Ranked 7 of 15 states · median $725/mo · CMS PY2026
Licensed Independent Agent · NPN #22052447 · 21 States
A 40-year-old plumber 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 highest out-of-pocket maximum, South Dakota ranks 12 of 15 for this occupation.
Trade work concentrates cost into rare, expensive events rather than spreading it across the year. That inverts the usual shopping logic: a lower premium with a $9,200 ceiling is a worse deal than a higher premium with a $6,000 one, because the ceiling is what you actually hit. These rankings follow the ceiling.
Occupational context: Confined-space entry; sewage and biohazard exposure; back 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 plumber 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 plumber 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 |
|---|---|---|---|---|
| Brule | $702 | Avera | $6,000 | 2 |
| Hyde | $702 | Avera | $6,000 | 2 |
| Tripp | $702 | Avera | $6,000 | 2 |
| Jackson | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Perkins | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Turner | $516 | Sanford | $6,000 | 3 |
The spread across just these six is $245/month — $2,941 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 — worst-case exposure | 2026 |
|---|---|
| Lowest annual out-of-pocket maximum | $0 |
| Highest annual out-of-pocket maximum | $0 |
| Cheapest Gold plan @40 | $559 — Sanford |
| Gold deductible | $2,000 |
| Cheapest Silver @40 | $512 — Avera |
| Cheapest Silver @50 | $715 |
For a plumber, the gap between $0 and $0 in annual out-of-pocket maximum is worth more than any premium difference on this page. One serious injury reaches that ceiling regardless of which plan you picked.
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
A caveat on the table above: rating is by residence, not by job site. A plumber living in South Dakota and working across a state line still buys South Dakota plans. A genuine permanent move does trigger a special enrollment period, but the plan year restarts with a fresh deductible.
If you file a Schedule C as a plumber, the categories that usually show up are: Tools, van, licensing, materials, liability insurance. The health premium itself is normally an above-the-line deduction under IRC §162(l), which reduces AGI rather than requiring you to itemize. Your CPA should confirm it against your actual situation.
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.
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 Plumbers in South Dakota and a blog covering deductibles, subsidies and special enrollment.