Head-to-head, from CMS Plan Year 2026 data.
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South Carolina is the cheaper of the two: a 40-year-old pays about $636/month for the median Silver plan, versus $725 — a difference of $89/month (14%) before subsidies.
| South Carolina | South Dakota | |
|---|---|---|
| Median Silver @40 | $636 | $725 |
| Cheapest Silver @40 | $456 | $512 |
| Most expensive county @40 | $931 | $882 |
| Age 27 | $374 | $420 |
| Age 60 | $968 | $1,087 |
| Carriers | 6 | 3 |
| Counties | 46 | 66 |
| 1-carrier counties | 0 | 0 |
| Plan types | EPO, HMO, POS, 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: South Carolina or South Dakota. There is also a blog covering deductibles, subsidies and special enrollment periods.
Put your ZIP code in and I 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 me — not a call center.
Moving permanently from South Carolina 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 South Carolina 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. South Carolina has 6 carriers filing, South Dakota has a separate 3, so a move means a new company as well as a new plan.
PPO availability is total on both sides, 46 counties in South Carolina and 66 in South Dakota. If you expect to keep needing care in both, that plan type is the reason this pairing is more workable than most.
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 South Carolina and another in South Dakota. The cost lands on care received in whichever of the two you did not choose.
Neither South Carolina nor South Dakota has one price. Give me a ZIP and I will pull the plans in that county and work out what help you qualify for.