Medicare is a federal health care program for individuals aged 65 and older, younger residents with specific disabilities and people with end-stage renal disease. Most beneficiaries don’t have to pay for Part A, which provides essential services, such as emergency care, inpatient treatments and medical care in skilled nursing facilities and at home. The premium for Part B in 2023 is $164.90 per month, which covers outpatient services and preventative care such as diagnostic tests, medical transportation and essential medical equipment and supplies. As of 2021, Medicare costs the state of South Dakota almost $1,556,000 per year.
Medicare Advantage, or Medicare Part C, merges all the benefits of Parts A and B into a single plan, excluding hospice care. Seniors have a choice of 30 plans in South Dakota in 2023. Premiums start at 0%, but beneficiaries often add extra coverage, such as prescription drugs, home meals and dental care, resulting in a median monthly premium of $16.30. Part D covers prescription drug costs for Original Medicare recipients and those enrolled in a Medicare Advantage Plan that doesn’t provide this coverage. Various factors determine the premium, such as the tier level of beneficiary’s medications and their individual prescriptions. Medicare Supplement Plans, also known as Medigap, can help seniors cover out-of-pocket costs such as copayments and deductibles.
The Centers for Medicare & Medicaid Services (CMS) administers Original Medicare, while private insurance companies handle Medicare Advantage. They’re entitled to design their plans without interference so long as they operate within the rules and regulations set by the CMS. As of July 2023, 17% of South Dakota’s eligible residents have purchased a Medicare Advantage Plan. Although this is a 5% increase from the previous year, the state falls far short of the national average of 48%. However, that 5% increase suggests a change: of the 3.26% increase in eligible enrollees from 2022 to 2023, a significant 36.76% chose Medicare Advantage.
This guide explores South Dakota’s various health insurance options. It also covers how seniors can personalize their plans and where they can find additional resources and support.
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 beneficiaries can obtain care services wherever they are in the country, including when they’re on vacation or have moved states. The program’s primary restriction is it rarely pays costs if the senior requires treatment in another country.
Who Should Consider Original Medicare
While Original Medicare is fixed, Medicare Advantage is flexible. Its appeal is in offering plans that more closely align with seniors’ health care needs. There are five types of plans available:
Each addresses specific requirements, such as seniors who want more control over which specialist provides their care and those looking to save on monthly premiums.
Who Should Consider Medicare Advantage
The Top 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 August 2023 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.
|Medicare Star Rating
|Monthly Cost Range
|$0 – $105
|$0 – $25
|Wellmark Advantage Health Plan
|$0 – $69
|BlueCross BlueShield of Tennessee
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:
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 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
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.
South Dakota has three regional SHINE offices. Seniors can contact the division that serves their part of the state.Visit Website
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.
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.
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.
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.
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.