If you live in South Dakota and need health insurance, the Affordable Care Act (ACA) Marketplace may be your best option in 2026. Through HealthCare.gov, South Dakota residents can compare and buy health plans from three private insurers, and depending on your income, you may qualify for significant financial help that lowers your monthly premium. This guide covers everything you need to know about South Dakota ACA eligibility in 2026, including income limits, subsidy rules, how Medicaid expansion changed the picture, and how to apply.
Not sure where you stand? Use our free benefits screener to check your eligibility for ACA coverage, Medicaid, and other programs in minutes.
How the ACA Marketplace Works in South Dakota
South Dakota uses the federally-facilitated Marketplace, which means all plans are available through HealthCare.gov rather than a state-run exchange. For 2026 coverage, three insurers offer plans in South Dakota:
- Avera (statewide)
- Sanford Health Plan (statewide)
- Wellmark Blue Cross Blue Shield of SD (42 of 66 counties)
Approximately 50,951 South Dakotans selected a Marketplace plan for 2026 coverage. Depending on your income, you may qualify for premium tax credits (PTCs) that reduce your monthly premiums, or cost-sharing reductions (CSRs) that lower your deductibles and out-of-pocket costs.
Who Qualifies for ACA Coverage in South Dakota
To buy a plan through the South Dakota Marketplace, you must:
- Live in South Dakota
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
To qualify for financial assistance (subsidies), you must also:
- Have household income between 100% and 400% of the Federal Poverty Level (FPL)
- Not have access to affordable employer-sponsored coverage
- Not be eligible for Medicaid or CHIP
- Not be eligible for premium-free Medicare Part A
- File a joint tax return if married (with limited exceptions)
South Dakota Medicaid Expansion: A Critical Factor
One of the most important things to understand about South Dakota ACA eligibility in 2026 is how Medicaid expansion affects your options.
South Dakota voters approved Medicaid expansion (Constitutional Amendment D) in November 2022, and coverage took effect on July 1, 2023. As a result, adults ages 19 to 64 with incomes at or below 138% of the FPL are now eligible for South Dakota Medicaid rather than ACA Marketplace subsidies.
This is a significant distinction because Medicaid is generally free or very low-cost, while Marketplace plans require premiums even with subsidies.
What this means for your ACA eligibility:
- If your income is below 138% FPL: You likely qualify for Medicaid and are not eligible for Marketplace premium subsidies
- If your income is between 138% and 400% FPL: You are in the ACA subsidy zone and may qualify for premium tax credits
- If your income is above 400% FPL: You can still buy a Marketplace plan but will pay full price with no subsidies
2026 ACA Income Limits for South Dakota
The following table shows the income thresholds that determine your options under the 2026 Federal Poverty Level guidelines:
Annual Income Thresholds by Household Size
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 250% FPL (CSR Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|---|
| 1 | $15,650 | $21,597 | $39,125 | $62,600 |
| 2 | $21,150 | $29,187 | $52,875 | $84,600 |
| 3 | $26,650 | $36,777 | $66,625 | $106,600 |
| 4 | $32,150 | $44,367 | $80,375 | $128,600 |
| 5 | $37,650 | $51,957 | $94,125 | $150,600 |
| 6 | $43,150 | $59,547 | $107,875 | $172,600 |
FPL figures based on 2026 federal poverty guidelines. Dollar amounts are approximate and rounded. Always verify current thresholds at healthcare.gov or benefits.gov.
Monthly Income Thresholds (Medicaid Expansion)
For South Dakota Medicaid, the monthly income limits (138% FPL) are:
| Household Size | Maximum Monthly Income |
|---|---|
| 1 | $1,835 |
| 2 | $2,488 |
| 3 | $3,142 |
| 4 | $3,795 |
| 5 | $4,448 |
| 6 | $5,102 |
If your income falls at or below these monthly limits, apply for Medicaid through the South Dakota BEES portal rather than the Marketplace.
Understanding ACA Subsidies in 2026
Premium Tax Credits (PTCs)
Premium tax credits reduce your monthly Marketplace plan premium. In 2026, the key change from prior years is that the enhanced subsidies provided under the American Rescue Plan (ARP) expired at the end of 2025. This means:
- The income cap for PTCs has returned to 400% of the FPL (from no cap during the enhanced period)
- Subsidies are somewhat smaller than they were in 2025
- Out-of-pocket costs may be higher for many enrollees compared to the past few years
Despite this, if your income falls between 138% and 400% FPL, you can still receive meaningful premium assistance.
Cost-Sharing Reductions (CSRs)
If your income is at or below 250% of the FPL, you may also qualify for cost-sharing reductions when you enroll in a Silver plan. CSRs lower your deductibles, copayments, and out-of-pocket maximums, which can save you thousands of dollars per year if you use medical care regularly.
Important: CSRs are only available with Silver-tier plans. If you qualify, a Silver plan is usually the best value even if a Bronze plan has a lower premium.
2026 Plan Tiers Available in South Dakota
Marketplace plans come in four metal tiers:
| Plan Tier | Average Premium Share You Pay | Average Deductible | Best For |
|---|---|---|---|
| Bronze | Lowest monthly premium | Highest deductible | Healthy people who want low monthly costs |
| Silver | Moderate premium | Moderate deductible | Most people; only tier eligible for CSRs |
| Gold | Higher premium | Low deductible | People who use regular medical care |
| Platinum | Highest premium | Very low deductible | People with significant ongoing medical needs |
Catastrophic plans are also available for adults under 30 or those who qualify for a hardship exemption.
2026 Open Enrollment and Special Enrollment Periods
The open enrollment period for 2026 Marketplace coverage ran from November 1, 2025 through January 15, 2026. If you missed that window, you can still enroll if you experience a qualifying life event that triggers a Special Enrollment Period (SEP).
Qualifying Events for Special Enrollment
You have up to 60 days from a qualifying event to enroll or make changes. Common qualifying events include:
- Losing health coverage (job loss, end of COBRA, losing Medicaid)
- Getting married or divorced
- Having a baby, adopting a child, or placing a child for adoption
- Moving to a new state or ZIP code
- Becoming a U.S. citizen or lawfully present immigrant
- Gaining access to a Navigator or enrollment assistant
- Change in income that affects your subsidy eligibility
Medicaid Enrollment is Year-Round
If you qualify for Medicaid or CHIP, there is no open enrollment deadline. You can apply at any time through the South Dakota DSS portal at eaportal.sd.gov.
Step-by-Step: How to Apply for ACA Coverage in South Dakota
Step 1: Check Your Eligibility First
Before starting your application, use our free benefits screener to get a quick estimate of which programs you may qualify for, including Medicaid, CHIP, and ACA subsidies.
Step 2: Gather Your Documents
You will need:
- Social Security numbers for all household members applying for coverage
- Employer and income information for everyone in your household (pay stubs, W-2s, or your most recent federal tax return)
- Information about any health insurance you currently have
- Your immigration documents if you are not a U.S. citizen
Step 3: Create an Account on HealthCare.gov
Go to healthcare.gov and create a Marketplace account. You will need to provide your name, address, date of birth, and email.
Step 4: Complete the Application
Fill out the application with your household size and income information. The system will automatically check whether you qualify for Medicaid, CHIP, or Marketplace subsidies based on your responses.
- If you qualify for Medicaid or CHIP, you will be referred to South Dakota DSS to complete your enrollment
- If you qualify for Marketplace plans with subsidies, you can proceed to compare and select plans
Step 5: Compare Plans
Review the available Avera, Sanford, and Wellmark plans in your area. Look at:
- Monthly premium (after your subsidy is applied)
- Deductibles and out-of-pocket maximums
- Covered services and prescription drug formularies
- Network of doctors and hospitals
Step 6: Enroll and Pay Your First Premium
Select the plan that best fits your needs and budget. Your coverage will begin based on when you enrolled and paid your first premium. Coverage for the next calendar year generally starts January 1 if you enroll by December 15.
Step 7: Report Changes During the Year
If your income or household size changes during the year, report it promptly through your HealthCare.gov account. Changes can affect your subsidy amount, and failing to report them may result in owing money when you file your taxes.
CHIP Coverage for Children in South Dakota
If your children do not qualify for Medicaid but your income is too high for full Medicaid coverage, they may qualify for the Children's Health Insurance Program (CHIP). In South Dakota, CHIP covers children under 19 with household incomes up to 204% of the FPL.
| Household Size | Max Monthly Income (CHIP, 204% FPL) |
|---|---|
| 1 | $2,780 |
| 2 | $3,768 |
| 3 | $4,759 |
| 4 | $5,748 |
| 5 | $6,736 |
Apply for CHIP through the same DSS portal at eaportal.sd.gov.
Getting Help with Your Application
You do not have to navigate ACA enrollment alone. Several free resources are available to South Dakota residents:
- Navigators and certified application counselors: Free enrollment help, available statewide
- Insurance brokers and agents: Can help you compare and select plans (they are paid by insurers, not you)
- HealthCare.gov call center: Call 1-800-318-2596, available 24 hours a day, 7 days a week
- South Dakota DSS: For Medicaid and CHIP questions, visit dss.sd.gov or find your local DSS office
For a full overview of all state benefits available to South Dakota residents, including Medicaid, SNAP, LIHEAP, and more, visit our South Dakota Benefits Overview.
Frequently Asked Questions
Does South Dakota have Medicaid expansion in 2026?
Yes. South Dakota expanded Medicaid in July 2023 after voters approved Constitutional Amendment D. Adults ages 19 to 64 with incomes at or below 138% of the FPL (approximately $21,597 per year for a single person in 2026) qualify for Medicaid expansion coverage with no asset test.
Can I get ACA subsidies if I earn below 138% FPL in South Dakota?
No. Because South Dakota has expanded Medicaid, individuals with income below 138% FPL are directed to Medicaid rather than Marketplace plans. Medicaid is generally better coverage at lower cost. If you are in this income range, apply for Medicaid through eaportal.sd.gov.
What changed about ACA subsidies in 2026?
The enhanced subsidies that were in place from 2021 through 2025 (under the American Rescue Plan) expired at the end of 2025. In 2026, the income cap for premium tax credits returned to 400% of the FPL, and subsidy amounts are somewhat lower than in recent years. South Dakotans earning above 400% FPL ($62,600 for a single person) no longer qualify for any premium tax credit.
How many plans are available in South Dakota for 2026?
Three insurers offer Marketplace plans in South Dakota for 2026: Avera, Sanford Health Plan, and Wellmark Blue Cross Blue Shield of SD. Avera and Sanford offer plans statewide, while Wellmark covers 42 of the state's 66 counties.
What if I missed open enrollment?
The 2026 open enrollment period ended January 15, 2026. If you missed it, you can still enroll if you experience a qualifying life event, such as losing coverage, getting married, having a baby, or moving. You have 60 days from the qualifying event to enroll. Medicaid and CHIP are available year-round with no enrollment deadline.
Are dental and vision covered under ACA plans?
Adult dental and vision coverage is typically not included in standard Marketplace plans in South Dakota. However, you may be able to purchase standalone dental or vision plans. Children's dental coverage is included in all Marketplace plans as an essential health benefit.
How do I know if a plan's doctors are in-network?
Each insurer's provider directory is available on its website and through HealthCare.gov. Before selecting a plan, search for your current doctors, preferred hospitals, and any specialists you see regularly. Check that your prescriptions are covered under the plan's formulary as well.
Can undocumented immigrants get ACA coverage in South Dakota?
To qualify for coverage through HealthCare.gov, you must be lawfully present in the United States. Undocumented individuals are not eligible for Marketplace plans or Medicaid. However, emergency Medicaid may be available for emergency services. Contact a local health center or social services office for guidance.
Check Your Eligibility Today
ACA coverage in South Dakota in 2026 depends on your income, household size, and access to other coverage. Whether you qualify for Medicaid, a subsidized Marketplace plan, or need to pay full price, understanding your options is the first step to getting covered.
Use our free benefits screener to check your ACA, Medicaid, CHIP, and other program eligibility in under five minutes. No signup required, and your information stays private.
For more information about all South Dakota assistance programs, including SNAP, LIHEAP, WIC, and childcare assistance, visit our South Dakota Benefits Overview.
