See your South Dakota health insurance coverage options.

In South Dakota, the open enrollment window for individual/family health coverage runs from November 1 through January 15.

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.

Learn more in our comprehensive guide to open enrollment and to special enrollment periods.

There are three insurers that offer coverage through South Dakota’s marketplace for 2023:

• Avera
• Sanford
• Wellmark Blue Cross Blue Shield of South Dakota (new for 2023; Wellmark had previously exited South Dakota’s market at the end of 2016).

In South Dakota, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). More than 90% of consumers who enrolled in 2022 coverage through HealthCare.gov received premium subsidies.

South Dakotans may also find affordable coverage through Medicaid if they’re eligible. This is especially true starting in July 2023, when Medicaid expansion takes effect in South Dakota. See Medicaid eligibility guidelines in South Dakota.

Short-term health insurance is also a lower-cost coverage option in South Dakota, where five insurers offer short-term plans.

For 2023 coverage, average premiums in South Dakota’s individual/family market increased by more than 11%, after decreasing slighly for 2022 and increasing slightly for 2021.

Average 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 40,000 people who enrolled in plans through South Dakota’s exchange for 2023, the average full-price monthly premium was about $699. But most enrollees – about 95% – received premium subsidies that averaged almost $642/month.

Subsidies are larger and more widely available than they used to be, thanks to the American Rescue Plan (ARP) and Inflation Reduction Act. These subsidy enhancements will remain in effect at least through the end of 2025.

For 2023 coverage, 47,591 people enrolled in private plans through South Dakota’s exchange during open enrollment. That was by far a record high, eclipsing the previous record high of 41,339 enrollees in 2022.

Enrollment is likely to decline in 2024, however, because Medicaid expansion takes effect in South Dakota in July 2023. Lower-income exchange enrollees will become eligible for expanded Medicaid instead of premium subsidies in the exchange, leading to an increase in Medicaid enrollment and a likely decrease in exchange enrollment.

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. But Medicaid expansion takes effect in South Dakota in July 2023, which will likely decrease the uninsured rate.

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).

From 2014 through mid-2023, there have been 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. But the coverage gap will be eliminated in South Dakota as of July 2023, due to Medicaid expansion.

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% of poverty as called for under the ACA. But that concept was rejected by both the Obama administration and the Trump administration (specifically, both administrations rejected the idea of the state receiving enhanced Medicaid expansion funding while only partially expanding Medicaid). 

The issue of Medicaid expansion was ultimately settled with a voter-approved ballot measure in 2022, and Medicaid expansion takes effect in the state as of July 2023.

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

South Dakota will implement the ACA’s Medicaid expansion starting July 1, 2023, under the terms of a ballot measure that voters approved in 2022.

Ballot measures are how Medicaid was expanded in Maine, Utah, Idaho, Nebraska, Oklahoma, and Missouri. 

Until Medicaid expansion takes effect, there’s no Medicaid coverage available in South Dakota 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. But starting in July 2023, Medicaid will be available to adults under the age of 65 if their household income isn’t more than 138% of the poverty level.

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.

The number of South Dakotans enrolled in Medicare reached 190,708 as of November 2022.

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

• 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.