South Dakota Medicare offers coverage for citizens older than 65, as well as people with specific disabilities who are eligible. The US government funds Medicare, but South Dakota also helps Medicare beneficiaries living in the state with its various educational and funding agencies.
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South Dakota Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2024 Medicare trends in South Dakota:
- There are 192,581 residents in South Dakota that are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased significantly in South Dakota from $20.12 in 2023 to $23.47 in 2024.
- There are 32 Medicare Advantage plans available in South Dakota.
- 94.6% of South Dakota residents with Medicare can purchase a Medicare Advantage plan with a $0 premium.
- There are currently 22 different Medicare prescription drug plans offered in South Dakota.
- The lowest monthly premium for a Medicare prescription drug plan is $0.50.
Medicare Offered in South Dakota
Medicare is a government program that offers financial assistance for health care to those 65 or older and people of any age with specific disabilities.
Original Medicare
Medicare starts with Part A and Part B, which makes up what is also known as Original Medicare. Part A usually has no premium, while Part B requires a specific premium due every month for beneficiaries who earn less than $88,000 a year. However, there are also deductibles, coinsurances, and copayments that make up the out-of-pocket expenses for Medicare beneficiaries.
Part A covers the hospital insurance part of the coverage, including inpatient hospital and psychiatric care. Part B is for medical insurance, covering medically necessary treatments and durable medical supplies.
Medicare Advantage
Medicare Advantage refers to a more comprehensive plan that provides the same coverage as Original Medicare, plus additional benefits similar to what can be found in Medigap policies. As of 2019, approximately 20% of beneficiaries in South Dakota have Medicare Advantage.
This plan contains Medicare Part A, Part B, and extra coverage for additional healthcare services. There are currently 4 Medicare Advantage plans with prescription drug coverage that offer lower out-of-pocket insulin costs through the Part D Senior Savings Model. (source)
100% of those living in South Dakota have access to a Medicare Advantage plan with a $0 monthly premium. Currently, there are 18 Medicare Advantage plans available from companies, with ratings, such as:
- Medica Prime Solution – 4/5 stars
- AARP – 4/5 stars
- Lasso – 2/5 stars
- Blue Medicare Advantage (PPO)
- United Healthcare – 4/5 stars
Availability varies from county to county as they are sold through private insurers.
Beneficiaries can enroll in a Medicare Advantage plan during their initial enrollment or annual election period (runs annually between October 15th and December 7th). Enrollees can change or drop their coverage during the Medicare Advantage open enrollment period (January 1st – March 31st).
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Medicare Supplement Plans
For those with Original Medicare looking for additional coverage, they can obtain supplemental “Medigap” policies. Medigap offers coverage for other health care services that are not covered by Part A and Part B. A common supplemental plan is called Medicare Part D, and it covers Medicare prescription drugs. Other plans may even help cover the cost of out-of-pocket expenses.
Over 30 companies offer Medigap plans in South Dakota. Reviewing your options carefully before signing up ensures that you have enough coverage at a reasonable price.
South Dakota Medicare Enrollment
Unless you meet the qualifications for automatic enrollment, you need to sign up for Medicare during an enrollment period. Use Medicare’s online eligibility tool if you are unsure if you qualify.
Requirements
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts October 15th
- Ends December 7th
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
South Dakota Enrollment Tips & Advice
A sizable number of Medicare beneficiaries in South Dakota cannot afford the Medicare expenses due to a lack of funds. However, the state government offers Medicare Savings Programs (MSPs) to help those in need. To determine individuals and married couples who need the most financial assistance, eligibility requirements include limits on income and assets.
Additional resources:
- Senior Health Information & Insurance Education. Visit SHIINE to learn more about Medicare, access SHIP counseling, and get help in your area. 800-536-8197.
- South Dakota Department of Social Services. Learn more about Medicare, Medicaid, and Long Term Care Support. 605-773-3165.
How Do I Enroll in a Medicare Plan?
If you have any questions about South Dakota Medicare and your eligibility for supplement or advantage plans, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.
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