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 29, 2022
Reviewed by Dr. Brindusa Vanta, MD

Medicare is a federal health insurance program that’s available to seniors aged 65 and older, as well as younger adults with certain disabilities. This program has been around since 1965, and it currently covers 177,500 South Dakota residents. Over 24% of Medicare enrollees chose Medicare Advantage plans in 2021, according to the Kaiser Family Foundation. Enrollment varies by county, since different plans are available in different geographic areas.

Seniors who choose to stay on Original Medicare receive Part A and Part B benefits through the federal government, including hospital stays, outpatient medical care care and diagnostics. However, there are other Medicare plans that are privately run. Medicare Advantage, or Part C, plans are sold by private insurance companies. These plans include the same benefits as Original Medicare, with the exception of hospice care, and they often include additional benefits, such as drug coverage (Part D, dental and vision care, gym memberships and more. Many Original Medicare users choose to supplement their coverage with Medigap plans, which can reduce their out-of-pocket expenses. Those enrolled in the Advantage Plans don’t need Medigap. There are also standalone Part D plans that cover prescription drugs for individuals on Original Medicare.

Although South Dakota is a sparsely populated state, about 30% of residents have a low or moderate income. This can make it difficult to afford copays and out-of-pocket costs without government subsidies, such as Extra Help. Medicare currently spends about $10,289 per enrollee per year in South Dakota, which adds up to about $1.4 billion statewide.

In this guide, seniors can find information about Medicare plans that are available in South Dakota, as well as other resources that can help older adults save money and maximize their insurance benefits.

Options for Medicare Coverage in South Dakota

When seniors first become eligible for Medicare, they’re enrolled in Parts A and B, also known as Original Medicare. Alternatively, they can sign up for a Medicare Advantage plan during the initial enrollment period that starts 3 months before their 65th birthday. Other supplemental options are available through private insurance companies.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

  • Travel frequently within the United States
  • Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
  • Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Nationally, enrollment in Medicare Advantage plans, commonly referred to as MA plans, has doubled over the past 20 years. One reason seniors choose these plans is that they cover additional benefits, such as vision, dental and hearing, that aren’t available through Original Medicare. Most plans also include prescription drug benefits, so there’s no need to purchase standalone Part D coverage. Medicare Advantage enrollment ranges from 3% to 30% in South Dakota counties where this coverage is available. Another benefit of Medicare Advantage plans is that they include an out-of-pocket maximum for both in-network and out-of-network services, which isn’t the case with Original Medicare. Finally, about 60% of enrollees pay no additional premium after they pay for Part B. Seniors must continue paying for Part B, although the benefits will be administered by their MA plan.

Although Part C plans cover some services that aren’t available through Original Medicare, they may require prior authorization. They’re not required to cover services that aren’t medically necessary, according to Medicare standards. Out-of-pocket costs and co-insurance rates vary by policy and depend on whether seniors sign up for an Health maintenance organization (HMO), Preferred Provider Organization (PPO) or Private Fee-For-Service Plan. There are also Special Needs Plans (SNPs) for individuals with certain medical conditions, such as diabetes. Unlike Original Medicare, which provides uniform benefits, each Medicare Advantage plan is different, so it’s important to shop around.

Who Should Consider Medicare Advantage?

Medicare Advantage can be useful for those who:

  • Need coverage not provided by Original Medicare
  • Will accept managed care
  • Want limits on their out-of-pocket expenses
  • Are generally healthy, so may benefit from lower premiums

The Top 10 Medicare Advantage Plans in South Dakota

South Dakota seniors have a lot of Advantage plans to choose from. The following table provides information on the most popular insurance providers as of April 2022 based on enrollment data, monthly cost range and satisfaction ratings. More information on Medicare Part C is available on the Medicare Advantage Plans in South Dakota page.


Total Enrollment

Star Rating

Min Cost

Max Cost

Plan Types













Aetna Medicare






Wellmark Advantage Health Plan






Sanford Health Plan






Blue Cross Blue Shield of Michigan






Anthem Blue Cross and Blue Shield






Kaiser Permanente






Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

  • Currently take prescription medication or expect to in the future
  • Want to avoid late enrollment penalties
  • Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

  • Have ongoing health issues and expenses
  • Travel overseas often
  • Want to access an expanded network of health care providers
  • Expect to need health services not covered by Original Medicare

Medicare Resources in South Dakota

Medicare is a complex health insurance system that’s administered by private insurance companies and the federal government. South Dakota seniors who are new to Medicare or want to change their coverage during the annual open enrollment period can contact the following agencies for assistance. Federal funding ensures that free insurance counseling is available to all Medicare beneficiaries. Seniors can learn more about these resources below.


Senior Health Information and Insurance Education (SHINE) is a federally funded program available to all current and future Medicare beneficiaries in South Dakota and their friends or families. It provides free one-on-one counseling, as well as informational guides and plan comparisons, to help beneficiaries understand their coverage options and select the best products for their needs.

Contact Info

South Dakota has three regional SHINE offices. Seniors can contact the division that serves their part of the state.

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South Dakota Department of Human Services, Division of Long Term Services and Supports

South Dakota’s LTSS division provides information and referrals and administers a wide range of programs that are designed to address seniors’ needs as they age. Many of these services are free to disabled adults and seniors aged 60 and over. It sponsors the SHINE insurance counseling program and oversees the state’s long-term care ombudsman. South Dakota has more than a dozen LTSS offices that serve seniors in designated counties.

Contact Info

For help with Medicare, Medicaid or other government services, seniors can contact their local LTSS office or the state office in Pierre.

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South Dakota Medicare Savings Plans

South Dakota offers several Medicare Savings Plans for seniors who have limited income and assets. Individuals may be eligible for help with their Part B premium, as well as some or all of their copays or co-insurance and deductibles, depending on their income. The average beneficiary saves about $2,040 per year through this program.

Contact Info

Seniors can contact the Social Security Administration or the South Dakota Department of Social Services for more information about the state’s Medicare Savings Plans.

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South Dakota Division of Insurance

The South Dakota Division of Insurance is responsible for regulating the state’s insurance industry, including licensing insurance companies and agents. It provides informational resources and educational materials, as well as a directory of individuals and companies that are permitted to sell insurance in the state. The DOI also investigates complaints and works to prevent fraud and deceptive business practices.

Contact Info

For general information about insurance or for help with a specific issue, seniors can contact the Division of Insurance directly. The number below will connect callers to the DOI’s customer service hotline.

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Social Security Offices

The Social Security Administration is responsible for handling Medicare enrollment and collecting Part B premiums. South Dakota has six Social Security field offices and several disability determination divisions. These offices are located in Rapid City, Sioux Falls, Aberdeen, Huron, Watertown and Yankton. Seniors can also manage their benefits or request a replacement Medicare card online or over the phone.

Contact Info

To contact a local field office, seniors can call the Social Security Administration’s customer service hotline or use the online office locator tool.

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South Dakota Long-Term Care Partnership Program

Medicare covers some long-term care services, but there are a number of exclusions and qualification requirements. The South Dakota Long-Term Care Partnership Program provides information about standalone long-term care insurance, expected costs and potential payment options. Certain long-term care insurance policies are endorsed by the state and can help individuals qualify for Medicaid sooner while protecting their assets.

Contact Info

Seniors can contact the South Dakota Department of Social Services at 605-367-5444, ext. 1000266 or the Department of Insurance at 605-773-3563 for more information.

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