Medicare in South Dakota
Key Takeaways
- Adults over 65 qualify for Medicare in South Dakota. Adults under 65 may also enroll in Medicare if they receive Social Security benefits or have a qualifying disability.
- Medicare in SD is not free. However, there are several federal and state assistance programs available to offset the cost of healthcare coverage.
- If you have health insurance through your employer, you don’t have to enroll in Medicare at 65. When your employer insurance ends, you have a Special Enrollment Period to enroll in Medicare without penalty.
Home to Mount Rushmore and the stunning badlands, South Dakota has a lot to offer. Whether you live in Rapid City, Sioux Falls, or somewhere in between, you have incredible man-made and natural places to explore.
When you’re ready to explore your South Dakota Medicare options, GoHealth can help. We’ll answer all your questions so you can find the perfect Medicare plan.
What Are the Parts of Medicare?
Your Medicare plan options vary, each with different premiums and benefits. Medicare Part A and Medicare Part B provide coverage towards the hospital and medical costs. You can enroll in a Part D prescription drug plan along with Original Medicare.
Medicare Supplement plans, or Medigap plans, help beneficiaries cover out-of-pocket expenses associated with Original Medicare, such as copays, coinsurance, and deductibles.
Medicare Part C plans, also called Medicare Advantage, includes Parts A, B, usually Part D, and may offer additional benefits like vision, dental, and hearing.
Your Ideal Medicare Plan is out there.
What Coverage Do you Get with Medicare?
Each of these Medicare plans in South Dakota will cover different healthcare services.
- Medicare Part A covers hospital care like inpatient hospital visits, short-term nursing home care, and home health care.
- Medicare Part B covers medical care and basic preventative services. This includes screenings and lab work, outpatient care, ambulance services, durable medical equipment like walkers, and other services.
- Medicare Part C, also called Medicare Advantage, combines the benefits you get with Original Medicare. These plans may also cover Part D. and you’ll only need one Medicare card. Medicare Advantage plans can include dental, vision, and hearing coverage.
- Medicare Part D provides prescription drug coverage. Costs and coverage depend on the plan you choose.
- Medicare Supplement plans can help you fill in the gaps in Original Medicare coverage. With a Medicare Supplement (Medigap) you will still need a stand-alone Part D plan. Medigap plans help cover out-of-pocket costs like coinsurance, copayments, and deductibles.
What Are the Requirements to Qualify for Medicare?
U.S citizens aged 65 and older are eligible for Medicare. You can enroll in Part A even if you’re still working. Legal permanent residents who have lived and worked in the U.S for at least five years are eligible for Medicare. Individuals with certain disabilities may also qualify.
Wondering how to first enroll in Medicare? The best time to enroll is during your Initial Enrollment Period (IEP). This is a seven-month period that starts three months before your 65th birth month.
Find the Medicare Plan that works for you.
How Do you Qualify for Medicare if you are Under 65?
Individuals who are under 65 can qualify for Medicare in certain circumstances. Younger people who receive social security benefits or who have a disability can enroll in Medicare.
- If you’ve received Social Security and Railroad Benefits for more than 24 months, you may qualify for Medicare before you’re 65.
- You will qualify for Medicare under 65 if you have a disability such as Lou Gehrig’s disease (ALS).
- If you have end-stage renal disease (ESRD), you can qualify for Medicare.
Does the State Pay for Medicare?
South Dakota doesn’t pay for Medicare. However, state-based programs like the State Health Insurance Assistance Program (SHIP) help low-income adults cover the cost of Medicare. Other programs like Medicare Extra Help and the Medicare Savings Program may offset the costs associated with Medicare coverage.
Is Medicare Free at 65?
Medicare is not free, and most Medicare plans in South Dakota have monthly premiums. There are programs available to help people with low-income access to healthcare. For example, if you qualify for both Medicare and (certain levels of) Medicaid, you are considered dual eligible. You can enroll in Medicare Advantage South Dakota, and Medicaid will help you access healthcare services at lower or no cost.
Low-income individuals can receive additional support with the Medicare Savings Program. It covers the cost of Original Medicare premiums, deductibles, copayments, and coinsurance.
Need help paying for medications? Medicare Extra Help provides state assistance for prescription medications. The program lowers your Medicare Part D premiums and caps out-of-pocket costs.
What Medicare Plans Are Required at 65?
If you’re turning 65, you’ll need to enroll in Medicare Part A. If you’ve paid Medicare taxes for at least 10 years, you can receive Part A with no monthly premium. Most people will also want to enroll in Part B and D.
After enrolling in Original Medicare, you are able to get a Medicare Advantage plan, if you choose.
If you miss your Initial Enrollment Period, you will have to pay enrollment penalties. If you don’t enroll in Original Medicare Part B when you’re first eligible, you may have higher Part B premiums when you enroll later.
Do you plan to work past 65? If you have employer benefits, you are not required to enroll in Medicare at 65. When your employer benefits end, you will be granted a special enrollment period (SEP) so you can enroll in Medicare with no penalties.
My Medicare coverage doesn’t address all of my needs.
Who Has the Best Medicare Advantage Program?
Each person has different healthcare needs, so take some time to explore your Medicare Advantage and Part D plan options. As you research Medicare you’ll want to consider:
- What plans are available in your area. Plans vary by county and provider.
- The Medicare Star Rating. Medicare plans in South Dakota with a four- or five-star rating have received positive reviews from plan members.
- Your health needs. Carefully consider your healthcare needs and prescription needs.
- If your doctor and pharmacy are in-network. You’ll want to choose a Medicare plan that’s accepted by your primary doctor.
What Is the Downside of Medicare Advantage?
Medicare Advantage in South Dakota provides comprehensive Medicare coverage, but it may not be right for everyone.
One downside is that Medicare Advantage in South Dakota doesn’t offer flexibility when accessing care out of state. If you need a larger network or want to visit a specialist without a referral, you may want to enroll in Original Medicare.
There are great benefits to enrolling in a Medicare Advantage plan. These plans cover all the same benefits as Original Medicare, and you’ll only need one Medicare card. You’ll also enjoy extra benefits not available with Original Medicare, which may include Part D coverage, dental, vision, and hearing coverage, and even fitness programs.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 171,230 people are enrolled in Medicare Part A and B in South Dakota. The total number of beneficiaries enrolled in Medicare Advantage increased from 39,501 to 44,048 year over year. Medicare Advantage participation in South Dakota went from 23.70% to 25.72% year over year. If you’d like to dive deeper into how Medicare in South Dakota breaks down across the state, we provide a glance at who is using Medicare and how.
171,230 Beneficiaries with Part A & Part B
44,048 Medicare Advantage Beneficiaries
25.72% Medicare Advantage Participation Rate
53.03% Female
46.97% Male
91.23% Non-Hispanic White
0.47% African American
0.79% Hispanic
7.52% Other/Unknown
14.46% Eligible for Medicaid
0.86 Average HCC Score
$9,228.07 Actual Per Capita Costs
15.20% Hospital Readmission Rate
23.54% % of Beneficiaries with an Emergency Department Visit
39,501 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
23.70% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
South Dakota Department of Labor and Regulation
https://dlr.sd.gov/insurance/
What should I know about the SD Department of Labor and Regulation?
If you purchased insurance in SD for yourself or your family and have questions, you can contact Labor and Regulation.
South Dakota Medicaid Program
https://dss.sd.gov/medicaid/
What should I know about the SD Medicaid Program?
If you’re having a difficult time with healthcare costs or want to know if you’re eligible for Medicaid, contact SD Medicaid.
South Dakota Department of Veterans Affairs
https://vetaffairs.sd.gov/
What should I know about South Dakota Veterans Affairs?
If you are a veteran and have questions about health and programs, contact Veterans Affairs in SD.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in South Dakota about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status