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View our comprehensive guides to coverage in South Dakota

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The American Rescue Plan's premium-cutting subsidies

Find out how the American Rescue Plan will drastically cut marketplace health insurance costs for South Dakotans from Sioux Falls, to Aberdeen, Rapid City and beyond. Enroll now if you have a qualifying event.

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Individual and Family

Short-term coverage in South Dakota

Short-term plans in South Dakota can have initial durations of up to 364 days, and total duration, including renewals, of up to three years Read more about short-term health insurance in South Dakota.

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Short-term

Medicaid in South Dakota

South Dakota has not expanded Medicaid under the ACA and has no imminent plans to do so. Read more about Medicaid in South Dakota.

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Medicaid

Medicare enrollment in South Dakota

Over 180,000 South Dakotans were enrolled in Medicare as of January 2021. Read more about Medicare in South Dakota, including the state’s rules for Medigap plans.

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Medicare

Flexible dental benefits. Fast approval.

Protect yourself from the soaring costs of dental procedures. Compare plan options to see premiums and deductibles that fit your budget.

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Dental

Frequently asked questions about health insurance
coverage options in South Dakota

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.

Open enrollment in South Dakota for 2021 coverage ended on December 15, 2020. The open enrollment period for 2022 coverage will run from November 1 through December 15, 2021.

Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan.

There are two insurers — Avera and Sanford — that offer coverage through South Dakota’s marketplace for 2021, and both offer plans statewide.

Across the more than 29,000 people who enrolled in plans through South Dakota’s exchange for 2020, the average full-price monthly premium was $687. But most enrollees – about 92 percent – received premium subsidies. After the subsidies are applied, the average premium is just $136/month.

During the open enrollment period for 2021 coverage, 31,375 people enrolled in coverage through South Dakota’s exchange – 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 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.

South Dakota has not expanded Medicaid under the ACA and has no imminent plans to do so. Instead, during the Trump administration, 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 58% of poverty.

As a result, in 2021, approximately 16,000 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.

Total enrollment in Medicaid/CHIP has increased nationwide by an average of 35% since 2013 (mostly as a result of the ACA’s expansion of Medicaid), but in South Dakota, it has only increased by 3%. 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.

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. Voters in Oklahoma and Missouri approved Medicaid expansion ballot measures in 2020, which is why those states are expanding Medicaid in 2021 (funding for Medicaid expansion in Missouri is still uncertain as of the spring of 2021).

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

The number of South Dakotans enrolled in Medicare reached 181,162 as of January 2021.

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

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.

When it comes to health insurance in South Dakota, we’re the voice of experience.

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Talking about health insurance since 1994.
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