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MoneyGeek Logo IconBest Health InsuranceSouth Dakota
2023

Best Health Insurance in South Dakota

Best Overall for Health Insurance in South Dakota

Avera Health Plans is the best overall health insurance provider in South Dakota, scoring 63 out of 100. It earned above-average MoneyGeek scores in premiums, out-of-pocket costs and plan options.

MoneyGeek analyzed approximately two EPO, eight HMO and eight PPO plans within the Silver tier.

MoneyGeek Pick: Avera Health Plans

Avera Health Plans

pros

One of the most affordable options

Low out-of-pocket costs

Wide variety of plans

cons

Less likely to approve claims compared to other options

COMPANY HIGHLIGHTS

Avera Health Plans offers four Silver HMO plans and four Silver PPO plans. The latter allows you to select doctors and hospitals out of your network.

The average cost of premiums from this provider is around $663, with MOOPs of around $7,675. However, Avera Health Plans has a lower claim approval rate than some other options, so your claim might not be accepted.

Plan Recommendations

We recommend the following plans from Avera Health Plans:

  • Avera Direct 4800 HSA Eligible HDHP: approximately $571 per month; MOOP $4,800
  • Avera 4800 HSA Eligible HDHP: approximately $793 per month; MOOP $4,800
  • Avera Direct 5800: approximately $515 per month; MOOP $8,000

Best Health Insurance in South Dakota for Low Out-of-Pocket Costs

Sanford Health Plan has the lowest out-of-pocket costs in South Dakota for plans in the Gold tier, earning a MoneyGeek score of 84 out of 100. It's also a good choice for those who want low rates, low MOOPs and multiple plan options to choose from.

We researched five PPO, five HMO and two EPO plans within the Gold tier to find the best options in this category.

MoneyGeek Pick: Sanford Health Plan

Sanford Health Plan

pros

Affordable rates

Offers low out-of-pocket costs

Numerous plans to choose from

cons

Didn’t score well in terms of claim denial rates

COMPANY HIGHLIGHTS

You may choose from three HMO and three PPO plans with Sanford Health Plan. PPO plans can be a good choice for out-of-network coverage because they may not limit your choices to certain doctors, hospitals or pharmacies. You also might not need to secure a referral to see a specialist.

On average, you may get health insurance at around $657 per month, and your out-of-pocket costs could be around $7,550. However, with a denial rate of 2.68%, there’s a chance you’ll hit a snag when it comes to getting your claims approved.

Plan Recommendations

Among Sanford Health Plan’s offerings, you may get the best coverage with:

  • Sanford TRUE Enhanced - Diabetes & Asthma/COPD Care Plan $1,250: approximately $539 per month; MOOP $5,500
  • Sanford Simplicity Enhanced - Diabetes & Asthma/COPD Care Plan $1,250: approximately $734 per month; MOOP $5,500
  • Sanford TRUE $1,750: approximately $527 per month; MOOP $8,450

Best Cheap Health Insurance in South Dakota

Sanford Health Plan is the most affordable health insurance provider in South Dakota, earning a score of 75 out of 100. MoneyGeek specifically looked at monthly payments to determine the winner. Note that it’s common to pay higher out-of-pocket costs in exchange for cheaper premiums.

MoneyGeek explored eight Silver PPO, eight Silver HMO and two EPO Silver plans for this category.

If you're focused soley on cost, MoneyGeek also determined the cheapest health insurance in South Dakota.

MoneyGeek Pick: Sanford Health Plan

Sanford Health Plan

pros

Affordable monthly premiums

Diverse plan types and options

cons

May come with high out-of-pocket costs

May not always approve claims

COMPANY HIGHLIGHTS

The average cost of plans from Sanford Health Plan is $652. MOOP costs are around $8,538, which may be one of the most expensive.

Your selection for Silver-tier plans with Sanford Health Plan includes four HMOs and four PPOs. PPO plans are especially great for any number of different reasons, especially if you can afford them. The in-network can be broad and may even extend to out-of-network without having to secure a referral from your primary health care provider.

One thing to consider about the provider is its denial rate of 2.68%, which may not be a good choice if you need solid assurance in having your claims approved.

Plan Recommendations

  • Sanford TRUE Enhanced - Diabetes & Asthma/COPD Care Plan $1,250: approximately $536 per month; MOOP $7,050
  • Sanford TRUE - Standardized $5,800: approximately $525 per month; $8,900 MOOP
  • Sanford TRUE $3,500: approximately $517 per month; $9,100 MOOP

Best Health Insurance for Low Income in South Dakota

Sanford Health Plan is our top pick for those who have low incomes. It earned an overall score of 78 out of 100. We only took into consideration plans that have low monthly premiums and provide cost-sharing reductions (CSRs). We looked at two Silver EPOs, eight Silver HMOs and eight Silver PPOs for this category.

CSRs could help you minimize the usual compromise between premiums and out-of-pocket costs and deductibles. For example, a standard Silver plan pays about 70% of expected costs. With CSR Silver plans, you can anticipate more coverage than that. Here's a breakdown of how much you'll likely be covered based on your income:

  • Individuals earning around $27,180 to $33,975 per year (201% to 250% of the federal poverty level) can expect 73% of their health insurance costs to be paid.
  • Individuals earning around $20,385 to $27,180 per year (151% to 200% of the FPL) will usually get 87% of their costs taken care of.
  • Individuals who earn less than $20,385 per year (up to 150% of the FPL) may have 94% of their health care costs paid for by their insurance company.

These brackets can change based on the number of people in your household.

MoneyGeek Pick: Sanford Health Plan

Sanford Health Plan

pros

Low monthly premiums

Several plan types

cons

High out-of-pocket costs

Denies 2.68% of claims

COMPANY HIGHLIGHTS

There are four Silver HMOs and four Silver PPOs available for low-income individuals with Sanford Health Plan. PPOs can be a great choice if you're willing to pay a little more to have greater freedom of choice and flexibility.

If your income falls below 250% of the Federal Poverty Level, you can get Sanford Health Plan’s health insurance for about $652. Out-of-pocket costs are around $6,875.

The provider’s denial rate score isn’t as good as some competitors, which may be something to keep in mind in the future.

Plan Recommendations

Sanford Health Plan’s best option for people earning less than average is Sanford TRUE Enhanced - Diabetes & Asthma/COPD Care Plan $3,700. Here’s how much it costs on average per income level:

  • 201% to 250% of the FPL: approximately $536 per month; MOOP $5,800
  • 151% to 200% of the FPL: approximately $536 per month; MOOP $1,950
  • Up to 150% of the FPL: approximately $536 per month; MOOP $1,400

Best Health Insurance for Young Adults in South Dakota

Our finding suggests that young adults’ best bet for the most affordable health insurance plan in South Dakota is Wellmark of South Dakota, Inc., with a MoneyGeek score of 72 out of 100. For this category, we analyzed companies that offer Bronze as well as Catastrophic plans, which tend to carry lower premiums as a trade-off for higher out-of-pocket costs. Catastrophic plans are only available to people under the age of 30.

For this category, we evaluated the following:

  • Catastrophic: Two HMO and two PPO plans
  • Bronze: One HMO and one PPO plan
  • Expanded Bronze: Three EPO, seven HMO and seven PPO plans

MoneyGeek Pick: Wellmark of South Dakota, Inc.

Wellmark of South Dakota

pros

Frequently approves claims

Lowest out-of-pocket cost among insurers

Ranked well for plan types

cons

High monthly premiums

COMPANY HIGHLIGHTS

You can expect to pay around $436 per month for Wellmark of South Dakota, Inc., with out-of-pocket expenses of around $8,333. We looked at three EPO Expanded Bronze plans. Keep in mind the provider is good about approving qualifying claims.

Note that EPOs tend to offer a balance between HMO and PPO plans.

Plan Recommendations

Here is our plan recommendation if you’re going for Wellmark of South Dakota, Inc:

  • Wellmark Bronze HDHP EPO: approximately $390.08 per month for 18-year-olds and $437.50 per month for 26-year-olds; MOOP $7,000
  • Wellmark Bronze Traditional EPO: approximately $386.66 per month for 18-year-olds and $433.66 per month for 26-year-olds; MOOP $9,000
  • Wellmark Standard Bronze EPO: approximately $388.75 per month for 18-year-olds and $436.01 per month for 26-year-olds; MOOP $9,000

Best Health Insurance by Plan Type in South Dakota

Health insurance providers may offer different plan types. Out of the two EPOs, eight HMOs and eight PPOs in the Silver tier, South Dakota residents can find the best providers for each category with:

  • HMO: Avera Health Plans (MoneyGeek score: 60 out of 100)
  • PPO: Sanford Health Plan (MoneyGeek score: 60 out of 100)
  • EPO: Wellmark of South Dakota, Inc. (MoneyGeek score: 100 out of 100)

Note that our recommendations are for the Silver tier. Silver plans usually strike the sweet spot between coverage and costs, which many people may find a good deal.

MoneyGeek Pick for HMO: Avera Health Plans

Avera Health Plans
COMPANY HIGHLIGHTS

Avera Health Plans offers four HMO plans under the Silver tier, which may cost you around $527 per month. Your out-of-pocket expenses could reach about $7,675.

HMO plans are the most common because they usually offer the cheapest monthly premiums compared to other types. Unless it’s an emergency, HMOs require you to use doctors, hospitals and other providers within their network. If you use out-of-network providers, you might have to pay more than what your plan would normally cover. You might also need to secure a referral from your primary provider.

One caveat to this provider: The approval rate isn't stellar, which means that some people might have trouble getting approval for a claim.

Plan Recommendations

For Silver-tier HMO plans from Avera Health Plans, MoneyGeek’s suggestions are:

  • Avera Direct 4800 HSA Eligible HDHP: approximately $571 per month; MOOP $4,800
  • Avera Direct 5800: approximately $515 per month; MOOP $8,000

MoneyGeek Pick for PPO: Sanford Health Plan

Sanford Health Plan
COMPANY HIGHLIGHTS

Sanford Health Plan offers four PPO plans for the Silver level, which you can expect to cost about $714 per month. You may have to pay about $8,538 out of pocket for care. This provider has a claims denial rate of 2.68%.

Next to HMOs, PPOs usually take second place in terms of popularity. They are a little more expensive than HMOs, but they can also be more flexible and provide you with more options. With a PPO, you'll have the option of seeing any doctor or specialist without first getting approval from your primary care physician.

Plan Recommendations

To receive adequate coverage at a reasonable cost, we recommend these policies:

  • Sanford Simplicity Enhanced - Diabetes & Asthma/COPD Care Plan $3,700: approximately $725 per month; MOOP $7,050
  • Sanford Simplicity - Standardized $5,800: approximately $701 per month; MOOP $8,900

MoneyGeek Pick for EPO: Wellmark of South Dakota, Inc.

Wellmark of South Dakota
COMPANY HIGHLIGHTS

Wellmark of South Dakota, Inc. offers two EPO plans in the Silver level, which you can expect to cost about $718 per month. You may have to pay an average of $8,800 in deductibles, copayments and other out-of-pocket costs before the plan will cover your care.

Generally, EPOs are on the less popular side among plan types, but they work much like HMOs in that they require you to use doctors and hospitals within their network. You'll pay higher out-of-pocket costs for any care you receive outside of that network, making it important to consider your options when selecting an EPO plan.

Unlike an HMO, however, an EPO plan can allow you to see a specialist without having to first get a referral from your primary care doctor. You may choose this option as a possible way to save money with health insurance while still keeping yourself covered.

Plan Recommendations

If you’re opting for an EPO plan from Wellmark of South Dakota, Inc., you might want to consider:

  • Wellmark Silver Traditional EPO: approximately $723 per month; MOOP $8,700
  • Wellmark Standard Silver EPO: approximately $713 per month; MOOP $8,900

Best Short-Term Health Insurance in South Dakota

Everest Reinsurance Company tops our list of best short-term health insurance companies in South Dakota with a MoneyGeek score of 85 out of 100.

The Affordable Care Act (ACA) requires all health insurance plans to cover certain essential health benefits such as emergency services, prescription drugs, mental health care and maternity care. Short-term health insurance, however, does not have to include these benefits. Consequently, it is often cheaper than major medical plans that meet ACA requirements. This can leave you vulnerable if you do get sick or injured.

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MoneyGeek Top Pick: Everest Reinsurance Company
Everest

Everest Reinsurance Company offers many plan options, each with a different coverage period, copay and deductible that may help you receive enough coverage without compromising your budget. The company’s coverage of pre-existing conditions or non-hospital prescriptions is not included in its plan, which means you will have to pay out of pocket if you require these services. This may come as a drawback.

How to Find the Best Health Insurance for You in South Dakota

The best health insurance providers in South Dakota can provide you with the required coverage and flexibility to meet your budget and health care needs. Following our tips may help you get a health insurance plan that works for you.

  • doctor icon

    Understand when a health insurance plan will cover you

    Typically, HMOs limit your coverage to care received within the network of physicians and hospitals designated by your insurer. PPOs are more flexible with access to care outside the network. You’ll want to consider these options to determine which is best for your needs.

    Across South Dakota, there are about nine EPOs, 31 HMOs and 31 PPOs.

  • money2 icon

    Weigh the cost of premiums vs. the cost of care

    It's important to consider not only monthly premiums but the out-of-pocket costs plans may come with as well. For example, Avera Health Plans' average premium is around $663 and out-of-pocket costs, at around $7,675. This may strike as a better deal than those that compel you to make a compromise between premiums and cost of care. While this isn’t the cheapest plan option, it does offer the lowest MOOP.

Consider South Dakota Medicare or Medicaid if You’re Eligible

Medicaid is a federal-subsidized health insurance program for qualifying residents of South Dakota. Eligible residents may receive this coverage for free. However, they must meet certain guidelines to do so. These guidelines vary depending on your income and conditions.

Medicare is another federal health care program that provides medical insurance for senior citizens aged 65 and above and individuals with disabilities with qualifying medical conditions. Unlike Medicaid, Medicare does not cover all medical expenses, but it does provide coverage for many common health issues.

Medicare is broken down into three parts:

  • Part A: This usually covers inpatient hospital stays, skilled nursing facility care and a few health care services.
  • Part B: This gives you access to outpatient medical services such as doctor visits. It also covers many preventive services and lab tests. The premium for this depends on how much you make.
  • Part D: This provides prescription drug coverage. The costs will depend on the plan you choose.

The coverage offered through Medicare can be restrictive, so it's important to know what they are and whether or not you are getting exactly what you need.

Frequently Asked Questions About Health Insurance in South Dakota

The cost and availability of health insurance plans are often concerns for potential customers. Here, we answer some frequently asked questions.

About Brenna Kelly, Licensed Health Insurance Agent


Brenna Kelly, Licensed Health Insurance Agent headshot

Brenna Kelly is a licensed health insurance agent and health insurance content manager at MoneyGeek. Licensed in Florida, Brenna is qualified to advise on medical insurance, disability, long-term care, critical illness, Medicare Supplements and Medicare Advantage Plans. She combines her experience in content production with expert insight into state, regional and local health insurance markets and policies. Brenna has also earned a Bachelor of Science and Master of Arts in Applied Sociology from the University of Central Florida.