mike Rounds in the Senate, and Dusty Johnson in the House. All three are opposed to the ACA; Rounds has called Obamacare “fatally flawed.”

Former Representative Kristy Noem, who is also opposed to the ACA, successfully ran for governor in South Dakota in 2018 (Johnson replaced her in the House of Representatives), and has been in the governor’s office since early 2019.

South Dakota has had only GOP governors since 1979 — the longest streak of Republican governors in the country. Former Gov. Dennis Daugaard was opposed to Obamacare, and opted to let HHS run the state’s exchange. But he was willing to negotiate on the issue of Medicaid expansion, proposing a compromise to cover only residents with incomes below the poverty level, rather than those with incomes up to 138 percent of poverty as called for under the ACA.

But under the Obama administration, HHS rejected both of his waiver proposals. The Trump administration is much more open to waiver proposals that were a no-go under the Obama administration, although no state has secured approval for Medicaid expansion capped at the poverty level.

South Dakota’s state legislature has a strong Republican majority, generally opposed to Obamacare.

How has Obamacare helped South Dakotans?

With a federally facilitated exchange and without Medicaid expansion, South Dakota has not fared as well under the ACA as states that expanded Medicaid, formed a state-run or partnership exchange, or did both.

According to U.S. Census data, 11.3 percent of South Dakota residents were uninsured in 2013, and that had dropped to 8.7 percent by 2016 — although it increased to 9.1 percent in 2017, and increased again in 2018, to 9.8 percent in 2018. Nationwide, the uninsured rate started out significantly higher, at 14.5 percent, but had dropped to 8.6 percent by 2016, and climbed slightly, to 8.7 percent, by 2017. It grew again in 2018, to 8.9 percent (various Trump administration policies have had the effect of increasing the number of Americans without health insurance).

If and when South Dakota expands Medicaid, the state’s uninsured rate will likely decrease sharply. Because the state has thus far refused to expand Medicaid, there are an estimated 14,000 people in the coverage gap in South Dakota, most of whom remain uninsured. They have income below the poverty level, are ineligible for Medicaid, and are also ineligible for premium subsidies in the exchange.

South Dakota and high-risk pools

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including South Dakota. This meant that pre-existing conditions could result in an application being rejected altogether, or a coverage offer with significantly higher premiums or policy exclusions. The South Dakota Risk Pool was created in 2003 to give people an alternative if they couldn’t purchase individual health insurance because of their medical history.

Implementation of the ACA and the switch to a guaranteed issue individual market made high-risk pools largely unnecessary starting in January 2014, and the South Dakota Risk Pool stopped enrolling new members as of December 31, 2013. The plan remained operational for existing members until June 30, 2015.

Medicare coverage and enrollment in South Dakota

The number of South Dakotans enrolled in Medicare reached 178,829 as of May 2020.

Read more about Medicare in South Dakota, including the state’s rules for Medigap plans.

South Dakota health insurance resources

State-based health reform legislation

Scroll to the bottom of the page for details about recent state-based health care reform legislation in South Dakota.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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