Medicare Plan Options
Your health needs may change throughout your retirement years. To accommodate these changes, the state’s Medicare program features diverse options from private health insurance companies. South Dakota’s Medicare Advantage program is a private option with more robust coverage comparable to the health plan you may have had through your employer or the federal Marketplace. Other private options include prescription drug coverage and supplemental insurance to help you control out-of-pocket costs.
Original Medicare is the health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). This coverage is available to those who are aged 65 and over, those who are younger and have drawn Social Security disability payments for at least 24 months, and those who have end-stage renal disease. Its different parts cover specific services. Part A pays out for inpatient hospital stays, skilled home health care services, hospice, and nursing home stays. Part B covers the care you get in your doctor’s office, medical supplies, outpatient care, and preventative services. Before your coverage kicks in, you must meet an annual deductible. After you’ve met your deductible, you usually pay 20% of the cost of covered services.
Medicare Advantage Plans
Medicare Advantage Plans are alternatives to Original Medicare. These plans are sold by private insurance companies that comply with CMS’s terms and have the same benefits as Original Medicare. Unlike the standard plan, MA Plans generally have annual out-of-pocket maximums, and some plans payout for services right away without requiring you to meet a deductible. Along with the standard Part A and Part B coverage, many MA plans have additional coverage for vision and dental services, assisted living, homemaker services, and wellness programs. Depending on your policy, you may need to choose a primary doctor and get referrals before scheduling appointments with specialists.
Medicare Prescription Drug Coverage Plans
Medicare prescription drug coverage helps you cover the cost of medications your doctor prescribes. Original Medicare provides prescription drug coverage for a few outpatient medications, such as injectables and some antigens. To have other medications covered, you have to join a Medicare drug plan. Each plan has a formulary – a list of specific medications it covers – but it must have a standard level of coverage as required by Medicare. Copays, coinsurance, and monthly premiums vary from one plan to another. Even if you don’t take medications when you first sign up for Medicare, it’s a good idea to enroll in a prescription drug plan when you first become eligible to avoid higher premiums later on.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance Plans are private insurance plans that help you pay for fees not covered by Original Medicare. The coverage you get depends on the plan you sign up for and may include deductibles for hospital and medical care, foreign travel emergency services, coinsurance and copays, and the first three pints of blood. Plans may also have out-of-pocket limits to help you control annual health care costs. Factors, such as your age and where you live, influence your monthly premium. Medicare Supplement Plans are guaranteed renewable, meaning that even if your health needs change, your policy can’t be canceled.
Medicare in South Dakota by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|139,413||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in South Dakota
As a South Dakota resident, you have access to a network of legal professionals, trained volunteers, and government employees who can help you enroll in the right Medicare plan for your needs. These agencies provide in-person and over-the-phone assistance to help you determine the level of coverage that’s right for you, understand enrollment deadlines to avoid penalties, and resolve issues related to the claims process.
Department of Labor & Regulation Division of Insurance
The state’s Division of Insurance ensures fair insurance practices in the state by advocating on behalf of residents and fielding complaints regarding problems with the claims handling process. Through this department, you can learn more about Medicare Supplement Insurance Plans sold in the state, enrollment periods, and managed care alternatives to Medigap.
Contact Information: Website | 605-773-3563
Senior Health Insurance & Information Education
Senior Health Insurance & Information Education is a free statewide program that provides confidential, unbiased health insurance options counseling for Medicare-eligible residents. Through this program, you can meet with a trained volunteer who can answer questions about your Medicare benefits, out-of-pocket costs, available Medicare Advantage and Medigap Plans, and prescription drug coverage. SHINE counselors can also help you recognize and resolve suspected fraud through the Senior Medicare Patrol program.
Contact Information: Website | 605-333-3314
East River Legal Services
East River Legal Services provides free legal aid to seniors in the Sioux Falls region. This agency helps residents enroll in Medicare and Medicare Savings Programs and research private Medicare options. It can also help older adults resolve issues, such as canceled policies, denied claims, or medical billing mistakes.
Contact Information: Website| 605-336-9230
Active Generations is a nonprofit organization in Sioux Falls that provides social and recreational activities and supportive services for older adults in the region. At this center, you can meet with a SHINE counselor for free, unbiased health insurance options counseling. Counselors aren’t affiliated with a health insurance company or licensed to sell insurance policies, but they can help you review your health needs, budget, and medication regimen and enroll in the health insurance plan that meets your needs.
Contact Information: Website | 605-336-6722
Learn More From Our Sources
- Medicare | What’s Medicare? | Last accessed June 2021
- Medicare | How to get prescription drug coverage | Last accessed June 2021
- Medicare | Part D late enrollment penalty | Last accessed June 2021
- South Dakota Department of Labor & Regulation | Division of Insurance | Last accessed June 2021
- Senior Health Information & Insurance Education | Last accessed June 2021
- East River Legal Services | Last accessed June 2021
- Active Generations | Last accessed June 2021