Medicare plays a key role in providing health and financial security to beneficiaries residing in South Dakota. With more than 178,800 South Dakota beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in South Dakota. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in South Dakota?

Medicare covers most South Dakota residents who are 65 or older, and it also covers disabled South Dakota residents. Medicare enrollment in South Dakota works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, 80% of your health care costs will be covered.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

South Dakota Medicare Enrollments

137,724

Original Medicare Plans
(Part A and B)

41,105

Medicare Advantage & Other Health Plans

109,299

Stand-alone Medicare
Part D (Drug plans)

178,829

Total Medicare Beneficiaries
in South Dakota

South Dakota Medicare Advantage Plans (Part C)

Nearly 21% of South Dakota Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in South Dakota who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 41,105 beneficiaries enrolled in Medicare Advantage and other plans in South Dakota. Nearly 21% of South Dakota Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 16 Medicare Advantage plans are available in South Dakota. The average monthly Medicare Advantage premium is $54.22 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in South Dakota. Depending on the county, beneficiaries in South Dakota can select from among at least seven Medicare Advantage plans, and up to 21 plans.

South Dakota Medicare Supplement (Medigap) Insurance Plans

Medicare beneficiaries in South Dakota who are under the age of 65 have the same Medigap open enrollment period as beneficiaries who are gaining access to Medicare due to age.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

South Dakota Medigap insurance is available to everyone with Medicare in the state, including those who are under 65 and are enrolled in Medicare. Often, Medigap plans in South Dakota can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B

During this period, an insurance company can’t use medical underwriting. 

There are currently 49 insurers licensed to sell Medigap plans throughout South Dakota. Medicare beneficiaries in South Dakota who are under the age of 65 have the same Medigap open enrollment period as those who are gaining access to Medicare due to age.

South Dakota Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 109,299 Medicare beneficiaries in South Dakota enrolled in stand-alone Part D prescription drug plans and 17,172 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 29 stand-alone Part D plans available in South Dakota, with premiums ranging from about $15 to $94 per month. About 20% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in South Dakota

  • Senior Health Information and Insurance Education (SHIINE) is a federally funded program through the Administration for Community Living (ACL) and administered by the South Dakota Department of Human Services Division of Long Term Services and Support (LTSS). SHIINE Regional Coordinators are located in three different regions of the state to assist Medicare beneficiaries, support local volunteer counselors, recruit new volunteers, and provide local SHIINE promotion.
    Contact: Call the Eastern South Dakota office toll-free at 1-800-536-8197, the Central South Dakota office at 1-877-331-4834, and the Western South Dakota office at 1-877-286-9072.

  • South Dakota’s Department of Social Services (DSS) offers an array of social service resources that includes providing information and enrollment for Medicaid, information on Medicare prescription drug coverage, and links to plan-finding portals and further avenues of support.
    Contact: Call 605-773-3495 or fill out an online contact form on the website.

  • Dakota at Home, operating under the oversight of the South Dakota Department of Human Services, is the state’s Aging and Disability Resource Center (ADRC). Dakota at Home provides free objective information, referral, and assistance to individuals regardless of age, disability, income, or resources. Dakota at Home also provides counseling and information about services and assistance available through Medicare.
    Contact: Call 1-833-663-9673

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of South Dakota. Our process makes it easier for you to access your Medicare eligibility in South Dakota so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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