Ranked 7 of 15 states · median $725/mo · CMS PY2026
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A 40-year-old bookkeeper in South Dakota pays a median $725/month for a Silver plan before subsidies — 7th of 15 on cost. The cheapest plan in the state is $512 from Avera in Lincoln. On cheapest Silver at age 27, South Dakota ranks 5 of 15 for this occupation.
Desk-based work usually means low claim volume and a younger buyer, which makes a high-deductible plan paired with an HSA the mathematically better bet in most years. These pages rank states by what a healthy buyer actually pays at ages 27 and 40.
Occupational context: Repetitive stress and eye strain from screen work.
This is background for choosing a plan, not for pricing one. Since 2014 every South Dakota exchange plan has been guaranteed issue and community rated: same age, same ZIP, same tobacco status means the same filed premium whether you are a bookkeeper or an accountant. Occupation changes the shopping criteria, nothing else.
Premium is set by rating area, so a bookkeeper in one South Dakota county can pay materially more than one an hour away. Six counties from across the state, cheapest Silver plan for a 40-year-old:
| County | Cheapest Silver @40 | Issuer | Deductible | Carriers |
|---|---|---|---|---|
| Spink | $679 | Sanford | $6,000 | 3 |
| Douglas | $702 | Avera | $6,000 | 2 |
| Miner | $702 | Avera | $6,000 | 2 |
| Custer | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Meade | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Lincoln | $512 | Avera | $6,000 | 2 |
The spread across just these six is $249/month — $2,989 a year for the same metal tier. Statewide the range runs $512 to $882. Coverage by County publishes all 66 South Dakota counties individually.
| South Dakota — the age curve | 2026 |
|---|---|
| Cheapest Silver @27 | $420 |
| Cheapest Silver @40 | $512 |
| Cheapest Silver @60 | $1,087 |
| Lowest deductible in state | $1,750 |
A 27-year-old bookkeeper in South Dakota starts at $420; the same plan class at 60 starts at $1,087 — roughly 2.6× as much. If a Bronze plan here is HSA-qualified, the deduction plus low claim volume usually beats Silver on total annual cost. Confirm HSA eligibility on the plan document, not the metal tier.
Source: CMS Plan Year 2026 Qualified Health Plan Landscape file. 1,822 plan records across 66 South Dakota counties. Full-price filed rates before premium tax credits — verify at enrollment.
Cheaper for the same coverage: Alabama ($680), Wisconsin ($687), Michigan ($708). More expensive: Oklahoma ($731), Kansas ($765), Florida ($789).
Side-by-side: South Dakota vs Wisconsin · South Dakota vs Michigan · South Dakota vs Oklahoma · South Dakota vs Kansas
Read the comparison as context, not as a shopping list. Your county of residence determines what you can buy, and for a bookkeeper that is fixed unless you relocate. Where it is actionable is a move already in progress — that is a qualifying life event, and you have 60 days on either side of it.
Expense categories that typically apply to this trade: Software subscriptions, home office, continuing education. Premiums are generally deductible above the line under IRC §162(l) when no employer plan is available to you or your spouse — a question for your CPA, not your agent.
If your household income is above the subsidy range, ACA is not automatically the answer. There are other categories of coverage that may fit, and they work very differently. That is a conversation, not a web page.
The cheapest Silver plan for a 40-year-old in South Dakota is $512 per month from Avera, with a state median of $725. Both figures are full price before premium tax credits; most buyers pay less after subsidies.
It cannot happen on an exchange plan. Rating in South Dakota uses four inputs only: age, ZIP code, tobacco use and how many people are on the policy. Trade, injury history and pre-existing conditions are all excluded from pricing by law.
Yes. Plan types filed for 2026: EPO, HMO, PPO.
South Dakota ranks 7 of 15 states covered here, at a median $725 per month. Indiana is cheapest at $558 and Nebraska is most expensive at $875.
Below the cliff. At this income a single-person household remains eligible for a premium tax credit in 2026.
This occupation is below the cliff in all 21 states reported.
What this figure is. It is the median annual wage BLS reports for Bookkeeping, Accounting, and Auditing Clerks (SOC 43-3031) in South Dakota. BLS surveys wage and salary workers and excludes the self-employed, so it is a benchmark for the occupation in this state — not the income of a self-employed bookkeeper. Premium tax credit eligibility is set by household modified adjusted gross income and household size, not by occupation, so treat this as a reference point rather than a determination of what you qualify for.
Why the cliff is back. The enhanced premium tax credits expired on 31 December 2025. For plan year 2026 the 400% FPL limit applies again, so household income above $62,600 ends premium tax credit eligibility outright.
This page compares states. For South Dakota specifically — county-by-county carriers, plan data and enrollment help — I publish that on Coverage by County, including a page written for Bookkeepers in South Dakota and a blog covering deductibles, subsidies and special enrollment.
Right now 3 carriers file plans across the 66 counties of South Dakota. Participation is reset annually, which is why Bookkeepers should check the roster in November rather than assume this year’s options carry over.
Rate filings for 2027 point to roughly a 15% median increase nationally, from −1% at one end to 54% at the other. South Dakota has not finalised, so treat exact local 2027 pricing as unavailable rather than unknown.
The window opens November 1, 2026, and December 15 is the date worth writing down — it is what secures January 1 cover in South Dakota and everywhere else. You will find later dates quoted; they stem from a 2025 rule that was vacated in June 2026 and is under appeal.
All 66 counties in South Dakota sell a PPO, which is unusual and useful. For a bookkeeper covering ground, it is the plan type that travels best.
Nothing about 2027 is urgent yet, which is exactly why it is worth ten minutes now. Come November you will be choosing between South Dakota’s carriers under a deadline; today you can do it without one.
Give me a ZIP and I will tell you three things:
Two Bookkeepers on opposite sides of South Dakota can be quoted very different premiums for the same plan. Your ZIP is what decides it.