Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage, or Medicare Part C, has a few key differences from Original Medicare or Medicare parts A and B. The federal government administers original Medicare, while approved private insurance companies provide Medicare Advantage plans. Medicare Advantage Plans cover all of the same services as Medicare parts A and B, except hospice care which remains covered under Medicare Part A. Most Advantage plans offer coverage for prescription drugs, which Original Medicare does not cover. Medicare Advantage plans also typically include coverage for additional services such as dental, vision, hearing aids and wellness programs.
Each Medicare Advantage plan differs by the provider because providers can set their own rules and policies for eligibility, out-of-pocket costs, physician referrals and in-network versus out-of-network health care facilities. While Original Medicare does not have a yearly annual maximum, Medicare Advantage plans do.
Medicare Advantage plans are growing in popularity across the United States, and 42% of all Medicare beneficiaries are enrolled in Medicare Advantage plans nationwide. As of 2021, South Dakota enrolled around 24% of residents as Medicare beneficiaries in Medicare Advantage plans. This makes South Dakota one of only nine states where Medicare Advantage enrollment is less than 25%.
South Dakota residents have several plans to choose from when considering Medicare Advantage. This guide provides an overview of what plans are available, who is eligible and how South Dakota residents can find the right Medicare Advantage plan to fit their health care needs.
The Top 8 Medicare Advantage Plans in South Dakota
South Dakota Medicare beneficiaries looking for a Medicare Advantage plan will find that they have numerous plan providers to choose from. The list below includes the most popular plan providers in the state in terms of enrollment, along with cost information. Many providers offer more than one plan, and pricing between plans varies, so the list displays cost information as a range rather than a set average amount. Some providers offer $0 premium plans as well, although plan availability depends on what service area beneficiaries live in.
All information included in the table is accurate as of April 2022. For the most up-to-date information about Medicare Advantage plans in South Dakota, beneficiaries and their families can visit Medicare.gov.
HMO, PPO, PFFS
Wellmark Advantage Health Plan
Sanford Health Plan
Blue Cross Blue Shield of Michigan
Anthem Blue Cross and Blue Shield
How Medicare Advantage Plans Work in South Dakota
Before choosing a plan, it’s crucial to understand what types of plans are available in South Dakota and how they differ from each other. The four main types of Medicare Advantage plans in South Dakota are Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service (PFFS) and Special Needs Plans (SNP). While they all offer the same basic services, plans differ when it comes to factors such as eligibility requirements, out-of-pocket costs and physician referrals.
Seniors can use the table below to compare and contrast the main types of Medicare Advantage plans.
What Medicare Advantage Plans Cover in South Dakota
By default, Medicare Advantage plans cover all of the same services as Medicare Parts A and B, except for hospice care. They also usually provide prescription drug coverage, which Original Medicare does not include, along with additional coverage for dental, vision, hearing aids and wellness programs. The table below shows what types of services Medicare Advantage covers versus those Original Medicare covers.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in South Dakota
All South Dakota residents aged 65 and older and younger residents with specific qualifying disabilities are eligible for Medicare Advantage. Before a qualified beneficiary can enroll in Medicare Advantage, they must enroll in Original Medicare. They must also live within a plan’s service area and be a U.S. citizen or lawful immigrant. Some Medicare Advantage plans have additional eligibility requirements. For example, Medicare Special Needs Plans (SNP) are only available to people living with specific diseases or chronic conditions.
Seniors and adults with qualifying disabilities can only enroll in Medicare Advantage during specific enrollment periods. Enrolling in a new plan or changing coverage is generally not allowed outside of enrollment periods, but Medicare makes limited exceptions for specific life events. South Dakota citizens should keep the following Medicare Advantage enrollment periods in mind.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in South Dakota
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Senior Health Information & Insurance Education (SHIINE)
SHIINE is a federally funded, state-run program whose mission is to provide confidential, free and unbiased information to Medicare beneficiaries. The program provides access to hundreds of committed volunteer counselors across South Dakota, drawn from the ranks of retirees and working professionals from Medicare-related fields (including nursing home staff, pharmacists and social workers). These counselors work one-on-one with individuals to educate them about Medicare, showing them how to find and protect the benefits they’re entitled to, how to avoid fraud and safeguard their personal information.
Contact SHIINE through any of its Regional Coordinators to find out more about the program and how to make an appointment with a volunteer counselor. The Eastern South Dakota office can be reached toll free at 1-800-536-8197, the Central South Dakota office at 1-877-331-4834 and the Western South Dakota office at 1-877-286-9072. Further contact information can be found on the program’s website, as well as links to other resources.
South Dakota’s Department of Social Services (DSS) offers an array of social service resources that includes providing information and enrollment for Medicaid, information on Medicare prescription drug coverage and links to plan-finding portals and further avenues of support. The department’s website is an excellent starting point for finding information about a wide range of health care needs, including information about Medicare savings programs.
The DSS provides an online contact form on its website, along with a staff directory and directories for its local offices throughout the state. Its Medical Services line can be reached at 605-773-3495.
The South Dakota Department of Veterans Affairs provides a wide range of support for veterans and their families, touching on everything from health care to disability benefits and long-term care. Each county in the state provides a dedicated Veterans Service Officer to offer guidance and counseling for veterans, helping them to navigate issues like medical benefits, including programs such as Medicare and Medicare Advantage.
Dakota at Home, operating under the oversight of the South Dakota Department of Human Services, is the state’s Aging and Disability Resource Center (ADRC). The agency provides information and referrals to resources and services that are available to South Dakota seniors in the local area where they live. Dakota at Home also provides options counseling and information about services and assistance available through Medicare.
Seniors can access information by clicking on their county on Dakota at Home’s interactive map and scrolling down a list of providers and organizations available to assist seniors in that locale. Seniors who prefer to talk to someone on the phone in their local area can call Dakota at Home toll free at 1-833-663-9673.