Ranked 7 of 15 states · median $725/mo · CMS PY2026
Prefer to talk? Call (713) 575-9904
Licensed Independent Agent · NPN #22052447 · 23 States
A 40-year-old therapist 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: Emotional load and burnout; sedentary 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 therapist 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 therapist 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 |
|---|---|---|---|---|
| Bon Homme | $702 | Avera | $6,000 | 2 |
| Hughes | $702 | Avera | $6,000 | 2 |
| Sully | $702 | Avera | $6,000 | 2 |
| Harding | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Pennington | $761 | Wellmark of South Dakota | $5,000 | 3 |
| Clay | $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 — 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 therapist 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 therapist 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.
Self-employed Therapists in South Dakota typically deduct: Licensing, malpractice insurance, EHR software, supervision. Health premiums sit separately, above the line under IRC §162(l), and only when neither you nor a spouse could have joined an employer plan — eligibility disqualifies you even if you declined the coverage.
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 sits above the cliff in 7 of the 20 states reported and below it in the other 13, so the answer changes with the state.
What this figure is. It is the median annual wage BLS reports for Marriage and Family Therapists (SOC 21-1013) 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 therapist. 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 Therapists 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 Therapists should check the roster in November rather than assume this year’s options carry over.
Nobody can tell you your 2027 South Dakota premium yet. Filings nationally cluster around a 15% median increase, with the full spread running −1% to 54% — and until this state signs off, a specific local number is invention.
Enrollment opens November 1, 2026. Treat December 15 as the deadline: it guarantees January 1 cover on every marketplace, South Dakota included. Conflicting end dates get quoted because a 2025 rule shortened the window and a court vacated it in June 2026, appeal pending — enrol by the 15th and the argument is irrelevant to you.
All 66 counties in South Dakota sell a PPO, which is unusual and useful. For a therapist 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:
Rates for Therapists in South Dakota are set by county, not by occupation. Start with your ZIP and I will show you the plans actually filed where you live.