Quick answer
South Dakota’s 2026 benchmark silver plan averaged $655 a month for a 40-year-old before subsidies, $30 more than the U.S. average of $625. Full prices run from about $513 a month at 21 to $1,538 at 64. About 83% of enrollees got a premium tax credit, and the average enrollee paid $211 a month after it. The state approved 2027 increases averaging 10.1% to 10.4% before subsidies, depending on the calculation, well below the 15% median that insurers proposed nationally.
Key takeaways
- South Dakota’s 2026 benchmark premium for a 40-year-old was $655 a month, slightly above the $625 U.S. average.
- Approved 2027 increases average 10.1% to 10.4% before subsidies, depending on the calculation.
- Avera, Sanford Health Plan and Wellmark Blue Cross Blue Shield of South Dakota all sold 2026 plans, and all three are back for 2027.
- South Dakota’s Medicaid expansion took effect July 1, 2023, and covered more than 31,000 people as of August 2026.
- On November 3, 2026, voters decide Amendment I, which would make the expansion depend on the federal government continuing to pay at least 90% of its cost.
On this page
What a South Dakota Marketplace plan costs before subsidies
| Age | Benchmark silver plan, per month (2026 estimate) |
|---|---|
| 21 | $513 |
| 30 | $582 |
| 40 | $655 |
| 50 | $915 |
| 60 | $1,391 |
| 64 | $1,538 |
| Child under 15 | $392 |
A family of four, with two 40-year-old parents and two children under 15, would pay about $2,094 a month for benchmark plans before subsidies.
What you’d pay after a tax credit
A premium tax credit covers the gap between the benchmark plan’s price and a set share of your income, as long as your household earns 100% to 400% of the federal poverty level. A single 40-year-old in South Dakota making $40,000 would pay about $287 a month for the benchmark plan in 2026, with a credit of about $368. Their share would rise to about $289 a month for 2027. Above 400% of the poverty level ($62,600 for one person for 2026 coverage, $63,840 for 2027), the credit ends.
In 2026, the average South Dakota tax credit was $568 a month. Enrollees who got one paid $118 a month on average, and the average across all enrollees was $211.
If your income is under 138% of the poverty level, you may qualify for Medicaid instead. Read more in health insurance for low-income families.
Costs beyond the premium
What you pay at the doctor or pharmacy depends on the plan. You’ll usually meet a deductible before the plan pays more, then pay copays or coinsurance until you reach the out-of-pocket maximum: $10,600 for one person in 2026 and $12,000 in 2027. Silver plans lower those costs through cost-sharing reductions when your income is under 250% of the poverty level.
South Dakota Marketplace facts
- Marketplace: HealthCare.gov, run by the federal government.
- Enrollment: 50,951 plan selections for 2026, down about 7% from 54,721 in 2025. About 83% got a premium tax credit.
- Insurers: Avera, Sanford Health Plan and Wellmark Blue Cross Blue Shield of South Dakota, all returning for 2027. In the 2027 rate filings, Avera had the most enrollees (about 21,500), followed by Sanford (about 17,900) and Wellmark.
- 2027 prices: Approved in September 2026. The average increase is 10.1% by ACA Signups’ calculation and 10.4% by healthinsurance.org’s. Both are below the 15% median increase insurers proposed nationally. See 2027 premium increases by state.
- State help: South Dakota has no state premium subsidy, reinsurance program or individual mandate, so federal tax credits are the main help with premiums.
- Medicaid: Voters approved Medicaid expansion in 2022 through Amendment D, and it took effect July 1, 2023, for adults up to 138% of the poverty level. More than 31,000 South Dakotans were in expanded Medicaid as of August 2026. Children qualify up to 209% through CHIP. Federal Medicaid work requirements start January 1, 2027, and expansion enrollees will renew every six months instead of once a year.
- Amendment I: This constitutional amendment on the November 3, 2026 ballot would make the expansion depend on the federal government paying at least 90% of its cost. The attorney general’s ballot explanation says it would end expanded coverage if federal funding fell below 90%. The measure’s sponsor says it would only let the legislature decide whether to end it.
When to enroll
South Dakota uses HealthCare.gov, where open enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027. Choose a plan by December 15 for coverage beginning January 1. How to lower your Marketplace premium has more ways to bring the cost down.
Other options in South Dakota
- Insurance through work, often the cheapest way to get covered if your employer offers it.
- Medicaid for adults up to 138% of the poverty level, and CHIP for children up to 209%; see health insurance for children.
- Medicare at 65.
Health insurance costs in nearby states: North Dakota, Minnesota, Iowa, Nebraska and Wyoming. You can also compare health insurance costs in every state.
See 2027 plans and prices in your South Dakota county: compare quotes by ZIP code.
Frequently asked questions
How much does health insurance cost in South Dakota?
Before subsidies, the 2026 benchmark silver plan for a 40-year-old averaged $655 a month. After tax credits, the average enrollee paid $211 a month, and those who got a credit paid $118.
How much are South Dakota health insurance rates going up in 2027?
The state approved average increases of 10.1% to 10.4% before subsidies, depending on the calculation. That’s below the 15% median increase insurers proposed nationwide.
What is Amendment I in South Dakota?
It’s a constitutional amendment on the November 3, 2026 ballot that would make Medicaid expansion depend on the federal government continuing to pay at least 90% of its cost. The attorney general’s ballot explanation says it would end expanded coverage if that funding dropped below 90%, while the sponsor says it would let the legislature decide.
Who sells Marketplace plans in South Dakota?
Avera, Sanford Health Plan and Wellmark Blue Cross Blue Shield of South Dakota. All three are returning for 2027.
Sources
- healthinsurance.org: South Dakota Health Insurance Marketplace
- ACA Signups: 2027 Rate Changes – South Dakota
- healthinsurance.org: South Dakota Medicaid
- South Dakota DSS: Medicaid eligibility changes coming soon
- South Dakota Searchlight: Ballot measure could auto-repeal Medicaid expansion, attorney general says
- KFF: Marketplace Average Premiums and Average APTC
This article is general information, not insurance or tax advice. Prices are averages and estimates; your actual premium depends on your county, age, income and plan. Last reviewed September 2026.