Ranked 7 of 15 states · median $725/mo · CMS PY2026
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A 40-year-old nurse practitioner 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 median Silver premium, South Dakota ranks 7 of 15 for this occupation.
Patient-facing and standing work means steady, predictable utilization — regular visits, prescriptions, physical therapy. Copay structure and network breadth drive real annual cost more than the headline premium, so these pages rank states on median premium and carrier count together.
Occupational context: Needlestick and infectious exposure; standing strain.
Worth being clear about what this does and does not affect: a carrier in South Dakota cannot ask what you do for a living, cannot charge a nurse practitioner more than a librarian of the same age in the same ZIP, and cannot exclude anything you were already treated for. Occupation only tells you which plan structure to shop for.
Premium is set by rating area, so a nurse practitioner 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 |
|---|---|---|---|---|
| Fall River | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Mellette | $761 | Wellmark of South Dakota | $5,000 | 3 |
| McCook | $512 | Avera | $6,000 | 3 |
| Hanson | $532 | Avera | $6,000 | 2 |
| Campbell | $679 | Sanford | $6,000 | 3 |
| Edmunds | $679 | Sanford | $6,000 | 3 |
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 — network and cost | 2026 |
|---|---|
| Median Silver premium @40 | $725 |
| Cheapest Silver @40 | $512 — Avera (Lincoln) |
| Most expensive Silver @40 | $882 |
| Carriers filing in the state | 3 — Avera, Sanford, Wellmark of South Dakota |
| Plan types available | EPO, HMO, PPO |
| Counties with only one carrier | 0 of 66 |
South Dakota has 3 carriers filing and 0 of 66 counties served by a single issuer. For a nurse practitioner with an established provider relationship, that carrier count is the number that decides whether you keep your doctor.
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 nurse practitioner 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: Malpractice insurance, licensing, DEA registration, CE. 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.
No. Under the ACA, carriers cannot rate, decline, or exclude based on occupation or health history. Rates vary only by age, ZIP code, tobacco use and household size.
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.
Above the cliff. At this income a single-person household receives no premium tax credit for 2026 and pays the full premium.
This occupation is above the cliff in all 20 states reported.
What this figure is. It is the median annual wage BLS reports for Nurse Practitioners (SOC 29-1171) 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 nurse practitioner. 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 Nurse Practitioners in South Dakota and a blog covering deductibles, subsidies and special enrollment.
South Dakota has 3 carriers filing across 66 counties right now. That list is rebuilt every year, so what you can choose from in November may not match what you see today — and for a nurse practitioner buying your own cover, who stays matters more than the headline rate.
On price the only honest number today is national: the Peterson-KFF read of 2027 filings puts the median proposed rise near 15%, spanning −1% to 54%. Final South Dakota rates are not approved, so any precise 2027 figure quoted for this state is guesswork.
Mark November 1, 2026 to open and December 15 to act. That second date guarantees cover from January 1 in South Dakota regardless of how the current litigation over the enrollment window resolves.
All 66 counties in South Dakota sell a PPO, which is unusual and useful. For a nurse practitioner 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:
Most Nurse Practitioners here are buying their own coverage without an employer. One ZIP is all I need to show you what is available in your part of South Dakota.