Health Insurance Basics > Marketplace
Health Insurance Marketplace
The Marketplace offers affordable health insurance to South Dakotans
To be eligible for health coverage in South Dakota through the Marketplace, you must:
- Live in South Dakota;
- Be lawfully present in the United States;
- Not be incarcerated; or,
- Not be enrolled in Medicare.
Depending on your household income, you may get help paying for your Marketplace health insurance plan. This can include a tax credit to lower your monthly payment and extra savings on costs like deductibles, copays, and coinsurance. Work with a Navigator (for free) to ensure you get the cost savings available to you! Or, use the Premium Tax Credit Calculator to estimate if you’re eligible for financial help, and how much to expect.
When to Enroll
You can enroll in a Marketplace plan or change your current coverage during:
Open Enrollment
You are eligible to enroll or change your plan during open enrollment, which occurs annually November 1 through January 15.
- Enroll by Dec 15, 2025 to get coverage by Jan 1, 2026.
- Enroll between Dec 16, 2025 and Jan 15, 2026 to get coverage by Feb 1, 2026.
or, Special Enrollment Period
Certain life events may qualify you to enroll in or change Marketplace health plans outside of the open enrollment period. You have 60 days before or after the event to change coverage. Qualifying life events include:
You Need to Re-Enroll Every Year!
During open enrollment, you will need to log in to your Marketplace account and update and verify your information to keep your coverage benefits.
Log in at HealthCare.gov.
- Employment/income changes;
- Loss of other health coverage (including Medicaid/CHIP);
- Moved zip codes;
- Turning 26 (aging off a parent’s plan)
- Marriage;
- Having a baby or adopting a child;
- Becoming a US citizen; or,
- Leaving incarceration.
Not sure if you qualify to enroll outside of open enrollment? We can help! Work with a Navigator to see if you qualify.
Learn more about special enrollment period here.
Meet with a Navigator During Your Employer’s Open Enrollment Period.
If you’re offered insurance through your employer, meet with a Navigator to compare all your insurance options for yourself and your family. See what you’re eligible for, for benefit coverage and cost.
Native American? Learn about your health insurance options here.
What Marketplace Plans Cover:
All Plans Include
Essential Health
Benefits
- Clinic visits (outpatient care);
- Hospital stays;
- Pregnancy and newborn care;
- Laboratory services;
- Immunizations;
- Preventative services and chronic disease management;
- Pediatric services;
- Prescriptions;
- Birth control;
- Mental health care;
- Substance use disorders; and,
- Rehabilitative and habilitative services and devices.
Some plans offer more. A Navigator can help you compare options so you can choose the best fit. Schedule an appointment with a Navigator to compare plans and get help enrolling.
You can also browse Plans and Pricing online at HealthCare.gov. Enter in your zip code to see plans available to you.
Medicaid Frequently Asked Questions
I applied for South Dakota Medicaid in the past and did not qualify. Can I apply again?
Yes, you can re-apply. Your eligibility may have changed based on new or updated eligibility requirements or if your income or household circumstances have changed.
Can I still qualify if I don’t have a home address?
You do not need a home address to apply. But you must give a mailing address where you can get mail. Examples of a mailing address that is not your home are: Sioux Falls Banquet or Bishop Dudley Hospitality House.
How long will it take to find out if I’m approved?
Most people get a letter in the mail within 45 days. The letter will say if you can get access to Medicaid or if you need to provide additional information. If approved, you will get a South Dakota Medicaid card in the mail.
What happens if I am not eligible for South Dakota Medicaid?
If you don’t qualify for Medicaid, your information will be sent to the Marketplace. The Marketplace will mail you a letter. You can also go to HealthCare.gov and make an account. Need help with the Marketplace? Our trained Navigators can guide you and help you find the best health plan for you.
I’m eligible for South Dakota Medicaid, but I have a Marketplace plan. Will my Marketplace plan automatically stop?
No. If you enroll in Medicaid, you will need to stop your Marketplace plan. Do not stop your Marketplace plan until you know you are approved for Medicaid.
If I get insurance through my employer, can my spouse or children have access to South Dakota Medicaid?
Possibly, yes. Medicaid coverage is available to your family members based, in part, on household income and household size.
Can I qualify for South Dakota Medicaid if I have Medicare?
Having Medicare does not mean you can’t get Medicaid. But it can make things more complicated. Some people have both Medicaid and Medicare. This is called “dual eligibility.” If you qualify for both, you can get help from both programs. To get both, you must meet your state’s income and asset rules for Medicaid. You also must qualify for Medicare based on your age or a disability. To apply, start with Medicare through Social Security.
For More Info
Brittany Zephier
Navigator Program Manager
bzephier@communityhealthcare.net
605-277-8405
Sioux Falls
196 E 6th Street, Suite 200
Sioux Falls, SD 57104
605-275-2423
This page is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $160,000 with 100-percent funded by CMS/HHS. The content are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.