People in the Mount Rushmore State have plenty of choices when it comes to health care in their state. According to a study by US News, SD has the 21st best health care in the country. That study looks at access, quality, and good public health.
Health insurance options in South Dakota
There are several ways for SD residents to access health care in their state:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most South Dakota residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 52% | ||
| Individual or family | 8% | ||
| Medicaid | 13% | ||
| Medicare | 15% | ||
| Military | 2% | ||
| Uninsured | 9% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Nine percent of SD residents are uninsured, equaling the national average. That’s good news for policyholders. A higher rate of uninsured people raises premiums for insured people.
South Dakota health insurance companies
SD residents have few options for health care companies. These providers offer both individual and family plans in your state:
- Avera
- Sanford
South Dakota health insurance costs and rate factors
SD residents spend an average of $8,933 per year on health care expenditures, more than the national average. What determines your prices in South Dakota State? Prices vary person to person, but depend primarily on these factors:
Health insurance plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. The more health care coverage you want, the more you’ll have to pay in monthly premiums.
How much is health insurance in South Dakota? These are the average prices for each plan type for a middle-aged South Dakota resident in 2020
| Bronze | Silver | Gold | |
|---|---|---|---|
| $438 | $588 | $659 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
A gold plan in SD costs about 50 percent more than a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs. Silver plans, on the other hand, cover 70 percent of costs.
Some people also qualify for catastrophic plans, the lowest level of coverage available in the marketplace. Catastrophic plans have low monthly premiums, but a yearly deductible of $8,150. Because of that high deductible, it may save you money to invest in a bronze or silver plan if you need to use your insurance. A catastrophic plan exists to prevent medical bankruptcy after a serious health issue. It’s not very useful in paying for preventative health care.
Body mass index
According to the CDC, a high body mass can lead to several serious health conditions. That’s why insurers analyze your BMI to determine your risk-level. A high body mass results in high health insurance rates.
In 2019, SD had a 33 percent obesity rate, the 24th highest rate in the country. Out of the many state residents who used QuoteWizard to compare health insurance plans, 29 percent of residents have a BMI in the obese range.
Tobacco use
Smokers will pay more for health care because of the risks from tobacco use. About 18 percent of state residents are smokers, the 32nd lowest rate in the country.
Age
Health insurance plans cost up to three times more for older people than for younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 41 years old.
Location
Your zip code also plays a role in your health insurance rates. That’s because every state has different rules, regulations, and providers for health insurance. Even within a state, options vary between counties.
Insurance companies also use community-rating, meaning your rates are partly based on the claims that everyone in your state files. If your area files an unusually high number of claims, your rates could rise.
That means that how health-conscious your state is also plays a role. According to America’s Health Rankings, SD is the 24th healthiest state in the country.
South Dakota health insurance laws
The Affordable Care Act limits what insurance companies can use to determine your policy prices.
- Pre-existing conditions: Under the ACA, insurance companies can’t refuse to cover or charge more to people with pre-existing conditions. People with pre-existing conditions used to pay more for coverage.
- Gender: Health insurance companies aren’t allowed to charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies can’t charge you more for previous medical problems or lapses in insurance. Providers used to analyze your medical history and your past insurance coverage.
There’s a limit to how much you’ll pay out-of-pocket for marketplace plans. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
SD state law requires health insurance companies to offer coverage for the following services:
- Diabetic supplies
- Minimum maternity stay
- Dental anesthesia
- Mental health parity
- Off-label drug use
- Inpatient alcoholism treatment
There are additional services that providers need to offer. Find the full list on cms.gov.
Medicare and Medicaid in South Dakota
Medicare and Medicaid are both government-funded health care programs in the US. Medicare covers seniors, whereas Medicaid covers low-income families and children.
Medicare
Medicare offers coverage to seniors 65 and older. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. There are also Medicare Savings Programs that you can qualify for if you meet these income limits:
- Single person with a monthly income lower than $1,357 and savings less than $7,280.
- Couple with a monthly income lower than $1,822 and savings less than $10,930.
Medicaid
Medicaid aids low-income families. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
South Dakota Division of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Larry D. Deiter
- Insurance Hotline:
- (605) 773 – 3563
- Office Hours:
- Monday - Friday
8:00 am to 4:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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