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Medicare Advantage Plans in South Dakota
Medicare Part C enrollment has nearly doubled over the past decade thanks in large part to greater plan availability and expanding benefits. More commonly known as Medicare Advantage (MA), 2019 saw more than 22 million people enrolled in an MA plan. This page explains Medicare Advantage plans in South Dakota, how the program works, and what to look for when comparing your options.
What Is Medicare Advantage in South Dakota?
Every South Dakota Medicare Advantage plan must provide the same coverage you have with Original Medicare. This includes:
- Medicare Part A: Pays for covered inpatient services that you'd receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B: Covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more
Prescription drug coverage is provided by Medicare Part D, not Original Medicare.
Medicare Advantage plans are not limited to the benefits you get with Parts A and B. In fact, over 90 percent of them offer additional coverage. The most common items are:
- Fitness programs
- Hearing aids
- Prescription drug coverage
- Routine vision services
- Routine dental care
Even if you join an Advantage plan, you're still responsible for the Medicare Part B premium.
South Dakota Medicare Advantage Plans with Prescription Drug Coverage
South Dakota's Medicare Advantage Prescription Drug plans (MA-PD) combine the benefits of Medicare Parts A, B, and D into a single plan.
To avoid the Medicare Part D late enrollment penalty (and get help paying your prescription costs), you must have creditable prescription drug coverage. (Creditable means a plan that is comparable to Medicare.) If your preferred Advantage plan doesn't cover prescriptions AND you don't have creditable coverage elsewhere, you need to join a standalone Medicare Part D plan.
How Do You Qualify for Medicare Advantage in South Dakota?
Once you sign up for Medicare Parts A and B, you qualify for a Medicare Advantage plan in South Dakota.
American citizens and permanent legal residents become eligible for Medicare when they turn 65. Enrollment in Parts A and B is only automatic if you started collecting Social Security benefits at least 4 months before turning 65. Everyone else needs to apply for Medicare.
You can qualify for Medicare before you turn 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically during month 25.
When Can You Sign Up for a Medicare Advantage Plan in South Dakota?
You may first join a Medicare Advantage during your Initial Enrollment Period (IEP). It starts 3 months before your Medicare eligibility month and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits is in June, your IEP runs from March 1 through September 30.
The General Enrollment Period is between January 1 and March 31. It is for anyone who did not sign up for Medicare Part A and/or Part B during their IEP. Once General Enrollment ends, you have from April 1 through June 30 to join an Advantage plan.
Current beneficiaries can sign up for a Part C plan during the Medicare Annual Enrollment Period (AEP) that occurs every year from October 15 until December 7.
If you're already in an MA plan, you may switch to a different one or move back to Original Medicare during the Medicare Advantage Open Enrollment Period from January 1 to March 31. If you to lose your prescription drug coverage after making that change, you can also join a standalone Medicare Part D plan.
You may be eligible for a Special Enrollment Period (SEP) if you experience certain life changes. Medicare.gov has the full list of qualifying special circumstances.
Types of Medicare Advantages Plans in South Dakota
Your South Dakota Medicare Advantage plan options are:
Health maintenance organizations account for over half of all MA plans. HMO plans help control costs with provider networks and rarely cover non-emergency care received from an out-of-network provider. If you join an HMO, you'll need to choose a primary care doctor and get a referral to visit a specialist.
Preferred provider organizations (PPO) also use provider networks but members can get out-of-network services for a higher copay. They also don't need a referral to see a specialist or a primary doctor.
Private fee-for-service (PFFS) plans set costs for covered services. Most use a provider network but are like PPOs in that they allow members to receive out-of-network care for a higher price. There is no requirement to choose a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people in one of the following populations:
- People who live in an institution, such as a nursing home, or require at-home care
- Those who are dual eligible, meaning they qualify for both Medicare and Medicaid
- Those who have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
Plans tailor benefits to meet their members' specific needs.
How to Choose a Medicare Advantage Plan in South Dakota
To get the best Medicare Advantage plan for your unique situation, consider the following:
- Costs: May include a yearly deductible, monthly premium, and copays or coinsurance.
- Coverage: The plan's benefits help put the premium in perspective. Don't forget to review the drug formulary of an MA-PD plan.
- Network: Any entity that provides healthcare services – doctors, labs, hospitals, etc. – may be included in the provider network.
- Ratings: Medicare rates plans on a variety of metrics and publishes its findings each fall before Annual Enrollment.
Our Find a Plan tool makes comparing Medicare Advantage plans in South Dakota easy. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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