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.
Coverage and Benefits
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)
Medicare is a basic healthcare benefit available to anyone living in South Dakota over the age of 65. If you decide to enroll for Medicare coverage, you’ll be enrolled to receive Medicare Part A automatically. Part A coverage includes in-patient care, nursing facility care, hospice care and some outpatient care as well. If you’re interested in obtaining additional coverage for things like more outpatient care, better medical devices and enhanced home healthcare, you can do so by opting into Medicare Part B and paying a monthly premium.
If the coverage from Medicare Parts A and B isn’t enough, you can get additional medical coverage by going for Medicare Parts C or D as well. To qualify for these, you must already have Parts A and B. You can go for Medicare Part C to get added coverage items from a private insurance company to cover costs for things like vision or for dental care. Medicare Part D for prescription drug coverage.
The Different Types of Medicare Plans in South Dakota
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.
What Are “Coverage Gaps”, and Why Do I Need to Supplement Them?
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.
Residents in South Dakota often end up investing in additional coverage for Medicare because the cost of quality healthcare is ever climbing. For those situations when Medicare is leaving behind major expenses that have to be covered out-of-pocket, a supplemental health insurance policy like Medicare Advantage or Medicare Supplement, also known as Medigap, is a powerful solution. There are several options available and they can help reduce the risk of South Dakota residents getting stuck with a major health bill.
Unfortunately, coverage gaps are a common occurrence today in the healthcare system. If you need something like an extended stay in the hospital, extensive outpatient care or expensive medications, you could get stuck with a substantial bill. That’s why many people go for a supplemental insurance policy to help minimize that risk.
For most looking for enhanced Medicare coverage today, Medicare Advantage policies or Medigap policies are two of the best options to consider. Both offer serious benefits, but they each have their weak points as well. We break down their key differences below which should make it easier for you to pick a policy type that fits your situation well.
South Dakota Medicare Supplement Plans
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:
Top Medicare Supplement Plans in the Area
|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|
Medicare Advantage Plans in South Dakota
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.
Comparing Medigap and Medicare Advantage
Even though Medicare Advantage policies and Medicare Supplement (Medigap) policies are offered through private insurance companies, they are very different in how they work. The type of policy that you decide to go with can influence how you pay for healthcare costs, the types of medical coverages that you have, and where you go for treatment.
Generally, Medigap is considered to be the simpler of the two policies. When you have Medigap for healthcare costs it helps pay for the gaps Medicare can leave behind. Medigap pays toward additional costs that aren’t paid for by Medicare after Medicare pays the medical facility. You must pay for any remaining costs after Medicare and Medigap pay toward your healthcare.
Medicare Advantage is more complicated and can be confusing to understand, but these policies do offer additional coverage that Medicare Parts A and B don’t offer. There are co-pays to cover, deductibles and variable premium rates depending on the type of coverage that you get. You will have to work harder to figure out what you are paying for when it comes to your healthcare costs with a Medicare Advantage policy.
Another key difference between these two insurance types is the overall medical coverage that’s offered. Medicare Advantage plans offer coverage for items not included in Medicare Parts A and B, helping you to cover additional medical care costs that you would otherwise be paying all on your own. This could include additional inpatient or outpatient services, medical devices, prescriptions, vision coverage and more. Medigap is much more limited in what it covers. With a Medigap policy you only get coverage for Medicare Part A and B items, but you get extra coverage toward them. You’ll pay a premium each month in exchange for having some or all of your remaining medical costs covered so that you have less expenses to worry about when you really need medical care.
The last difference is how choosing Medicare Advantage or Medigap can influence where you are allowed to go for healthcare. With a Medicare Advantage policy, you are given a care network with specific doctors and hospitals that you are expected to go to. Being limited to a specific network can make it more difficult to get medical care, especially if you live in a rural area without many different hospitals to choose from. With Medigap you are free to go anywhere that accepts Medicare, which often means that you have more options to work with.
If you still aren’t sure which policy is right for you, our chart below has some common questions and answers about the difference between Medicare Advantage and Medicare Supplement (Medigap) policies. You can also speak with us about your options, get a free quote and have any additional questions that you have answered.
|Questions||Medicare Advantage||Medicare Supplement|
|How do these plans handle all the medical expenses?||When you have Medicare Advantage your insurance plan pays for your medical costs and then Medicare pays some and you pay the rest.||With a Medigap policy, Medicare pays its portion toward your healthcare costs and then Medigap pays its portion and finally you pay yours if any.|
|Is it necessary to pay for Medicare Part B still?||Yes||Yes|
|What will this policy cost me?||It’s difficult to give an exact amount or even a very accurate estimate of what your costs will be with a Medicare Advantage plan because of all the different potential coverage items you can get with this policy. Costs also change depending on the amount of healthcare you need.||Medigap policies will cost you a monthly premium and any remaining medical expenses that aren’t covered by the policy itself if any.|
|What coverage does this plan come with?||Medicare Parts A and B as well as any added items like vision and dental if you choose.||Just Medicare Parts A and B are covered. But Medigap helps cover the additional costs left by Medicare’s gaps.|
|Is budgeting simple when using this policy?||Not usually. If you need infrequent care this policy can be affordable, but a Medicare Advantage plan changes and is split up into deductibles, premiums and co-pays, that make it difficult to figure out what you are spending in total.||Budgeting is usually simple with a Medigap policy, especially with a comprehensive plan. You pay your monthly premium and your medical costs are covered from there.|
|Can I keep this plan forever, or can I lose it?||There’s is a chance you can lose an Advantage policy. There are review periods where a company can drop you off your current policy if they want to.||You are protected with Medigap and guaranteed to be able to keep your policy if you pay your premium and the insurance provider remains in business.|
|Is there a pre-approval process to go through first?||Yes, you will likely need to go through a pre-approval process to qualify for a Medicare Advantage policy.||No, you will qualify for a Medigap policy if you have Medicare already.|
|Am I limited to specific doctors or hospitals?||Sadly, you are limited to a network of specific providers and facilities.||Medigap is accepted anywhere Medicare is and Medicare is widely accepted by doctors and hospitals.|
|What type of plan is best for me?||Urban-living younger seniors with less frequent health requirements do best with Medicare Advantage plans.||Seniors with more frequent medical care needs or that live in rural environments with few providers do best with a Medigap policy.|
Additional South Dakota Medicare Resources
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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Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.