Health Insurance South Dakota 2021

Last modified: December 30, 2020

People can purchase cheap health insurance in South Dakota through the Health Insurance State Marketplace. These are plans that meet the government requirements per the ACA (Affordable Care Act). The other option is to go through the multiple carriers that offer health insurance.

What is the South Dakota Marketplace and how you can buy health insurance?

The South Dakota Marketplace gives residents access to buy ACA (Affordable Care Act) health insurance for individuals and families. Self-employed entrepreneurs/Freelancers have the same access. 

It’s a federally facilitated marketplace that provides easy access to a range of healthcare plans, allowing you to find the right coverage for you and your family. 

If you live in South Dakota, the health insurance exchange can connect you with affordable coverage in your area.  HealthCare.gov is a great destination to help make better-informed decisions about getting health insurance in South Dakota during open enrollment.

ACA health plans come in Bronze, Silver, Gold, and Platinum. Each policy pays a percentage of your covered medical expenses ranging from 60% for bronze to 90% for platinum. 

South Dakota carriers also offer an alternative called Catastrophic health insurance. It’s available to adults under 30, but older adults experiencing hardship can also enroll. Catastrophic insurance offers similar coverage levels as the Bronze plan. They also include the same ACA protections and benefits as the Bronze levels.

The ACA prohibits companies from denying you coverage because of your health or a pre-existing condition. All Bronze policies provide 10 essential health benefits, such as emergency services, ambulatory patient services, laboratory services, prescription drug coverage, hospitalization, pediatric services, mental health and addiction services, rehab services, pregnancy care, and free preventive care. 

South Dakota Health Insurance Providers and SD Health Insurance Plans Comparison

There are currently only two South Dakota health insurance companies on the state exchange: Avera and Sanford. 

Even though the plan names might be different in both companies, they both have the standard Metal Tier breakdown. The plan levels that are offered are Bronze, Silver, Gold, and Catastrophic which allow their consumers to choose their own combination of coverage and cost.

Avera

Avera health insurance in South Dakota is a not-for-profit health insurance company serving  SD. They provide comprehensive healthcare insurance for individuals and families with a faith-based approach, as they were founded by two Catholic orders as a mission. 

The plans they offer are Catastrophic, Bronze (High and Low), Silver and Gold.

Sanford 

As one of the largest nonprofit health South Dakota health insurance companies is the leading insurance provider in the state for affordable and sustainable health coverage. 

The plans they offer are Sanford Basic, Vital, Active, and Ultimate.

Catastrophic

Catastrophic plans are best for young, healthy people. They offer low monthly rates but are limited to people younger than 30. These plans provide the least coverage and are only recommended if you have the financial strength to cover your health care expenses in case of an emergency.

Bronze

Bronze plans are open to everyone, and they also offer cheap monthly premium with reduced coverage and high out-of-pocket costs. In case you need medical care during the year, you would have to pay more out of pocket before any coverage kicks in. It is expected that a Bronze plan can cover about 60% of health costs. Expanded Bronze plans increase coverage to about 65%, while you cover the rest.

Silver 

Silver plans are best for people with low income or average medical costs. This insurance plans are balanced between cost and benefits. 

Still, Silver plans can become costly if you aren’t qualified for premium subsidies, because the cost-sharing subsidies are no longer funded by the federal government. They cover about 70% of your health care costs, with 30% co-pay.

Gold

The Gold plans are best for high expected medical costs. They typically cover a greatest share of out-of-pocket costs and have lower deductibles, copays and coinsurance. Very cost-effective if there are high medical expenses to be incurred, mainly chronic conditions, or costly prescriptions. Gold plans cover 80% of medical costs, with 20% co-pay.

Cheapest Health Insurance Plans by Cities in South Dakota

All counties in the state have access to both insurance companies, but the monthly premium for a health plan will depend on the city. Finding the cheapest health insurance in South Dakota can be a challenge, since the plans and monthly premium may change depending on the region. 

For example, Aberdeen and Sioux Falls have the cheapest monthly cost for a Silver tier plan for a 40-year-old subject which is the most affordable health insurance in South Dakota out of the major cities. 

Pierre and Brookings follow next with rates that range at $570 t0 $580 again for a 40-year-old person. Rapid City in Pennington county has one of the most expensive rates with $740 for health coverage for the same 40-year-old. 

The average cost of health insurance in South Dakota when considering a family insurance plan can vary depending on the number of people and their age. Adding a child under 15 years old will cost a flat rate. Upon reaching the age of 15, monthly rates will increase. 

A health insurance quotes in South Dakota for a family of three with both parents at 40 years of age for a Silver plan will cost around $1,650 per month. Adding another child on the same plan will raise the price for $350-$380 per month, with around $2,000 or $2,030 monthly premium.

South Dakota Health Insurance Guide 

There are three types of health insurance that South Dakota residents can purchase.

Employer-provided health insurance – coverage provided by the employer or through a spouse’s employer. Over 50% of South Dakota residents get their health insurance this way.

Individual or Family Plans – can be accessed through HealthCare.gov or directly from a health insurance company. Around 8% of the population buys their health insurance directly from the State Marketplace.

Medicare and Medicaid – government-assisted health care programs in the U.S. Medicare covers seniors, and Medicaid covers low-income families and children.

  • Medicare – seniors 65 and older are the ones that qualify for this coverage. The coverage options within the program are parts A, B, C, D, along with the supplemental coverage plans. About 174,000 South Dakotans have this coverage. 

Medicare provides inpatient hospital care Part A and outpatient medical services Part B. Medigap or Part C helps pay for covered out-of-pocket costs like Part A coinsurance and Part B copayments. 

  • Medicaid  – this program is jointly funded by the state and federal government. It covers low-income adults and their families for a low monthly cost. It provides health, vision, dental, and prescription drug benefits coverage. 

Medicaid also offers the Children’s Health Insurance Program or CHIP, which is available for children under 19 years old that come from low-income families. 

Over 16,000 children have been enrolled in this program in South Dakota. CHIP includes primary care, vision care, dental visits, wellness exams, check-ups at the physicians’ check-ups.

Tips to save on South Dakota Health Insurance

There are a few effective ways to save when shopping for health insurance.

These are some factors that contribute to your premium costs:

  •         Body mass index (BMI)
  •         Tobacco use/ smoking
  •         Age
  •         Location
  •         Cost-sharing reductions
  •         Individual health insurance
  •         Family health insurance 
  •         Pre-existing conditions
  •         Gender
  •         Insurance and medical history

Quitting smoking, losing some weight, and taking care of your overall health are some of the ways to keep your monthly premiums down.

Pros & Cons

The Pros

The Cons

Final Verdict

FAQs

When is open enrolment for 2021 health insurance coverage in South Dakota?

Open enrolment for 2021 lasts from November 1, 2020 through December 15, 2020. Coverage takes effect on January 1, 2021.

Did South Dakota expand Medicaid?

South Dakota has not accepted federal funding to expand its Medicaid program, so eligibility rules in the state remain the same as they were prior to Obamacare, or the Affordable Care Act (ACA). The state does not expand Medicaid. It asks federal approval for a work requirement for low-income parents in the already existing Medicaid program.

Is health insurance mandatory in South Dakota?

There is no state law requiring employers to offer group healthcare insurance to their employees, but most employers offer this benefit. Health plans where the employer pays the benefits without the use of the insurance policy cannot apply South Dakota’s mandated benefit provisions.

What is the income limit for Medicaid in South Dakota?

The max gross income limit as eligibility for family health insurance in South Dakota for a family of 4 is $994 monthly income, and for a family of 5 and 6 is $1,105 and $1,217 respectively.

Why is healthcare so expensive in South Dakota?

It can be difficult to find cheap health insurance in South Dakota. Employee healthcare costs around 12% of the median income in South Dakota. The use of new technologies and drugs may be the largest single factor increasing health care costs. Average monthly premium range anywhere from $231 to $395.

What are short-term health insurance conditions?

South Dakota short-term health insurance allows plans to last no more than 6 months, and renewals are not permitted.

What is the uninsured population rate in South Dakota?

The uninsured rate in South Dakota is between 8% and 9% of the population.