For health insurance coverage, South Dakota ranked 33rd among the 50 states, behind first-place Massachusetts at 2.9% and ahead of last-place Texas at 18.6%. Regionally, South Dakota outranked No. 44 Wyoming with a 13.4% uninsured rate. No. 4 Minnesota led the region with just 4.8% of its population under 65 without insurance. The table below provides additional information on health insurance coverage in the region:
| State | Percent Uninsured | National Rank |
| Minnesota | 4.8% | 4th |
| Iowa | 5.0% | 5th |
| North Dakota | 8.1% | 8th |
| Montana | 9.8% | 28th |
| Nebraska | 9.9% | 30th |
| South Dakota | 10.3% | 33rd |
| Wyoming | 13.4% | 44th |
For those under 18, South Dakota ranked 33rd, up seven places from 44th in 2015. Just 4.5% of individuals under 18 were without health insurance in 2016—the same rate as the national rate. Massachusetts ranked first in this category at 0.9% in 2016. Alaska was last, at 10.0%.
South Dakotans between the ages of 25 and 34 experienced an uninsured rate of 17.9%. Overall, however, the highest uninsured rate of 23.4% was found in the group of South Dakotans living in poverty, compared to 8.3% rate for those not living in poverty.
Of the Rushmore State’s metropolitan areas, the Rapid City metro area’s uninsured rate dropped to an eight-year low of 10.3% from 15.1% in 2015. By comparison, the Sioux Falls metro area dipped to 8.1% from 8.7%, and the Sioux City metro area fell to 6.8% from 8.1%.
