Head-to-head, from CMS Plan Year 2026 data.
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South Dakota is the cheaper of the two: a 40-year-old pays about $725/month for the median Silver plan, versus $773 — a difference of $48/month (7%) before subsidies.
| South Dakota | Tennessee | |
|---|---|---|
| Median Silver @40 | $725 | $773 |
| Cheapest Silver @40 | $512 | $646 |
| Most expensive county @40 | $882 | $1,001 |
| Age 27 | $420 | $530 |
| Age 60 | $1,087 | $1,372 |
| Carriers | 3 | 6 |
| Counties | 66 | 95 |
| 1-carrier counties | 0 | 0 |
| Plan types | EPO, HMO, PPO | EPO |
Network note: Tennessee has no PPO plans in 2026 while South Dakota does.
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 Dakota or Tennessee. 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 | South Dakota | Tennessee |
|---|---|---|
| Marketplace benchmark Silver, full price | $815 | $929 |
| Tax credit | none | none |
| You pay for the benchmark plan | $815 | $929 |
| Private plan estimate (low end: no deductible) | $255–$485 | $350–$485 |
At 45 on $85,000, the benchmark plan costs $1,366 a year more in Tennessee 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.
A move between South Dakota and Tennessee triggers a 60-day special enrollment period, so the 6 carriers filing in Tennessee (or the 3 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.
Nothing transfers. You close the old plan and enroll fresh against the new state’s counties — 66 in South Dakota, 95 in Tennessee — which means a new network and a new price regardless of which insurer you land on.
No insurer files in both states, so the move means a new company as well as a new plan: 3 carriers in South Dakota, 6 in Tennessee.
This is the asymmetry that bites. South Dakota has PPO plans across all 66 counties; Tennessee sells none in any of its 95. The PPO is the plan type most likely to pay outside its own network, so heading toward Tennessee usually costs you the ability to see South Dakota providers for anything short of an emergency.
Only one of the two can be your plan state. Marketplace eligibility runs on primary residence, so if you file from South Dakota the Tennessee care is the out-of-network half, and the reverse if you file from Tennessee.
Picking between South Dakota and Tennessee 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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