Understanding Medicare can be mind-boggling — there’s so much fine print! Benzinga breaks down whether you qualify for Medicare, the difference between the various Medicare plans and reviews the best South Dakota Medicare companies.
Best Medicare in South Dakota:
- Best Overall in South Dakota: Great Plains Brokerage
- Cheapest in South Dakota: Medica
- Best for Variety: Medica
- Best for Flexibility: Humana
- Best for Medicare Supplemental Insurance: UnitedHealthcare
What is Medicare?
Medicare is the federal health insurance program that covers you:
- Or your spouse, age 65 or older, if:
- You’ve worked at least a decade (or 40 quarters) for a Medicare-covered employer
- You enroll as a voluntary enrollee and pay the Part A monthly premium in full if you’ve worked up to 29 quarters for a Medicare-covered employer
- If you’re younger than 65 and:
- Have a disability and Social Security Disability Insurance (SSDI) or railroad retirement disability payments for 24 months
- If you have end-stage renal disease (ESRD) or kidney failure that mandates transplant or dialysis
- If you have amyotrophic lateral sclerosis (Lou Gehrig’s disease) and have received the first month of SSDI payments
Eligible candidates must be U.S. citizens or legal residents for 5 years or more. Call the Social Security Administration at 800-772-1213 or visit online to learn more. Use the calculator to fine-tune your eligibility or calculate your premium.
What are Medicare Plans and Who is Eligible?
Medicare is broken down into Medicare Part A, B, C and D — each part indicates a different type of health coverage.
Part A — Hospital insurance: Medicare Part A covers hospice care, home health care, inpatient hospital care, skilled nursing facility care and inpatient care in a skilled nursing facility — not long-term or custodial care. You’re eligible if you’re 65 or older, disabled or have ESRD.
Part B — Medical insurance: This voluntary component requires you to pay a monthly premium. Medicare Part B covers medical insurance, including services and supplies essential for managing your health, such as preventive services, medical equipment, outpatient care and ambulance services. It also includes elective services like rehabilitation and home health support as ordered by your physician. You’re eligible if you’re 65 or older, disabled or have ESRD.
Part C — Medicare Advantage Plan: Part C plans are private insurance offerings approved by Medicare. Medicare Advantage Plans provide both Part A and Part B coverage and may also offer extra services including dental, vision, hearing and health and wellness programs. Most of these plans also provide Medicare Part D or prescription drug coverage. You’re eligible if you’re enrolled in both Medicare Part A and B — also known as Original Medicare — along with living in a Medicare Advantage service area that accepts new applicants. Note: You must not have ESRD.
Part D — Prescription coverage: Medicare Part D plans have a list known as a formulary, or covered drugs, which include both brand names and generics. While all Medicare Part D plans must cover at least 2 drugs per category, individual plans have the right to choose which drugs they offer. Your specific medication may not be offered, but a similar drug should be provided. You’re eligible for Medicare Part D if you’re eligible for Original Medicare.
Legalities of Medicare in South Dakota
South Dakota Medicare served more than 170,000 enrollees in 2018 — only 20% were in Medicare Advantage plans. It's also estimated that Original Medicare spending per enrollee is 9th lowest in the United States. You’ll find 28 Medicare Part D plans in South Dakota — premiums range from $15 to $94.
Medicare is administered by the Centers for Medicare and Medicaid Services (CMS). You can either get direct benefits from the government through Original Medicare or from a private Medicare Advantage plan if you're enrolled. The latter is available throughout the majority — but not all — of the country.
Medigap coverage is also available in South Dakota. Medigap bridges the gulf between Original Medicare and any costs not covered, including coinsurance, copayments and deductibles. Some Medigap policies cover international travel, which is not covered by Original Medicare.
If you want Medigap, you’re required to have Original Medicare. These policies cover only 1 person and can be purchased from any South Dakota insurer licensed to sell it. That said, an insurer cannot legally sell you a Medigap policy if you already have a Medicare Advantage Plan.
Medigap doesn’t cover everything. It excludes long-term care, hearing aids, vision or dental care, private-duty nursing and eyeglasses.
Types of Medicare Advantage Plans
There are 4 main types of Medicare Advantage Plans, but the 2 most common are health maintenance organization (HMO) plans and preferred provider organization (PPO) plans:
HMO plans mandate your medical care comes from network providers. There are a few exceptions: out-of-area urgent care, out-of-area dialysis and emergency care. These plans typically cover prescription drugs, but make sure that’s the case before you commit. You’ll be responsible for the entire cost if you get care outside your network.
PPO plans are provided by private insurers. PPOs offer network physicians, care providers and hospitals — you can use out-of-network providers if you’re prepared to pay more. Prescriptions are typically covered but make sure you confirm before signing on the dotted line.
How to Sign Up for Medicare in South Dakota
You can sign up for Medicare online. If you’re only seeking Original Medicare, the process should take approximately 10 minutes and requires no documentation or signatures. Social Security works in conjunction with the Centers for Medicare and Medicaid services to enroll participants.
Here’s a checklist of information and documents you’ll want to gather before you begin your application:
- Date and place of birth
- Medicaid number
- Current health and insurance
- Marriage and divorce information, if applicable
- Child-related information, if applicable
- Military service information, if applicable
- Employer details for current year and prior 2 years
- Self-employment details for current year and prior 2 years
- Direct deposit information
Already enrolled in Medicare Part A and want to sign up for Medicare Part B? You must complete the CMS 40B form and return it to your local Social Security office either by mail or in person.
You may apply online for Medicare as long as you:
- Are at least 64 years and 9 months
- Do not wish to start receiving Social Security benefits
- Are not currently receiving any Social security retirement, disability or survivors’ benefits
- Wish to enroll in Medicare but have no Medicare coverage
It’s a good idea to sign up for Medicare 3 months before you turn 65. You can enroll in Medicare Part A as well as Part B online, but if you wish to turn down Part B due to the premium, be sure to do so when you fill out the app. You may also apply by phone at 800-772-1213 or in person at your local Social Security office.
Once your application is processed, you’ll receive a decision letter in the mail.
Average Cost of Medicare Advantage Plans in South Dakota
We’ve pulled together some information to help you comparison shop.
| Plan Name | Company | Plan Type | Health & Drug Costs |
|---|---|---|---|
| Lasso Healthcare MSA | Lasso Healthcare | Medicare Advantage without drug coverage | $144.60 Standard Part B monthly premium |
| Medica Prime Solution Thrift | Medica | Medicare Advantage without drug coverage | $49.00 monthly plus $144.60 Standard Part B monthly premium |
| Medica Prime Solution Thrift w/RX | Medica | Medicare Advantage with drug coverage monthly premium | $88.70 monthly plus $144.60 Standard Part B monthly premium |
| Medica Prime Solution Core w/RX | Medica | Medicare Advantage with drug coverage monthly premium | $125.50 monthly plus $144.60 Standard Part B monthly premium |
| Medica Prime Solution Premier w/RX | Medica | Medicare Advantage with drug coverage monthly premium | $239.60 monthly plus $144.60 Standard Part B monthly premium |
Best Medicare Insurance Providers in South Dakota
Here’s Benzinga’s list of standout Medicare providers in South Dakota.
1. Best Overall in South Dakota: Great Plains Brokerage
Heralded for great service and coverage flexibility, Great Plains Insurance is our choice for top Medicare provider in South Dakota.
Knowledgeable staff members provide excellent service, and as an insurance wholesaler, Great Plains agents are independent and objective.
2. Most Affordable in South Dakota: Medica
Media’s Prime Solution Thrift Medicare Advantage plan is just $49 per month, with 20% coinsurance for primary care doctors and specialists. The out-of-pocket maximum here is $6,700 with a $50 annual in-network deductible. It’s a great budget-friendly option.
3. Best for Variety: Medica
From its Thrift plan to its Premium selection, Medica’s offerings run the gamut.
What’s more, the website is easy to navigate and provides clear-cut information. You can enroll online or by phone.
- Medicare Advantage Plans
4. Best for Flexibility: Humana
Humana’s wide range of Medicare insurance products includes Medicare Advantage, Part D plans and Medicare Supplemental Insurance plans.
You’re also able to add on dental and vision coverage if needed or even a free fitness program! Partnerships with Walgreens and Walmart offer expanded drug coverage.
- Same day coverage available
5. Best for Medicare Supplemental Insurance: UnitedHealthcare
UnitedHealthcare provides affordable, accessible Medicare Supplemental Insurance to bridge the gap between Original Medicare and your individual needs. The website provides a wealth of information to help you make the right choice for your situation.
Plans are easily customizable as well. UnitedHealthcare reviews praise caring, well-informed customer service representatives.
Get the Best Medicare Plan in South Dakota?
Comparison shopping is the best way to find the right Medicare plan for your needs. Read the fine print, ask questions and make a competent decision so you get the best coverage for you.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click to get a Medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.