South Dakota Health Insurance Marketplace
In South Dakota, the federal government operates the health insurance Marketplace.
South Dakota now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.
South Dakota Plans, Benefits, and Costs
Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $34 per month after tax subsidies. See if you qualify for a free or low cost plan.
Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.
Tobacco Surcharge: South Dakota allows insurance companies to charge tobacco users 50% more than non-tobacco users.
Who Is Selling Insurance in the South Dakota Marketplace?
On exchange plans in South Dakota
Off exchange plans in South Dakota
All approved plans in the state must cover the same package of benefits, called essential health benefits. In Alabama, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital
- Emergency services
- Hospital stays, including weight loss surgery
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment
- Prescription drugs, including generic and certain brand-name drugs
- Rehab and habilitative services
- Lab services
- Preventive and wellness services, along with those that help people manage chronic conditions
- Services for children, including dental and eye care
Some services not included: long-term nursing care, routine eye exams for adults, cosmetic surgery, weight loss programs, acupuncture, and hearing aids.
Will These Benefits Be in All Plans?
Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.
You may be eligible for financial aid to help pay for insurance. Here’s what South Dakota will offer:
Medicaid Expansion: Some states are expanding Medicaid so more people can get health insurance coverage. South Dakota is not expanding Medicaid at the time being, but a task force is studying the issue. You may still be eligible for assistance.
Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you’ll be eligible if you’re single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.
Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.
CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid.