Introduction to Medicare Part C in South Dakota (Medicare Advantage)

Medicare tries its best to give seniors the medical coverage they need in order to enjoy their retirement years in the best possible health. However, there are certain gaps in Medicare Parts A and B which, if you neglect to cover them, can end up costing you thousands. Thankfully, this is the reason that Medicare supplement insurance exists – to protect you from these coverage gaps. Medicare Advantage is one such form of supplement insurance. We’ll discuss the pros and cons of Medicare Advantage in this article.

Federal Regulations for Medicare Advantage

Some people refer to Medicare Advantage as a “Medicare replacement” policy. This is not far from the truth. These policies are sold by private health insurance companies which provide coverage that is equal to or better than Original Medicare. This minimum level of coverage is required by federal law. Once you purchase an Advantage plan, the government will no longer pay out claims on your Medicare-related procedures. That responsibility of your new health insurance company.

Medicare Advantage Enrollment In South Dakota

Of all the seniors in South Dakota which are enrolled in Medicare, only about 15% have replaced those benefits with a Medicare Advantage plan. Of these, take a look at the chart below to discover which Advantage plans are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in South Dakota, as opposed to somewhere like Florida or New York, will have you paying dramatically different rates. There are many other circumstances, such as age, weight, and current health status, which will influence your specific monthly premium.

Most Popular Medicare Advantage Plans in South Dakota

The popularity of Advantage plans is significantly influenced by price. As you can see, HMOs are much more popular than the others. It should come as no surprise that they are also the most affordable plans. PPOs and PFFS plans are more costly, hence less popular. The differences in price are directly related to each plan’s provider network.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Your provider network determines where, when, and how you can get the medical care you need. Smaller, less expensive networks (like HMOs) will limit where you can get care, and there are expensive penalties for seeking care outside of the network. Larger networks, like PPOs or PFFS plans, are more expensive but give you more options as far as doctors and hospitals go.

Doctor/Providers List

Drug, Vision and Dental Coverage

Despite the hassle of provider networks, Medicare Advantage plans have a strength when it comes to ancillary coverage options. You have the option to add dental, vision, and/or prescription drug coverage (under an MAPD plan) to your policy. With most other supplements, you would be purchasing those coverages either separately, or not at all.

Enrollment Options & Best Time To Enroll

Are you within your IEP, or is your IEP approaching soon? If so, then you’re in luck. Enrolling in Medicare during your IEP virtually guarantees you coverage with little hassle. And when you enroll in a Medicare Advantage plan during the same time frame, it will be much easier to get approved. You are more likely to run into trouble if you enroll after your IEP has expired, if you are outside of your Special Enrollment Period, or if you have a serious medical condition such as ESRD. However, your state department of insurance or your local insurance agent may be able to help you get covered. For more information, you can also take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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