South Dakota residents enjoyed the nation’s lowest health‑insurance claim denial rate in 2025, according to a recent study that examined federal data from the Centers for Medicare & Medicaid Services (CMS). The analysis, conducted by research firm NovaKratom, found that insurers denied just 5.9% of in‑network claims filed through HealthCare.gov, placing the state at the very bottom of the list of 29 participating states.

How South Dakota’s Rate Compares Nationwide

Across the 29 states included in the study, the average denial rate was 15.6%, meaning roughly one in six requests for coverage was rejected. South Dakota’s 5.9% figure was dramatically lower than the national average and well below the 6.8% denial rate recorded by neighboring North Dakota, which ranked 28th.

Wyoming’s Contrasting Experience

In stark contrast, Wyoming recorded a 20.2% denial rate, the fourth‑highest among the states examined. Insurers in Wyoming denied more than 352,000 of the nearly 1.75 million in‑network claims submitted, a rate only surpassed by Hawaii, Alaska and Delaware.

Scope of the Study

The NovaKratom analysis covered more than 533 million in‑network claims submitted to 130 insurers across the 29 states that use HealthCare.gov. Researchers used the CMS Transparency in Coverage public‑use files, focusing on claims for health‑care services provided in 2025.

What the Numbers Mean for Consumers

South Dakota’s low denial rate translates to roughly 95,100 denied claims out of more than 1.6 million in‑network submissions in the state. While any denial can be frustrating, the study notes that patients often have the option to appeal a decision. Some appeals result in overturned denials, allowing patients to receive coverage for care that was initially rejected.

Implications for Policy and Practice

These findings highlight the variability in claim‑denial practices across the country and suggest that state‑level factors—such as regulatory oversight, insurer competition, and consumer advocacy—may influence outcomes. Policymakers and health‑care leaders in states with higher denial rates may look to South Dakota’s approach for potential best practices.

Looking Ahead

As the health‑insurance market continues to evolve, ongoing transparency and data analysis will be essential for ensuring that consumers receive the coverage they need. Stakeholders are encouraged to monitor future CMS releases and state‑level initiatives aimed at reducing unnecessary claim denials.

Original reporting: KOTA (Gray) – local — read the source article.