South Dakota Health Insurance Exchange Guide for Consumers

If you're a South Dakota resident looking for health insurance, you're in the right place. The South Dakota Health Insurance Exchange is a marketplace where you can compare and purchase health insurance plans.

The open enrollment period for the South Dakota Health Insurance Exchange typically runs from November to December, but you may be eligible for a special enrollment period if you experience certain life changes, such as losing your job or getting married.

You can apply for health insurance through the South Dakota Health Insurance Exchange online, by phone, or in person with the help of a licensed insurance agent.

You can choose from several types of coverage through the South Dakota health insurance exchange. One option is to visit HealthCare.gov to access South Dakota's health insurance Marketplace and shop for plans.

You can also 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.

If you need assistance, you can call HealthCare.gov's contact center at 1-800-318-2596 (TTY: 1-855-889-4325).

Short-term plans offer temporary health insurance for people who need coverage between jobs or during a gap in their regular insurance.

In South Dakota, these plans are available to provide short-term coverage.

Short-term plans are not a substitute for comprehensive coverage, but they can help bridge the gap until you find a better option.

In South Dakota, you can learn more about short-term plan availability, so be sure to do your research.

Supplemental insurance is an add-on to your main insurance policy that helps cover unexpected expenses.

Supplemental insurance can be purchased separately or bundled with your main policy.

It's designed to fill gaps in coverage, such as deductibles or copays, and can help with out-of-pocket expenses.

For example, Medicare Supplement Insurance, also known as Medigap, helps cover Medicare deductibles and copays.

This type of insurance is often purchased by those who are 65 or older and have Medicare.

Supplemental insurance can also be used to cover expenses not covered by your main policy, such as dental or vision care.

In some cases, supplemental insurance can even help with long-term care expenses, such as assisted living or home care.

If you're looking for Marketplace coverage in South Dakota, you're in luck - three insurers offer health plans through the exchange.

In fact, three insurers offer health plans through the South Dakota exchange/Marketplace for 2025.

Residents in much of south-eastern South Dakota have access to two insurers' plans, while those in other areas have more options.

Plan availability varies from one area to another, so it's worth checking what's available in your specific location.

If you're looking for affordable health insurance in South Dakota, you're in luck because the state uses the federally run exchange for individual market plans. This means you can enroll through HealthCare.gov during the open enrollment period.

Nearly everyone who enrolled through the South Dakota Marketplace in 2024 qualified for premium subsidies, which averaged about $611/month, bringing the average enrollee's monthly cost down to about $111/month.

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

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

Three insurers offer health plans through the South Dakota exchange/Marketplace for 2025: Avera, Sanford Health Plan, and Wellmark Blue Cross Blue Shield of SD.

Plan availability varies from one area to another, but residents in much of south-eastern South Dakota have access to two insurers' plans in the Marketplace.

You can expect the following average rate changes for 2025 for the insurers that offer health insurance through South Dakota's Marketplace:

The South Dakota Division of Insurance doesn't publicize information about the rate review process until regulators have finalized the rates.

To enroll in a South Dakota Marketplace plan, you can visit HealthCare.gov to shop, compare, and choose the best health plans. You can also 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.

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.

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.

Here are some key Marketplace details to keep in mind:

You can buy Marketplace health insurance if you live in South Dakota and are lawfully present in the United States. This means you must be a resident of the state and not be incarcerated.

To qualify for financial assistance with your Marketplace plan, you must have a household income that makes you eligible for premium subsidies. These subsidies can help lower your monthly health insurance premiums.

You won't qualify for financial assistance if you have access to an affordable employer-sponsored health insurance plan. However, if you feel your employer's plan is too expensive, you can use the Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.

To qualify for financial assistance, you must also not be eligible for Medicaid or CHIP. This is because Medicaid expansion took effect in South Dakota in mid-2023, and people who are newly eligible for Medicaid are no longer eligible for premium subsidies as of 2024.

Here are the key requirements for buying Marketplace insurance:

In South Dakota, the average rate changes for health insurance through the Marketplace have been approved for 2025. Avera's rates are actually decreasing by 4.53%, which is a positive sign for consumers.

However, not all insurers are decreasing their rates. Sanford Health Plan's rates are increasing by 6.2%, and Wellmark Blue Cross Blue Shield of SD's rates are increasing by 5.29%. These increases might be concerning for those who are unsubsidized.

Historically, rates in South Dakota have tended to be approved as filed. In fact, for 2025, regulators didn't make any changes to the proposed rates.

Here's a look at how full-price (unsubsidized) average premiums have changed over time in South Dakota's individual/family market:

It's worth noting that regulators in South Dakota have the authority to reject rate filings that aren't justified, but historically, rates have been approved as filed.

If you're looking for health insurance resources in South Dakota, the South Dakota Health Insurance Exchange offers a range of options. You can visit their website at sdhealthexchange.com to explore plans and apply for coverage.

The exchange also has a helpline you can call at 1-844-224-8417 for assistance with enrollment and other questions. This helpline is available Monday through Friday, 8am to 5pm CT.

The South Dakota Department of Health has a website with information on health insurance and other health-related topics. You can find this website at doh.sd.gov.

The Affordable Care Act (ACA) also provides resources for health insurance, including a website at healthcare.gov where you can compare plans and enroll in coverage.

You can enroll in a health insurance plan outside of the open enrollment period if you've experienced certain life changes. These changes can include income changes, losing past health insurance coverage, or losing Medicaid or CHIP coverage.

If you've recently lost Medicaid or CHIP coverage, you may qualify for a Special Enrollment Period. This is because your income has changed, making you ineligible for Medicaid or CHIP.

You can also qualify for a Special Enrollment Period if you've experienced other significant life changes, such as getting married. This is a great way to get health insurance coverage when you need it most.

Here are some specific reasons that qualify you for a Special Enrollment Period:

If you're unsure about your eligibility, you can use the screener tool to check. If you're eligible, you can apply for a health insurance plan at any time.

South Dakota has a unique dental insurance system, with two main options: Medicaid and private plans.

Medicaid dental plans are available to eligible low-income individuals and families.

For those who qualify, Medicaid covers essential dental services, including routine cleanings, fillings, and extractions.

Private dental plans, on the other hand, are available through the South Dakota Health Insurance Exchange.

These plans offer a range of coverage options, from basic to comprehensive, and often include additional benefits like orthodontic care and dental implants.

Some private plans also offer discounts for preventive care, such as routine cleanings and x-rays.

Eligible South Dakotans can enroll in Medicaid dental plans year-round, but private plan enrollment is typically limited to the annual open enrollment period and special enrollment periods.