Frequently asked questions about health insurance
coverage options in South Dakota
In South Dakota, the open enrollment window for 2022 health coverage ran from November 1, 2021 through January 15, 2022.
Outside of open enrollment, you’ll need a special enrollment period to enroll in a plan or make a change to your coverage. Most special enrollment periods are linked to a qualifying life event, although some special enrollment periods (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) don’t depend on having a specific life event.
There are two insurers that offer coverage through South Dakota’s marketplace for 2022, and both offer plans statewide.
Average premiums decreased by about 1.4% for 2022 in South Dakota’s individual market, after increasing by an average of 2.6% for 2021.
Those rate changes are calculated before any subsidies are applied. Most marketplace enrollees in South Dakota receive premium subsidies, so their net premium changes can be quite different, as they also depend on how subsidy amounts change from one year to the next.
Across the nearly 30,000 people who enrolled in plans through South Dakota’s exchange for 2021, the average full-price monthly premium was $694. But most enrollees – about 93% – received premium subsidies that averaged nearly $622/month.
Those subsidies got larger and became more widely available mid-year in 2021, due to the American Rescue Plan (ARP). The ARP’s subsidy enhancements remain in effect through the end of 2022.
For 2022 coverage, 39,292 people had enrolled in private plans through the South Dakota exchange as of mid-December 2021. There was still another month left in open enrollment at that point, and yet enrollment had already far surpassed the prior year’s open enrollment total (31,375), which had been a record high. The previous high point was in 2018, when 29,652 people enrolled.
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% of South Dakota residents were uninsured in 2013, and that had dropped to 8.7% by 2016 — although it has been steadily increasing since then, reaching 10.2% in 2019. Nationwide, the uninsured rate started out significantly higher, at 14.5%, but had dropped to 8.6% by 2016, and had increased to 9.2% by 2019 (various Trump administration policies 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 14000 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’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 Daugaard 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 that concept was rejected by both the Obama administration and the Trump administration.
The issue of Medicaid expansion will be decided by South Dakota voters on the November 2022 ballot. But another ballot measure, which is on the June 2022 primary ballot, might require at least 60% support for passage of the Medicaid expansion ballot measure.
South Dakota’s state legislature has a strong Republican majority, generally opposed to Obamacare.
South Dakota has not expanded Medicaid under the ACA. But the issue will be on the November 2022 ballot (Amendment D), allowing the state’s voters to decide whether to expand Medicaid. However, there’s another ballot measure (Amendment C) on the June 2022 primary ballot, which would (if approved by voters) require at least 60% support for passage of the Medicaid expansion ballot measure.
Ballot measures are how Medicaid was expanded in Maine, Utah, Idaho, Nebraska, Oklahoma, and Missouri.
During the Trump administration, instead of expanding Medicaid, South Dakota was seeking federal approval to impose a work requirement in two counties for the existing Medicaid population (the Biden administration has notified states that Medicaid work requirements are a non-starter).
In the dwindling minority of states, 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 63% of poverty.
As a result, approximately 16,000 South Dakotans remain 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.
Total enrollment in Medicaid/CHIP has increased nationwide by an average of 45% since 2013 (mostly as a result of the ACA’s expansion of Medicaid and the COVID pandemic), but in South Dakota, it has only increased by 12%. And even that slight increase has been driven by the COVID pandemic, with widespread job/income losses. Prior to the pandemic, Medicaid enrollment was lower in South Dakota than it had been in 2013.
Read more about Medicaid expansion in South Dakota.
Until late 2020, South Dakota imposed a six-month limit on short-term plans. But that changed in late 2020, when the state relaxed its rules to allow short-term plans to follow the federal guidelines that the Trump administration implemented in 2018.
Short-term plans in the state can now have initial terms of up to 364 days, and total duration, including renewals, of up to three years (insurers can still choose to offer shorter terms and limit renewals, and most of the available short-term plans in South Dakota do have shorter term and duration limits.
Read more about short-term health insurance in South Dakota.
- Division of Insurance – South Dakota
- Great Plains Tribal Chairmen’s Health Board and Community HealthCare Association of the Dakotas — Federally funded Navigator organizations in South Dakota
- Western South Dakota Community Action Partnership
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.