Sanford Individual Simplicity $4,750
Silver · PPO · Sanford Health Plan · South Dakota
At age 40 it costs between $709.23 and $881.65 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What this Silver plan costs if your income qualifies
Below certain incomes the marketplace improves a Silver plan's cost sharing automatically — you do not apply for it, and it happens on Silver and on no other metal level. The premium does not change; the deductible and what you pay at the doctor do.
| If your income is | Deductible | Most you could pay in a year | Primary care | Generic drugs |
|---|---|---|---|---|
| Above 250%, or not applied for | $4,750 | $9,750 | $45 | $30 |
| up to 150% of the federal poverty level | $0 | $1,800 | No Charge | No Charge |
| 150% to 200% | $1,500 | $3,000 | $15 | $10 |
| 200% to 250% | $4,750 | $7,750 | $45 | $30 |
CMS calls these cost-sharing reductions. The percentages are actuarial values, not discounts. HealthCare.gov works out which one you get from the income you report when you apply.
What CMS publishes about it
| Plan ID | 31195SD0110005 |
|---|---|
| Insurer | Sanford Health Plan |
| Metal level | Silver |
| Plan type | PPO |
| Deductible (individual) | $4,750 |
| Deductible (family) | $9,500 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $9,750 |
| Family maximum | $19,500 |
| Primary care visit | $45 |
| Specialist visit | $70 |
| Emergency room | 50% Coinsurance after deductible |
| Inpatient stay | 50% Coinsurance after deductible |
| Generic drugs | $30 |
| Preferred brand drugs | $40 |
| Specialty drugs | 50% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | Yes |
| Share of premium buying essential health benefits | 100.00% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-800-752-5863 · TTY 1-877-652-1844 |
Where it is sold, and what it costs there
66 counties. The premium is the price before any tax credit; what you pay depends on your income.
| County | At 21 | At 30 | At 40 | At 50 | At 60 |
|---|---|---|---|---|---|
| Clay County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Lake County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Lincoln County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| McCook County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Minnehaha County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Moody County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Turner County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Union County | $554.95 | $629.87 | $709.23 | $991.14 | $1,506.14 |
| Beadle County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Brookings County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Brown County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Campbell County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Clark County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Codington County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Corson County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Day County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Deuel County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Dewey County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Edmunds County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Faulk County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Grant County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Hamlin County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Kingsbury County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Marshall County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| McPherson County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Potter County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Roberts County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Spink County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Walworth County | $567.83 | $644.49 | $725.69 | $1,014.15 | $1,541.09 |
| Aurora County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Bon Homme County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Brule County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Buffalo County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Charles Mix County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Davison County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Douglas County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Gregory County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Hand County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Hanson County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Hughes County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Hutchinson County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Hyde County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Jerauld County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Lyman County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Miner County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Sanborn County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Stanley County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Sully County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Tripp County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Yankton County | $601.72 | $682.95 | $769 | $1,074.67 | $1,633.06 |
| Bennett County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Butte County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Custer County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Fall River County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Haakon County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Harding County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Jackson County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Jones County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Lawrence County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Meade County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Mellette County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Oglala Lakota County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Pennington County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Perkins County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Todd County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
| Ziebach County | $689.87 | $783 | $881.65 | $1,232.11 | $1,872.30 |
Open enrollment for 2026 coverage runs 1 November 2025 to 15 January 2026 in most states. Outside that window you need a qualifying life event — losing other coverage, moving, marrying, having a child — to enrol.
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Premiums, deductibles, out-of-pocket maximums and cost sharing are reproduced from the HealthCare.gov Qualified Health Plan landscape file published by the Centers for Medicare & Medicaid Services for plan year 2026. Nothing on this page is calculated by us. This is not a complete list of your options and it is not advice: to see every plan and to enrol, use HealthCare.gov or call 1-800-318-2596.