South Dakota Medicare Guide

Get free support from our licensed South Dakota Medicare Advisors. Schedule a free consultation or give us a call at (888) 604-0055 to get started.

This guide will help you understand what you need to know about Medicare in South Dakota to make informed decisions and get the most value from Medicare.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in South Dakota

• Medicare Eligibility and Enrollment Steps

• South Dakota Medicare Advantage Plans

• South Dakota Medicare Supplement Plans

• South Dakota Medicare Part D Plans

• Get help paying for Medicare in South Dakota

A Snapshot of Medicare in South Dakota

There are 185,000 South Dakota Medicare beneficiaries, making up 21% of the state’s total population. The majority of beneficiaries are on Medicare due to their age, but about 10% are on Medicare due to a disability. 12% of South Dakota’s Medicare enrollees also receive Medicaid benefits. When it comes to Original Medicare vs. Medicare Advantage (which we’ll explain more later), 74% of South Dakota beneficiaries stay on Original Medicare and 26% choose to enroll in a Medicare Advantage plan. 

South Dakota Medicare Eligibility and Enrollment Steps

Eligibility is the same for all US citizens. If you’re 65 or older, you are eligible for Medicare. You’re also eligible if you have certain disabilities like ALS or End-Stage Kidney Disease.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

When you first enroll, you’ll sign up for Original Medicare, which consists of Part A and Part B. If you’re already drawing from Social Security, then you’ll be automatically enrolled. Otherwise, you’ll apply during your Initial Enrollment Period (IEP). Your IEP is unique to your 65th birth month. It starts three months before the month you turn 65 and ends three months after it. 

Some Americans who are still working at 65 choose to delay their Part B enrollment and keep their work coverage. We recommend comparing Medicare to your employer coverage because it’s common for Medicare to provide better value. If you do choose to delay your Part B enrollment, just be sure you’re eligible for the Part B Special Enrollment Period so you don’t have to pay a Medicare late enrollment fee. 

2. Compare additional coverage options

Once you’ve enrolled in Original Medicare, you can choose to stay on Original Medicare or switch to a Medicare Advantage plan. We’ll explain more about each of these later on to help you make an informed decision. For now, just know that if you cannot be on both Original Medicare and Medicare Advantage. If you stay on Original Medicare, you can choose to add a Medicare Supplement (also commonly called Medigap) plan and/or a prescription drug plan to enhance your Medicare insurance. 

3. Get the most value from your Medicare

Once you’ve chosen the best Medicare insurance option(s) to meet your health and financial needs, you need to use your plan! Schedule your preventive visits and be sure to share your new plan information with your pharmacy to ensure you’re getting the most value from Medicare.

We also recommend that Medicare beneficiaries review their Medicare coverage each year during the Open Enrollment Period to be sure they’re still getting the best value. The Open Enrollment Period lasts from October 15 - December 7 every year, and during this time you can change your Medicare Advantage and/or prescription drug plan. Why would you want to switch from the Medicare coverage you chose that best fits your needs? Medicare plans change every year, and your healthcare needs can too! Furthermore, more plans may become available to you. While we often find people are on the best plan during the Open Enrollment Period, it can only help to shop around!

South Dakota Medicare Advantage Plans

There are 25 Medicare Advantage plans available in South Dakota, but pricing and availability vary by county. For example, Hanson County has 21 Medicare Advantage plans available and Campbell County only has 9.

Medicare Advantage plans replace Original Medicare and must provide at least the same amount of coverage. Most Medicare Advantage plans also provide Part D (prescription drug) coverage and a selection of additional benefits, which may include:

• Dental services

• Vision services

• Hearing services

• Flex spending cards

• Fitness perks

• Transportation services

• Meal services

Medicare Advantage plans offer some of these added benefits and charge low or no premiums. Note: you do still need to pay your Part B premium when enrolled in an Advantage plan. 

More coverage and benefits with no (or a low) additional cost sounds great. It’s important to know that these plans also have their disadvantages, including:

• Limited networks

• Preauthorization requirements

• High out-of-pocket costs

South Dakota Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement plans stack on top of them. Medicare Supplement (also called Medigap) was created to help fill the gaps in Original Medicare coverage. These plans help cover the 20% of costs that Original Medicare doesn’t, significantly reducing out-of-pocket costs. 

There are ten types of Medigap plans in South Dakota, each labeled by letters A-N. Each provides varying levels of coverage, and Medigap Plan G is the most comprehensive. With a Medigap Plan G, you won’t owe anything for Medicare-covered services once you’ve met your annual Part B deductible, which is quite low!

Compared to Medicare Advantage plans, Medigap plans have some important benefits, like:

• They allow you to see any doctor who accepts Medicare

• They don’t require prior authorization for Medicare-covered services

• They reduce your out-of-pocket Medicare expenses

When you enroll in a Medigap plan matters! The best time to enroll is during the first six months after your Medicare Part B effective date. This is called your Medigap Open Enrollment Period, and it’s one of a handful of guaranteed issue periods for Medigap plans. While you can enroll in a Medigap plan any time, enrolling during a guaranteed issue period is easiest. This is because, during guaranteed issue periods, insurance companies cannot ask you questions about your health history or deny your Medigap application. They also can’t charge you more based on your health history.

South Dakota Part D Plans

Most Medicare Advantage plans provide prescription coverage. If you’re on Original Medicare, you should get a standalone Part D (prescription drug) plan. There are 24 stand-alone drug plans in South Dakota. Like with Medicare Advantage with an average monthly premium of $28.92.

Even if you don't have any prescriptions when you first enroll in Medicare, we recommend enrolling in a low-cost Part D plan. This will ensure you avoid paying a Medicare penalty if you do need prescription coverage later in life!

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed South Dakota Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in South Dakota

There are three government programs for low-income individuals that can help you pay for Medicare-related costs.

South Dakota Medicaid and Medicare Savings Programs

Medicaid programs are jointly funded by the federal and state governments, and each state is responsible for operations. South Dakota Medicaid is run by the South Dakota Department of Social Services. South Dakota Medicaid provides the following support for its 65+ residents:

• Long-term care support

• Medicare Savings Programs

Medicare Savings Programs are provided nationwide by Medicaid programs to provide financial aid to low-income Medicare beneficiaries. There are three Medicare Savings Programs in South Dakota that can help individuals save up to $1,978.80 each year!

• The Qualified Medicare Beneficiary (QMB) Program pays for Medicare Part A and Part B premiums, deductibles, and coinsurance.

• The Special Low-Income Medicare Beneficiary (SLMB) Program pays for the Medicare Part B premium.

• The Qualified Individual (QI) Program pays for the Medicare Part B premium.

To get help determining if you’re eligible for Medicaid programs and applying for aid, reach out to our licensed South Dakota Medicare Advisors at (888) 604-0055.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage. Extra Help is also commonly called the Part D Low Income Subsidy (or LIS). 

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from South Dakota

• South Dakota pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you may still be eligible. Talk to one of our licensed South Dakota Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.