Head-to-head, from CMS Plan Year 2026 data.
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Alabama is the cheaper of the two: a 40-year-old pays about $680/month for the median Silver plan, versus $725 — a difference of $45/month (7%) before subsidies.
| Alabama | South Dakota | |
|---|---|---|
| Median Silver @40 | $680 | $725 |
| Cheapest Silver @40 | $583 | $512 |
| Most expensive county @40 | $1,124 | $882 |
| Age 27 | $478 | $420 |
| Age 60 | $1,238 | $1,087 |
| Carriers | 4 | 3 |
| Counties | 67 | 66 |
| 1-carrier counties | 7 | 0 |
| Plan types | EPO, PPO | EPO, HMO, PPO |
Source: CMS Plan Year 2026 Qualified Health Plan Landscape. Full-price filed rates before premium tax credits; not a quote or an offer of coverage.
This page sets two states against each other. For county-by-county carriers, plan data and help actually enrolling, I publish a page for each state on Coverage by County: Alabama or South Dakota. There is also a blog covering deductibles, subsidies and special enrollment periods.
Change the age or income and both states recalculate: the 2027 marketplace price after any tax credit, and the private plan estimate.
| Monthly, age 45, $85,000 | Alabama | South Dakota |
|---|---|---|
| Marketplace benchmark Silver, full price | $880 | $815 |
| Tax credit | none | none |
| You pay for the benchmark plan | $880 | $815 |
| Private plan estimate (low end: no deductible) | $350–$470 | $255–$485 |
At 45 on $85,000, the benchmark plan costs $778 a year more in Alabama than in South Dakota, at full price in both, since that income is over the tax-credit line.
2027 estimates: KFF 2026 benchmark raised by each state’s average 2027 change, on the federal age curve; 2027 tax credit rules. Your county will differ. Every state at once: what you would pay in each state.
Put your ZIP code in and a licensed agent will show you the carriers filing in your county, what the cheapest plan costs, and what you would actually pay after any help you qualify for. No cost, and you talk to a licensed agent — not a call center.
An Alabama-to-South Dakota move triggers a 60-day special enrollment period, so the 3 carriers filing in South Dakota are open to you outside the usual window. The catch is on both ends — you normally need to have carried qualifying coverage for a day or more in the 60 days before moving, and moves made for treatment or travel are excluded.
Coverage does not port across the state line. Ending in Alabama and starting in South Dakota is two separate transactions, and the plan you end up with in South Dakota is priced on its own county, not on what you paid before.
There is no overlap to lean on: none of Alabama’s 4 carriers file in South Dakota, where 3 other insurers write instead. Changing state means changing company.
Both sides keep the option open: PPOs are sold in every county — 67 in Alabama, 66 in South Dakota. That is the type most likely to cover care outside its network, and it is the one to prioritise if you will genuinely be in both rather than simply leaving.
Only one of the two can be your plan state. Marketplace eligibility runs on primary residence, so if you file from Alabama the South Dakota care is the out-of-network half, and the reverse if you file from South Dakota.
State averages hide enormous county-level spread. Whichever of Alabama or South Dakota you are in, your ZIP is what sets your premium.
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