Finding the right Medicare plan, including original Medicare and Medicare Advantage, can help you strike the right balance between coverage and cost.

Whether you’re learning about Medicare for the first time, or want to reevaluate your coverage needs in 2020, researching Medicare South Dakota can help you make the best decision for your healthcare needs and budget.

There are a number of Medicare plans in South Dakota, including government funded and privately funded plans. To decide on the coverage level you need, take a look at the different Medicare plans in South Dakota.

Original Medicare (parts A and B)

Basic Medicare coverage, referred to as original Medicare, is separated into two parts: Part A and Part B. If you qualify for Social Security or Railroad Retirement Board (RRB) benefits, you’ll automatically be enrolled in Part A on your 65th birthday.

Together, Medicare parts A and B cover:

  • inpatient hospital care
  • outpatient hospital care
  • X-rays and lab tests
  • doctors’ appointments
  • preventive services
  • durable medical equipment such as wheelchairs
  • some, part-time home care
  • hospice care

Medicare Advantage plans (Part C)

Medicare Advantage plans in South Dakota offer a variety of coverage. These plans are delivered by private insurers who’ve been approved by Medicare South Dakota. These all-in-one plans will provide coverage for:

  • original Medicare (parts A and B) hospital and medical coverage
  • prescription drug coverage
  • supplemental coverage for services such as vision, dental, or hearing

Prescription drug coverage (Part D)

Prescription drug coverage, also known as Part D, is offered by private health insurance companies. Part D provides assistance for costs of medications and vaccines.

Part D can be added to your original Medicare South Dakota coverage. Each drug plan has a list of covered prescriptions, so make sure your medications are covered by the plan you want to select.

Medicare Supplement (Medigap)

Medicare Supplement coverage, also called Medigap, is offered by private insurance companies. There are 10 plans to choose from. Even though the plans are sold by private companies, each plan’s coverage is the same nationwide. For example, plan A offers the same benefit in every state.

Medicare Advantage and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).

Healthline

Medicare South Dakota approves private health insurance carriers to provide Medicare Advantage plans in South Dakota. The following carriers offer one or more Medicare plans in South Dakota, and each has different coverage options and premiums.

  • Medica
  • Humana
  • Coventry Health and Life
  • Harken Health
  • Sierra Health and Life
  • CHA HMO
  • Aetna
  • Good Samaritan Insurance Plan of South Dakota
  • Anthem

Available Medicare Advantage plans in South Dakota may vary by county. When searching for Advantage plans, make sure the plans you’re considering are all available in your zip code and county.

You’ll be eligible for Medicare South Dakota if you are are a U.S. citizen or permanent resident and fit one or more of these qualifications:

  • You are 65 years old or over.
  • You are under age 65 and have a chronic condition, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
  • You are under age 65 and have received Social Security disability benefits for 24 months.
  • You are receiving or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board.

You can enroll in Medicare plans in South Dakota through the Social Security Administration, and if you’re already receiving Social Security benefits you’ll automatically be enrolled in original Medicare South Dakota. If you don’t qualify for Social Security, or want to enroll in an Advantage Plan, there are several enrollment periods for Medicare plans in South Dakota.

Initial enrollment period

You can enroll in Medicare South Dakota during your initial enrollment period (IEP). This is a seven-month period that begins three months before your 65th birthday. It includes the month of your birthday and continues another three months after your birthday. While you do have seven months to consider plans, it’s best if you enroll during the three months before your birthday. Enrolling after your birthday will result in a delay in coverage.

General enrollment period (Jan. 1 to March 31)

If you didn’t sign up for Part D or an Advantage plan during your IEP, you can change your coverage during the general enrollment period from Jan. 1 to March 31. During this time, you can also enroll in original Medicare South Dakota.

Open enrollment period (Oct. 15 to Dec. 7)

During the open enrollment period you can reevaluate your Medicare coverage, or apply for Part D or Medicare Advantage plans in South Dakota. You can also switch between Part C plans. This period lasts from Oct. 15 to Dec. 7, and any changes will take effect Jan. 1.

Special enrollment period

A special enrollment period can be granted if you meet one of the following criteria:

  • You have recently lost employer healthcare coverage.
  • You moved into or out of a retirement home.
  • You moved out of the range of coverage of your current plan.

Special enrollment will allow you to enroll in original Medicare or an Advantage plan outside of the normal enrollment periods.

There’s a lot of information to get through when comparing Medicare plans. You’ll need to decide if you need Part D coverage or want to consider Medicare Advantage plans.

Follow these tips to narrow your search, and find a plan that matches your needs and your healthcare budget:

  • Call your doctor’s office to inquire about the insurance providers they work with. Compare plans that are accepted by your primary doctor. Not all physicians will accept Medicare payments, and Medicare Advantage plans in South Dakota work with specific lists of in-network doctors.
  • Make a comprehensive list of all your medications. If you’re comparing Part D or Advantage plans, check your list against the covered medications. Make sure the plan you select will provide the best drug coverage, and lower your out-of-pocket costs.
  • Look for a plan that will provide adequate coverage for all your healthcare needs. Do you have a lot of additional healthcare expenses such as vision or hearing care? Do you need coverage for specific medical equipment?

You can find more resources for Medicare plans in South Dakota through these state organizations:

  • Senior Health Information & Insurance Education. Visit SHIINE to learn more about Medicare, access SHIP counseling, and get help in your area. 800-536-8197.
  • South Dakota Department of Social Services. Learn more about Medicare, Medicaid, and Long Term Care Support. 605-773-3165.

Carefully consider the Medicare coverage you need in 2020, whether original Medicare, an Advantage plan, or a prescription drug plan.

  • Make a list of the plans that provide the right drug coverage, fit your budget, and are accepted by your doctor.
  • Use Medicare’s plan finder to compare these plans, and decide which one will give you the best coverage.
  • Call Medicare or the private carrier to begin the enrollment process.