Health insurance in South Dakota

Reviewed September 4, 2026 · 2026 federal data

Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.

Where you enroll

South Dakota uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.

Medicaid covers the bottom of the range in South Dakota

South Dakota expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.

70,579 under-65 South Dakota residents are uninsured all the same, 9.9% of them — 19th of the 51 states and DC, and 1.0× the 26-state median of 9.9%.

How much choice South Dakota counties get

Counties in South Dakota carry between 2 and 3 insurers, so competition is fairly even across the state without being uniform.

No county in South Dakota is down to a single insurer. Since the previous plan year, 55 counties in South Dakota gained an insurer and none lost one.

How many South Dakota residents buy on the marketplace

50,383 South Dakota residents selected a marketplace plan for 2026. Against the state's under-65 population that is 70 per thousand, below the 26-state median of 79, and 16th highest of the 26 states on this site.

Of those, 6,645 — 13% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (19th of 26).

The spread inside South Dakota

Minnehaha County is the largest county we publish here, with 175,330 under-65 residents; Lincoln County is the smallest, with 64,397. Minnehaha County has 2 insurers offering 41 plans, and Lincoln County has 2 offering 41.

The widest choice in South Dakota is in Pennington County — 3 insurers, 28 plans. The narrowest is Minnehaha County, with 2 insurers and 41 plans. Same state, same rules, -13 more plans to choose from.

Uninsured rates range from 6.9% in Lincoln County to 10.5% in Pennington County — 1.5 times as high, within one state.

The 3 largest counties in South Dakota

By under-65 population, covering 46% of the state's under-65 residents. South Dakota has 61 counties with complete federal data; we publish pages for the largest.

Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.

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