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GoldEPO

Wellmark Gold Traditional EPO

Wellmark of South Dakota, Inc.

Starting at

$740

/month before subsidy

Key facts

Wellmark Gold Traditional EPO is a 2026 Gold EPO health insurance plan from Wellmark of South Dakota, Inc., sold on the ACA Marketplace in South Dakota under plan ID 50305SD0310004. The monthly premium starts at $740 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $1,750 ($3,500 for a family), and the individual out-of-pocket maximum is $7,500 ($15,000 for a family). After the deductible, coinsurance is 25% for covered in-network care. The plan is not HSA-eligible.

Plan ID
50305SD0310004
Plan year
2026
State
South Dakota
Metal level
Gold
Plan type
EPO
HSA-eligible
No

Individual Deductible

$1,750

Family: $3,500

Out-of-Pocket Max

$7,500

Family: $15,000

Coinsurance

25%

You pay after deductible

Network Type

EPO

SDN001

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

Medical Services

Primary Care Visit$20.00
Specialist Visit$45.00
Urgent Care$20.00
Emergency Room25.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$20.00
Brand Name Drugs$125.00
Specialty Drugs$300.00
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.
3.0overall
Medical care

How well doctors manage and coordinate care

Member experience

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

$4,520

your estimated cost

Deductible
$1,750
Copays
$10
Coinsurance
$2,700

Managing type 2 diabetes

A year of routine care

$2,020

your estimated cost

Deductible
$400
Copays
$1,600
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,050

your estimated cost

Deductible
$1,750
Copays
$100
Coinsurance
$200
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.
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Official Plan Documents
Published by Wellmark of South Dakota, Inc.. 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 Gold EPO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

  • Have ongoing health conditions requiring regular care
  • Take multiple prescription medications
  • Prefer lower costs at the time of service
  • Want peace of mind with comprehensive coverage

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

$1,365/month

Annual Premium

$8,880

OOP Maximum

$7,500

💡 What this means:

With a $1,750 deductible, you pay 100% of costs until you've spent that much. After that, you pay 25% (coinsurance) until you hit $7,500 total. Then insurance covers everything else for the year.

More plans from Wellmark of South Dakota, Inc. in South Dakota

View all Marketplace plans in South Dakota

Frequently asked questions about Wellmark Gold Traditional EPO

How much does Wellmark Gold Traditional EPO cost per month?

Wellmark Gold Traditional EPO from Wellmark of South Dakota, Inc. starts at $740 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 Wellmark Gold Traditional EPO?

The individual medical deductible is $1,750, and the family deductible is $3,500. 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 Wellmark Gold Traditional EPO?

The most you would pay in a year for covered in-network care is $7,500 for an individual and $15,000 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Wellmark Gold Traditional EPO HSA-eligible?

No. Wellmark Gold Traditional EPO 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 Wellmark Gold Traditional EPO use?

Wellmark Gold Traditional EPO is a EPO plan. EPO plans cover in-network care only (except emergencies) and usually do not require referrals to see specialists.

Understand what you'd actually pay

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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.