What Are Medicare Advantage Plans in South Dakota?

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans bundle Medicare Part A (hospital care) and Part B (medical services) into one plan—and most include prescription drug coverage (Part D). Many also offer added benefits such as dental, vision, hearing, fitness programs, and telehealth services.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare (Parts A and B). Most people are eligible for Medicare enrollment at age 65, but you may qualify earlier due to disability, ALS, or ESRD. Key enrollment periods include:

• Initial Enrollment
• General Enrollment
• Special Enrollment (triggered by life events)

Late enrollment may lead to penalties, particularly if you don’t qualify for premium-free Part A.

What Types of Medicare Advantage Plans Are Available in South Dakota?

South Dakota offers several Medicare Advantage (MA) plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at a higher cost and typically don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Allow you to see any provider who accepts the plan’s terms; some have provider networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, HIV/AIDS, or heart disease.
  • I-SNPs: For individuals living in institutions or needing nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those who qualify for both Medicare and Medicaid; often include drug, dental, and vision coverage at low or no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible plan with a savings account funded by your insurer.

Note: South Dakota also offers Medicare Cost Plans, available in limited areas with fewer than three insurers offering MA plans. These plans allow out-of-network care and let you switch back to Original Medicare at any time.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, exceptions apply:

• MSAs and some PFFS plans don’t include drug coverage.
• If your plan doesn’t include drug coverage:
  • You may enroll in a standalone Part D plan if eligible.
  • You could face penalties if you delay enrollment without other creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, understand Medicare Advantage costs:

• Premiums: Many MA plans have $0 premiums, though you still pay the standard Medicare Part B premium.
• Deductibles, Coinsurance, and Copays: Know your out-of-pocket costs for medical services.
• Out-of-Pocket Maximums: Protects you by capping annual expenses.
• Extra Benefits: Look for plans offering dental, hearing, vision, transportation, OTC allowances, and fitness programs.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: Starts 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Switch, join, or drop MA plans.
• General Enrollment (Jan 1–Mar 31): For those who missed initial enrollment.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment: For life changes like moving or losing other coverage.

What If You Want to Change Your Medicare Advantage Plan?

You can change your plan during:

• Annual Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in South Dakota?

• South Dakota SHIINE Program: Free counseling to help you choose Medicare coverage.
• South Dakota SMP Program: Educates beneficiaries on how to avoid healthcare fraud.
• South Dakota Division of Insurance: Handles insurance complaints.
• For low-income residents, South Dakota Medicaid may help with costs. Visit https://dss.sd.gov/medicaid/ or call 1-800-305-3064.
• Learn about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement plans, also known as Medigap, help pay expenses not covered by Original Medicare, such as copayments and coinsurance. You must be enrolled in Medicare Parts A and B.

• The best time to enroll is during your six-month Medigap Open Enrollment Period (starting when you enroll in Part B).
• Medigap plans don’t cover prescription drugs—you’ll need a separate Part D plan.
• There are 10 standardized plans; Plans G and N are among the fastest-growing.
• Medicare Supplement Plan G is the most popular choice as of 2023.
• Plan F is no longer available to those newly eligible after 2020.
• Plans vary by state, but all offer predictable costs and nationwide access to Medicare providers.

Learn more about Medicare Supplement Plans in South Dakota.

Next Steps

If a Medicare Advantage plan in South Dakota is right for you, start by comparing available options in your area. Review costs, networks, extra benefits, and be ready to enroll during your eligible period.