Table of Contents

Medicare Plans by State

STATE -Select-
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Page Reviewed / Updated – September 19, 2022

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

Name

Total Enrollment

Star Rating

Min Cost

Max Cost

Plan Types

Humana

9,769

4

$0

$106

HMO, PPO, PFFS

UnitedHealthcare

7,649

4

$0

$39

PPO

Aetna Medicare

2,801

4

$0

$0

PPO

Wellmark Advantage Health Plan

518

0

$19

$69

PPO

Sanford Health Plan

464

0

$49

$49

PPO

Blue Cross Blue Shield of Michigan

92

0

$0

$0

PPO

Anthem Blue Cross and Blue Shield

81

0

$0

$0

PPO

Kaiser Permanente

18

0

$0

$0

HMO

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. 

Medicare Advantage Plan Types Graphic

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?

Preventive Screenings

Yes

Yes

Hospital Care

Yes

Yes

Durable Medical Equipment

Yes

Yes

Prescription Drugs

No

Yes**

Vision Care

No

Yes*

Dental Care

No

Yes*

Hearing Aids

No

Yes*

*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.

Start Date

End Date

Initial Coverage Election
Period

3 Months Before One’s
65th Birth Month

3 Months After One’s
65th Birth Month

Annual Election Period
(AEP)

October 15th

December 7th

Medicare Advantage Open
Enrollment Period

January 1st

March 31st

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.

Choose a Medicare Advantage Plan



State-Wide Medicare Advantage Resources

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 Info

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.

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South Dakota Department of Social Services 

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.

Contact Info

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. 

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South Dakota Department of Veterans Affairs

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.

Contact Info

A comprehensive directory of Veterans Service Officers in South Dakota can be found on the Department’s website. General inquiries can be directed to the department’s toll-free line at 1-877-579-0015.

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Local Medicare Advantage Resources

Dakota at Home

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. 

Contact Info

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.

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