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South Dakota Health Insurance

Some residents of the Mount Rushmore State can take advantage of new health insurance options thanks to the Affordable Care Act. According to an April 2013 Kaiser Family Foundation profile of South Dakota health reform, Gov. Dennis Daugaard announced the state would not create its own health insurance marketplace. Additionally, South Dakota is one of 21 states that chose not to expand Medicaid in 2014.

However, South Dakotans may register and apply for marketplace coverage on the federal health insurance marketplace located at HealthCare.gov. After completing the application process during open enrollment, state residents can find out if they and their family members qualify for private South Dakota health insurance plans, subsidies to help pay for private insurance, Medicaid or the Children’s Health Insurance Program.

Do you qualify for a health insurance subsidy in South Dakota?

According to a January 2014 Kaiser Family Foundation profile of the uninsured in South Dakota, about half of formerly uninsured residents can qualify for some type of assistance with their health insurance coverage. Typically, the assistance comes in the form of tax credits (subsidies), Medicaid or CHIP. If you already have access to other affordable health insurance options, you might not qualify for assistance.

Here are a few ways you can get help paying for health insurance in South Dakota.

The Affordable Care Act offers tax credits to offset premium costs for people without access to affordable plans. Eligibility for Medicaid and CHIP typically is based on 2014 poverty level guidelines, and subsidy eligibility will be based on 2013 limits.
Income requirements for a subsidy are between 100 and 400 percent of the federal poverty level, which is between $23,550 and $94,200 for a family of four and between $11,490 and $45,960 for an individual.
Medicaid eligibility for nondisabled adults is restricted to parents with a family income of less than 50 percent of the poverty level — or less than $11,925 for a family of four.
Children from South Dakota families with an income lower than 209 percent of the poverty level, or $49,845 for a family of four, might qualify for CHIP.

Some South Dakota residents may earn too much to qualify for any assistance or have access to other affordable health insurance, but they may decide to sign up for private marketplace plans anyway. Qualified marketplace health insurance plans must offer 10 mandated benefits, and insurers can’t decline your application based on your pre-existing medical conditions.

South Dakota residents are free to keep their old health insurance policies as long as those policies follow certain guidelines.

Marketplace health insurance in South Dakota

According to the South Dakota Division of Insurance, the following companies provide qualified marketplace plans for individuals and families in the state.

Avera Health Plans Inc.
Sanford Health Plan
South Dakota State Medical Holding Company, Inc., called Dakotacare

South Dakota health and coverage statistics

South Dakota population (2013): 844,877
Population 65 and older (2012): 14.7 percent
Life expectancy (2010): 79.5 years
Number of Medicaid beneficiaries (2012): 116,000
Number of Medicare beneficiaries (2012): 110,400
Estimated number of uninsured residents (2012): 112,100

Overall state health ranking: 22

Sources: Kaiser Family Foundation, U.S. Census Bureau, America’s Health Rankings 2014 report.