South Dakota seniors 65 and older should be getting ready to enroll in Medicare if they haven’t started the process already. Original Medicare, which is the basic plan that all seniors are eligible for, Includes Medicare Part A and Medicare Part B. These two parts will take care of most of your treatment needs, from basic doctor appointments and outpatient procedures to hospital stays and services.
Because most seniors 65 and older are thought to be retired, and therefore living on a fixed income, Medicare benefits are designed to be as affordable as possible. Part B comes with certain fess, which are listed here, and are calculated based on your income. Your Part A benefits could be free, but that all depends on your employment history. Anything less than 10 years (or 40 quarters) cumulative, and you will have to pay additional fees in order to gain access to Medicare Part A.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
In total, there are approximately 141,079 individuals participating in the Medicare program within the state of South Dakota. Of those, only 15% (21,162 seniors) are supplementing their Medicare benefits with a Medicare Advantage policy. Medigap supplement insurance, however, is a much more popular option – 48% of beneficiaries have chosen to protect themselves from the gaps in Traditional Medicare coverage with these simple, affordable supplements. The remaining 52,199 beneficiaries (37%) are either supplementing their healthcare needs with some sort of employer benefit program, or aren’t protecting themselves from potentially costly Medicare coverage gaps at all.
While supplementing your coverage is easy, it does require that you enroll in Medicare first. For more information on Medicare enrollment, click the link provided.
Just to be clear, supplemental coverage is not required – purchasing a policy is completely optional. But if you don’t, you might leave yourself vulnerable to Original Medicare coverage gaps. The chart below outlines some (but not all) of these gaps, and if you aren’t covered, you could end up paying full price for certain medical treatment:
|Medicare Part A Costs||Medicare Part B Costs|
To avoid these potential expenses, many seniors choose to supplement their coverage with either a Medicare Advantage policy, or a Medigap supplement. Either plan can protect you from coverage gaps, but each type of plan will have its own pros and cons as well. Below, we’ll talk about each plan in detail.
Adding a Medigap supplement plan to your current Medicare benefits is a simple, affordable way to protect yourself from coverage gaps. These policies are specifically designed with Traditional Medicare gaps in mind to make sure you get exactly the coverage you need. You won’t be expected to pay additional fees, premiums, or deductibles for excess coverage that you don’t want. Each of the ten available plans offer identical benefits, regardless of your location. Therefore, supplement providers and prices may vary from state to state, but your benefits will stay the same.
Take a minute to familiarize yourself with the benefits offered by each plan:
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$81||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$116||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$86||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$98||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$88||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$115||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$54||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$71||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$48||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$102||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Whether you call it “Medicare Advantage”, “Medicare Part C”, or “Medicare Replacement”, you can replace your Original Medicare benefits by purchasing one of these copycat policies from a private health insurance company. To ease some of your fears, you should know that these policies, even though they are being offered by a private institution, cannot legally give you any less coverage than Traditional Medicare. They have to offer you “equal or better” benefits. And, sometimes, the “better” can come in the form of extra coverage, such as prescription drug benefits. However, adding such coverage to your policy will likely increase your rates.
But before you get on board with a Medicare Advantage plan, make sure to do a little research first. This is especially important if you are particularly attached to your current doctor. In order to keep costs down, most Medicare Advantage networks are very selective about which practitioners they will allow you to see. If you don’t want to be forced to switch doctors, make sure you find an Advantage plan that will accept your current practitioner.
Consumers should be aware that Medicare Advantage plans provide care through HMO and PPO (Health Maintenance and Preferred Provider Organizations) networks. Getting care outside of your network is often difficult and expensive.
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating||There are no plans to show|
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||Coventry Total Care (PPO)||Health and Drug||$0.00||$0|
|$0||Coventry Advantra Platinum (PPO)||Health and Drug||$0.00||$0|
|$576||HumanaChoice H6609-019 (PPO)||Health and Drug||$48.00||$310|
To clear up the confusion about the difference between these two policies, we’ve compiled the following chart with some of the most frequently asked quesitons:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
Do you still have questions about Medigap supplement and Medicare Advantage policies? If so, we know some experts who can help you out. Feel free to use our directory, included here on this page, to find contact information for local Medicare insurance offices near you.
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