PlanVoyager
All plans in South DakotaCompare with subsidy estimate
SilverHMO

Sanford Individual TRUE $3,500

Sanford Health Plan

Starting at

$549

/month before subsidy

Key facts

Sanford Individual TRUE $3,500 is a 2026 Silver HMO health insurance plan from Sanford Health Plan, sold on the ACA Marketplace in South Dakota under plan ID 31195SD0080008. The monthly premium starts at $549 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $3,500 ($7,000 for a family), and the individual out-of-pocket maximum is $9,750 ($19,500 for a family). After the deductible, coinsurance is 50% for covered in-network care. The plan is not HSA-eligible.

Plan ID
31195SD0080008
Plan year
2026
State
South Dakota
Metal level
Silver
Plan type
HMO
HSA-eligible
No

Individual Deductible

$3,500

Family: $7,000

Out-of-Pocket Max

$9,750

Family: $19,500

Coinsurance

50%

You pay after deductible

Network Type

HMO

SDN004

Cost Sharing
What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$45.00
Specialist Visit$70.00
Urgent Care$60.00
Emergency Room50.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$30.00
Brand Name Drugs$150.00
Specialty Drugs50.00% Coinsurance after deductible
CMS Quality Rating
The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.
4.0overall
Medical care

How well doctors manage and coordinate care

Member experience
Not rated

Member-survey satisfaction with the plan

Plan administration

Customer service, billing, and access to information

What you'd typically pay
Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$6,070

your estimated cost

Deductible
$3,500
Copays
$10
Coinsurance
$2,500

Managing type 2 diabetes

A year of routine care

$1,720

your estimated cost

Deductible
$100
Copays
$1,600
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,500

your estimated cost

Deductible
$2,100
Copays
$400
Coinsurance
$0
Is your medication or doctor covered?
Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.
Check a medication
Check a doctor

Enter your ZIP code first to search nearby doctors.

Official Plan Documents
Published by Sanford Health Plan. These are the authoritative source for coverage details.
Summary of Benefits & Coverage (SBC)Standardized cost & coverage summaryPlan BrochureFull plan details from the insurerDrug FormularyCovered prescriptions & drug tiers
Who This Plan Is Best For

This Silver HMO plan offers a balanced approach between monthly premiums and out-of-pocket costs, making it a popular choice for many families.

Consider this plan if you:

  • Visit the doctor a few times per year
  • Take regular prescription medications
  • Want moderate protection against high medical bills
  • May qualify for Cost-Sharing Reductions (CSR) to lower deductibles

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost
What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,362/month

Annual Premium

$6,588

OOP Maximum

$9,750

💡 What this means:

With a $3,500 deductible, you pay 100% of costs until you've spent that much. After that, you pay 50% (coinsurance) until you hit $9,750 total. Then insurance covers everything else for the year.

More plans from Sanford Health Plan in South Dakota

View all Marketplace plans in South Dakota

Frequently asked questions about Sanford Individual TRUE $3,500

How much does Sanford Individual TRUE $3,500 cost per month?

Sanford Individual TRUE $3,500 from Sanford Health Plan starts at $549 per month before any subsidy in South Dakota. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for Sanford Individual TRUE $3,500?

The individual medical deductible is $3,500, and the family deductible is $7,000. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for Sanford Individual TRUE $3,500?

The most you would pay in a year for covered in-network care is $9,750 for an individual and $19,500 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Sanford Individual TRUE $3,500 HSA-eligible?

No. Sanford Individual TRUE $3,500 is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does Sanford Individual TRUE $3,500 use?

Sanford Individual TRUE $3,500 is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.

Understand what you'd actually pay

Enroll at HealthCare.govBrowse South Dakota plans

Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.