Medicare in South Dakota

In this article...
  • Take some time to educate yourself about Medicare in South Dakota. Learn about the plans and enrollment options so you can make a good decision about benefits.

What South Dakota Medicare Plans Are Available?

Medicare provides essential medical benefits for South Dakota’s 65-and-over population and individuals with disabilities. Through this federal program, nearly 180,000 state residents received health care coverage in 2020. Applicants who meet the program’s eligibility requirements may choose between two types of plans: Original Medicare or Medicare Advantage.

Original Medicare

In 2020, more than 139,000 South Dakota beneficiaries received benefits through Original Medicare. The program, which is administered by the federal government, is one of two options for Medicare enrollees. Original Medicare provides coverage through the following three components, which are purchased individually:

  • Part A: Medicare Part A, which is Medicare’s hospitalization component, helps beneficiaries cover expenses related to inpatient stays. Enrollees must seek care at Medicare-approved facilities, and coverage includes treatment, a semiprivate room, meal service and medically necessary supplies. Part A also covers hospice, skilled nursing and home health care.

  • Part B: Medicare Part B covers general medical expenses for care received in outpatient settings. This may include visits to physicians, routine physicals, diagnostic services and treatments for illnesses and injuries. Part B coverage also includes vaccinations, ambulance transport and some medical health care services.

Medicare Part D prescription drug plans may be purchased in conjunction with Parts A and/or B to provide coverage for prescription medications. Part D may also be added on to certain Medicare Advantage plans that don’t already provide prescription drug coverage. Copays and deductibles vary by individual policy.

Medicare Advantage

In 2020, more than 38,000 Medicare beneficiaries opted for a Medicare Advantage plan, otherwise known as Medicare Part C. These all-in-one plans are administered by private insurers who must adhere to strict Medicare guidelines. MA plans bundle coverage of inpatient and outpatient services and often include prescription drug benefits. Part C plans may also offer extras that aren’t available through Original Medicare, such as vision, dental and hearing coverage. 

Medicare beneficiaries enrolling in Part C have four main types of plans to choose from:

  • HMO: HMOs may offer services at a lower out-of-pocket cost, but members must receive care exclusively through in-network providers and facilities.

  • PPO: PPOs offer members a choice of in- or out-of-network care, with out-of-network services typically incurring higher costs.

  • PFFS: Beneficiaries who opt for a PFFS plan may seek care from any provider that agrees to the plan’s terms.

  • SNP: Individuals with specific medical needs or conditions may enroll in a Special Needs Plan, if a relevant plan is available in their location. These plans typically maintain networks that include specialists, facilities and drug formularies designed for the unique needs of its members. SNPs vary widely by region. 

Medicare Supplement Insurance

Although Medicare plans cover a percentage of the cost of many medical services, beneficiaries typically still have to pay deductibles and copays or co-insurance. Medicare Supplement Insurance, which is commonly referred to as Medigap, is designed to cover some or all of those expenses. This supplemental insurance, including South Dakota’s Med Select, is issued by private insurers and may be purchased during Medicare’s open enrollment period.

Who Is Eligible for South Dakota Medicare?

You’re eligible to receive health care coverage through Medicare the month you turn 65, but you may begin the enrollment process several months earlier. South Dakotans who are younger than 65 but have a disability or have been diagnosed with end-stage renal disease may also qualify for Medicare benefits and should contact their local Social Security office for information on eligibility requirements and how to apply.

Medicare Enrollment Periods

South Dakota residents who’ve been receiving retirement benefits through Social Security for at least four months will be automatically enrolled in Original Medicare when they turn 65. All other qualified individuals must sign up or make plan changes during one of Medicare’s enrollment periods: 

  • Initial Enrollment Period: During the 7-month initial enrollment period, qualified applicants may sign up for an Original Medicare or Medicare Advantage plan and a Part D prescription drug plan. This window includes your birthday month and the 3-month period before and after.

  • General Enrollment Period: If you didn’t sign up for a plan during the initial enrollment period, you’ll have another chance during the annual general enrollment period. The GEP also offers current Medicare Advantage enrollees the chance to switch to a different plan or return to Original Medicare. This enrollment window remains open between January 1 and March 31 annually.

  • Open Enrollment Period: Between October 15 and December 7, beneficiaries may switch between Original Medicare and Medicare Advantage. They may also purchase a Part D plan if they haven’t already done so.

  • Special Enrollment Period: SEPs are enrollment windows designed for individuals who’ve lost health care coverage through qualifying events such as a job loss or no longer qualifying for Medicaid. This 8-month enrollment period opens on the first day of the month after the qualifying event. Late-enrollment fees may be waived for applicants who qualify for a special enrollment period.

How Do I Enroll in Medicare in South Dakota?

If you don’t qualify for automatic enrollment, there are several simple ways to apply for Medicare benefits:

  • Submit an online application through the Social Security Administration’s website.
  • Call the Social Security Administration at 1-800-772-1213.
  • Complete an application in person at a regional Social Security office.

Contact Information for South Dakota Medicare, Medicaid and Insurance Help

South Dakota has several no-cost resources to help Medicare beneficiaries or other state residents seeking information on available health insurance options.

South Dakota Medicaid

Low-income South Dakota families may be eligible to receive health care insurance through the state’s Medicaid program. Questions should be directed to the South Dakota Department of Social Services, which oversees the program. The agency may be reached by calling (800) 597-1603.

SHIINE

South Dakota’s SHIINE program offers Medicare assistance and other insurance education programs to the state’s elder population. This federally funded program has three regional offices, where seniors may receive confidential health care counseling. For more information, contact the closest branch by phone at:

  • Eastern South Dakota: (800) 536-8197
  • Central South Dakota: (877) 331-4834
  • Western South Dakota: (877) 286-9072

South Dakota Division of Insurance

Through South Dakota’s Division of Insurance, state residents can learn more about Medicare and Medicaid. The site also maintains a comprehensive list of companies that sell health care insurance in the state. The agency may be reached by calling (605) 773-3563.

South Dakota Rx Card

This no-cost prescription drug program is available to all state residents. It provides discounts on medications at more than 68,000 pharmacies statewide. Additional information is available by visiting the South Dakota Rx Card website.

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