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.

Medicare Plans in South Dakota

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 fees 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) is cumulative, and you will have to pay additional fees in order to gain access to Medicare Part A.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

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.

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 in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • Medicare pays 80%, you pay 20% out-of-pocket

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:

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.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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