Head-to-head, from CMS Plan Year 2026 data.
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Ohio is the cheaper of the two: a 40-year-old pays about $625/month for the median Silver plan, versus $725 — a difference of $99/month (16%) before subsidies.
| Ohio | South Dakota | |
|---|---|---|
| Median Silver @40 | $625 | $725 |
| Cheapest Silver @40 | $482 | $512 |
| Most expensive county @40 | $924 | $882 |
| Age 27 | $395 | $420 |
| Age 60 | $1,023 | $1,087 |
| Carriers | 11 | 3 |
| Counties | 88 | 66 |
| 1-carrier counties | 0 | 0 |
| Plan types | HMO | EPO, HMO, PPO |
Network note: Ohio has no PPO plans in 2026 while South Dakota does. If you work across county or state lines that difference matters more than the premium gap.
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: Ohio 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 | Ohio | South Dakota |
|---|---|---|
| Marketplace benchmark Silver, full price | $674 | $815 |
| Tax credit | none | none |
| You pay for the benchmark plan | $674 | $815 |
| Private plan estimate (low end: no deductible) | $275–$435 | $255–$485 |
At 45 on $85,000, the benchmark plan costs $1,689 a year more in South Dakota than in Ohio, 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.
Moving permanently from Ohio to South Dakota is a qualifying life event, so you get a 60-day special enrollment window counted from the move date — time enough to work through the 3 carriers filing in South Dakota without waiting for open enrollment. Two conditions trip people up: you generally need to have held qualifying coverage for at least one day in the 60 days before the move, and relocating purely for treatment or a holiday will not qualify.
Coverage does not port across the state line. Ending in Ohio 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.
No insurer spans both. Ohio has 11 carriers filing, South Dakota has a separate 3, so a move means a new company as well as a new plan.
The plan types do not match up. PPOs cover all 66 counties in South Dakota and zero of the 88 in Ohio. Since the PPO is the one type that reliably pays out of network, moving into Ohio narrows where you can be seen rather than just changing what you pay.
Splitting the year does not mean splitting the coverage. You can hold a marketplace plan only in your state of primary residence — the address you file from — not one in Ohio and another in South Dakota. The cost lands on care received in whichever of the two you did not choose.
Picking between Ohio and South Dakota on the headline number is a mistake. Enter your ZIP and a licensed agent will show you what is actually filed for you.
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