Sanford Individual Simplicity $6,500
Starting at
$563
/month before subsidy
Sanford Individual Simplicity $6,500 is a 2026 Expanded_bronze PPO health insurance plan from Sanford Health Plan, sold on the ACA Marketplace in South Dakota under plan ID 31195SD0110007. The monthly premium starts at $563 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $6,500 ($13,000 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 HSA-eligible, so it can be paired with a Health Savings Account.
- Plan ID
- 31195SD0110007
- Plan year
- 2026
- State
- South Dakota
- Metal level
- Expanded_bronze
- Plan type
- PPO
- HSA-eligible
- Yes
Individual Deductible
$6,500
Family: $13,000
Out-of-Pocket Max
$9,750
Family: $19,500
Coinsurance
50%
You pay after deductible
Network Type
PPO
SDN003
Medical Services
Prescription Drugs
- Medical care
- Member experience
- Not rated
- Plan administration
How well doctors manage and coordinate care
Member-survey satisfaction with the plan
Customer service, billing, and access to information
Having a baby
Normal delivery
$7,570
your estimated cost
- Deductible
- $6,500
- Copays
- $10
- Coinsurance
- $1,000
Managing type 2 diabetes
A year of routine care
$1,220
your estimated cost
- Deductible
- $100
- Copays
- $1,100
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,700
your estimated cost
- Deductible
- $2,100
- Copays
- $600
- Coinsurance
- $0
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Review the plan details above to determine if this plan fits your healthcare needs and budget.
This summary is generated based on plan attributes for educational purposes only.
If you max out this year
$1,376/month
Annual Premium
$6,756
OOP Maximum
$9,750
💡 What this means:
With a $6,500 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
- Sanford Individual Simplicity $10,600from $377/mo
- Sanford Individual TRUE $10,600from $291/mo
- Sanford Individual Simplicity $7,200 HSA Qualifiedfrom $577/mo
- Sanford Individual Simplicity Standardized $7,500from $540/mo
- Sanford Individual TRUE $6,500from $433/mo
- Sanford Individual TRUE $7,200 HSA Qualifiedfrom $438/mo
- Sanford Individual TRUE Standardized $7,500from $416/mo
- Sanford Individual Simplicity $3,500from $704/mo
Frequently asked questions about Sanford Individual Simplicity $6,500
How much does Sanford Individual Simplicity $6,500 cost per month?
Sanford Individual Simplicity $6,500 from Sanford Health Plan starts at $563 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 Simplicity $6,500?
The individual medical deductible is $6,500, and the family deductible is $13,000. 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 Simplicity $6,500?
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 Simplicity $6,500 HSA-eligible?
Yes. Sanford Individual Simplicity $6,500 is a qualified high-deductible health plan, so you can pair it with a Health Savings Account (HSA) and pay for eligible medical expenses with pre-tax dollars.
What type of network does Sanford Individual Simplicity $6,500 use?
Sanford Individual Simplicity $6,500 is a PPO plan. PPO plans let you see specialists without a referral and use out-of-network providers (at higher cost), offering the most flexibility.
Understand what you'd actually pay
- 2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
- How ACA subsidies work
Premium tax credits and who qualifies
- The 2026 subsidy cliff
Why income near 400% FPL matters again this year
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.