South Dakota health insurance Marketplace guide

To qualify for health coverage through the South Dakota Marketplace, you must:⁵

• Live in South Dakota
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare 

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your household income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to an affordable employer-sponsored health insurance plan. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP (note that Medicaid expansion took effect in South Dakota as of mid-2023, so people who are newly eligible for Medicaid are no longer eligible for premium subsidies as of 2024).
• Not be eligible for premium-free Medicare Part A.⁶
• If married, file a joint tax return.⁷
• Not be able to be claimed by someone else as a tax dependent.⁷

In South Dakota, the open enrollment period for individual and family health coverage runs from November 1 to January 15.⁸ 

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁵

Open enrollment will be shorter, however, starting in the fall of 2026. At that point, for coverage effective in 2027 and future years, the enrollment window will run from November 1 to December 15, and all plans selected during open enrollment will take effect January 1.

Outside of open enrollment, you’ll need a special enrollment period (SEP), triggered by a qualifying life event, to enroll or make changes to your coverage. 

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in South Dakota, you can: 

• Visit HealthCare.gov to access South Dakota’s health insurance Marketplace. Here you will find an online platform to shop, compare, and choose the best health plans. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁹

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

South Dakota uses the federally-facilitated exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

During the open enrollment period for 2025 coverage, nearly everyone — 94% — who enrolled through the South Dakota Marketplace qualified for premium subsidies. The subsidies averaged about $600/month, bringing the average subsidy-eligible enrollee’s monthly cost down to about $99/month.¹⁰

People with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that result in lower deductibles and out-of-pocket expenses for Silver plans.¹¹

Between the premium subsidies and cost-sharing reductions, you may find that a South Dakota Marketplace plan provides the best value when you’re shopping for health coverage.

Source: CMS.gov¹⁰

The ACA’s Medicaid expansion took effect in South Dakota in mid-2023, due to a ballot measure that voters approved in the 2022 election. An estimated 52,000 low-income South Dakota residents were initially expected to enroll in Medicaid under the expanded eligibility guidelines, but enrollment has trended lower than expected. Fewer than 30,000 people were enrolled in South Dakota’s Medicaid expansion as of 2025.¹²

People with income between 100% and 138% of the poverty level were eligible for premium subsidies in the South Dakota Marketplace in 2023 and previous years. But they’re no longer eligible for subsidies, as they’re eligible for Medicaid expansion instead.

Three insurers offer health plans through the South Dakota exchange/Marketplace for 2025,³ and all three will continue to offer coverage in 2026:¹³

• Avera
• Sanford Health Plan
• Wellmark Blue Cross Blue Shield of SD

Plan availability varies from one area to another. Residents in much of south-eastern South Dakota have access to two insurers’ plans in the Marketplace, while residents in much of the western and north-eastern portion of the state have access to plans offered by all three insurers.¹⁴

The following average rate changes have been approved for 2026 for the insurers that offer health insurance through South Dakota’s Marketplace, amounting to a weighted average rate increase of 6.4%, before subsidies are applied.⁴ 

Source: RateReview.HealthCare.gov⁴

Although average full-price premiums are increasingly only modestly in South Dakota for 2026, after-subsidy premiums will increase sharply if the federal subsidy enhancements expire at the end of 2025. This will happen unless Congress takes action to extend the subsidy enhancements.

The South Dakota Division of Insurance doesn’t publicize information about the rate review process until regulators have finalized the rates. However, regulators in South Dakota do have the authority to reject rate filings that aren’t justified, or to require insurers to make adjustments to proposed rates.¹⁵ (Under federal rules, this is not required, and insurers can implement rates even if they’re determined to be unreasonable.¹⁶ But states can go beyond the federal minimum rate review requirements.) However, rates in South Dakota have historically tended to be approved as filed, as was the case for 2026.

For perspective, here’s an overview of how full-price (unsubsidized) average premiums have changed over time in South Dakota’s individual/family market:

• 2015: Average decrease of 21%.⁶
• 2016: Average increase of 27.4%.¹⁷
• 2017: Average increase of 37.9%.¹⁸
• 2018: Average increase of 27.4%.¹⁹
• 2019: Average increase of 5.2%.²⁰
• 2020: Average increase of 6.5%.²¹
• 2021: Average increase of 2.6%²²
• 2022: Average decrease of 1.2%.²³
• 2023: Average increase of 11.4%.²⁴
• 2024: Average increase of 2.5%.²⁵
• 2025: Average increase of 2.3%²⁶

A record high of 54,721 people enrolled in private health coverage through the South Dakota exchange during the open enrollment period for 2025 coverage.²⁷ That was the fifth consecutive year of new record high enrollment for South Dakota’s exchange (see graph below).

The surge in enrollment during these years was due in part to the American Rescue Plan (ARP) which made ACA’s premium subsidies more substantial. Under the ARP – and extended through 2025 by the Inflation Reduction Act – premium subsidies are larger and more widely available than they were prior to 2021.²⁸

The enrollment spike in 2024 was also due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. By April 2024, nearly 8,000 South Dakota residents had transitioned from Medicaid to a Marketplace plan during the unwinding process.²⁹

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023,³⁹ 2024,⁴⁰ 2025²⁷

HealthCare.gov
800-318-2596

South Dakota Division of Insurance
Regulates health plans sold in the SD Marketplace, approves premiums, and licenses and oversees health insurers as well as agents and brokers.

State Exchange Profile: South Dakota
The Henry J. Kaiser Family Foundation overview of South Dakota’s progress toward creating a state health insurance exchange.