South Dakota dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in South Dakota, premiums in May 2024 ranged from about $15 to $30 per month.²

If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.

The pediatric stand-alone dental plans available on the South Dakota health insurance Marketplace (HealthCare.gov) must comply with the ACA’s coverage rules for children’s dental.

This means the out-of-pocket costs for pediatric dental care on a stand-alone dental plan obtained via HealthCare.gov won’t be more than $400 per child in 2024 (or $800 for all the children on a family’s plan),³ and there is no cap on medically necessary pediatric dental benefits. (For 2025, the out-of-pocket maximums will increase to $425 and $850, respectively.⁴)

If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care, since it’s an essential health benefit.

According to a Milliman analysis of 2024 coverage, some medical plans available through South Dakota’s Marketplace include embedded pediatric dental coverage (but not embedded adult dental coverage).¹ There are also stand-alone dental plans available.

As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care (either embedded in an ACA-compliant individual market plan, or obtained via HealthCare.gov as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.

The South Dakota benchmark plan does include coverage for both basic and major dental services for children.

In 2024, one insurer offers stand-alone individual/family dental coverage through the health insurance marketplace in South Dakota. These are dental plans that are not included with a medical plan and must be purchased separately.

This coverage can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.

There are a variety of dental insurers that sell stand-alone dental policies directly to consumers in the Mount Rushmore State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the South Dakota Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In South Dakota, there are also various dental discount plans available. Dental discount plans are not insurance, but they can offer discounted prices on care at participating dentists. Learn about the differences between dental insurance and dental discount plans.

To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.

Adults enrolled in Medicaid in South Dakota are eligible for some dental services up to an annual limit of $1,000. Dental services for Medicaid eligible adults include preventive, crowns, root canals and dentures. Children eligible for Medicaid in South Dakota also receive these dental benefits with no annual cap.

South Dakota’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• South Dakota Dental Association
• Low-fee dental clinics in South Dakota
• South Dakota Medicaid
• HealthCare.gov