What You Need to Know
You must have Medicare Part A and B to buy a Medicare Supplement plan.
Medigap policies don’t include prescription drug coverage.
Three of the most popular Medigap policies are F, G and N.
Medicare is a federal health insurance program covering South Dakota residents age 65 or older, plus younger people with certain health conditions. Original Medicare, or Medicare Part A (hospital care) and B (outpatient care), offers many benefits but covers only about 80% of medical expenses. You’ll have to pay out-of-pocket expenses like deductibles, coinsurance, and copayments with no cap on your annual spending.
To pay the costs that Original Medicare doesn’t, you can buy a Medicare Supplement Insurance plan called Medigap from private insurance companies. Medigap policies, named by letters, are offered as standardized benefit packages. For example, Plan N provides the same benefits across different insurers, though the price may differ.
Insurers that offer Medigap policies to South Dakota Medicare beneficiaries under age 65 can’t charge more than someone who qualified at age 65 and is now age 75. 1 When those members reach age 65, they will have another Open Enrollment Period without such upcharges. 2
Medicare Select or Med Select is a managed-care version of Medigap that offers lower premiums. Plans are identical to the standardized Medigap plans, but you must use doctors and hospitals within the provider’s network to receive full insurance benefits, except in emergencies. You also may need to get a referral from a primary care doctor to see a specialist. 3 Two insurers, Avera Health, and Sanford Health, offer Med Select in South Dakota. 4
You can buy a cancer policy in conjunction with a Medigap policy. To be allowed, the cancer policy must pay regardless of whether Medicare pays. 5
Medigap policies are guaranteed renewable as long as you pay your premiums, which are in addition to your Medicare Part B monthly premium ($148.50 in 2021). They don’t include Medicare Part D prescription drug coverage. You’ll need to buy a separate Part D prescription drug plan.
When Can You Enroll in Medigap in South Dakota?
Your first chance to enroll is during your one-time Medigap Open Enrollment Period, also known as a Guaranteed Right Period. It’s also your best chance since your policy will have the lowest premium rate, and your health won’t impact your eligibility. This six-month period starts when you turn 65 and you enroll in Medicare Part B. You can buy any Medigap policy offered in South Dakota, regardless of your health condition.
You can buy Medicare Supplement Insurance outside of your Open Enrollment Period at any time, but you’ll go through health underwriting, and the company can legally refuse coverage or make you pay more.
You may have guaranteed issue rights at other times. For example, your employer group health coverage ends, or you’re leaving a Medicare Advantage plan for the first time during the 12-month trial. 6
Guaranteed issue rights offer you the same protections as if you were in your Open Enrollment Period. An insurer can’t refuse your application, must cover your preexisting conditions, and can’t charge you more than anyone else your age. 7
You may also have access to a Special Enrollment Period if you move, your coverage changes or you lose your plan through no fault of your own. You will have guaranteed issue rights for a short period.
When to Buy
The best time to buy a Medicare Supplement plan at the lowest price is during your Medigap Open Enrollment Period.
What Are the Most Popular Medicare Supplement Plans?
The most popular is Plan F because it provides the most benefits. It covers: 9
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayment
- The first three pints of blood
- Medicare Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Medicare Part A deductible
- Medicare Part B deductible
- Medicare Part B excess charges
- Foreign travel emergency costs, up to 80%
Plan F is one of only two plans covering excess charges from doctors who will treat you but who don’t accept Medicare assignment. They are allowed to charge up to 15% more than the Medicare-approved amount for those services.
Plan F isn’t available to people new to Medicare as of January 2020. But if you had another Medigap policy before January 2020, you may be able to switch to Plan F if you have a guaranteed issue right or meet the insurer’s underwriting requirements.
Plan G covers everything covered by Plan F except the Part B deductible (the reason Plan F was discontinued). It offers slightly lower premiums than Plan F.
Medigap Plan N covers everything covered by Plan G except for the Part B excess charges. You may owe a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in inpatient admissions.
Each letter plan offers the same coverage across companies, but insurers may charge different amounts for the same plan.
How Do You Choose a Medicare Supplement Plan?
Depending on the plan you choose, your Medicare Supplement plan will cover some, most, or all expenses not paid by Medicare. Decide which benefits you want and choose the plan that meets your needs from among Plans A through N. Not all insurance carriers offer all plans in South Dakota, so use the Medicare Plan Finder to see the options in your area.
Find two or three insurers that offer the plan you chose and compare their prices. Review companies’ performance through trusted friends and the South Dakota Division of Insurance at (605) 773-3563. It’s not easy to change Medicare Supplement providers, so you may be dealing with the company for many years.
An insurer will use one of three methods to calculate your premium each year. With “attained age,” prices increase as you age. With “issue age,” the premium is based on your age when you buy and won’t increase (aside from inflation and other factors). With “community” or “no age” premiums, everyone pays the same regardless of age. 10
How Much Do Medigap Policies Cost in South Dakota?
The pricing of Medicare Supplement plans in South Dakota can be affected by factors such as your age, gender, whether you use tobacco, marital status, and how you pay your premiums.
A nonsmoking woman living in Sioux Falls could buy Plan G for $93 to $351 a month at age 65, but it could cost $125 to $351 at age 75. A 66-year-old nonsmoking woman living in Rapid City could buy Plan B for $114 to $283. A man would pay $129 to $320. And a 70-year-old man in Pierre could get Plan N for $93 to $303 as a nonsmoker but $103 to $303 as a smoker. 11
What If You Want to Change Your Medigap Policy in South Dakota?
You may decide to change your Medicare Supplement plan because: 12
- You’re paying for benefits you don’t need.
- You want more benefits.
- You want to change insurance companies.
- You want a less expensive policy.
Unless you qualify for a Special Enrollment Period or a guaranteed issue right, you may face medical underwriting and possibly higher premiums.
To switch, find a new insurer or policy and apply. If your application is accepted, you can cancel your current policy. You have a 30-day “free look period” with a new policy. You may want to be sure you’re keeping the new policy before canceling the old one, even if it means paying double premiums for a month.
What Are Alternatives to Medicare Supplement in South Dakota?
The combination of Original Medicare and Medigap can be replaced with a Medicare Advantage (MA) plan, or Medicare Part C. In MA plans, private insurers usually bundle Medicare Part D prescription drug plans with Medicare Part A and B benefits, along with other coverage such as vision, dental, and hearing. MA plans generally restrict you to provider networks for coverage.
What Are Medicare Resources in South Dakota?
South Dakota offers several resources for you to learn more about Medicare coverage:
Senior Health Information and Insurance Education (SHIINE) is a federally funded program administered through the Department of Human Services that helps you understand your Medicare options and find the best coverage. For free, unbiased help, call (800) 536-8197 (Eastern South Dakota), (877) 331-4834 (Central South Dakota), and (877) 286-9072 (Western South Dakota).
South Dakota’s Division of Insurance is responsible for protecting the public and making insurance available and affordable. Call (605) 773-3563 for help.
Eligibility for South Dakota Medicaid services is determined by the Department of Social Services Division of Economic Assistance. Through the Medicare Savings Program, you can save up to $1,782 per year in premiums, deductibles, or coinsurance. 13 Call (800) 772-1213 with any questions.
If you’re about to enroll in Original Medicare and you’d like a Medicare Supplement plan, review your options and contact several insurance companies to compare prices for the plan you want.