Medicare Advantage, also known as Medicare Part C, has continuously grown in enrollment. And it's no surprise; Medicare Advantage plans offer a number of different plans and benefits to suit a variety of needs.

What is Medicare Advantage in South Dakota?

All Medicare Advantage plans have to provide the same coverage you would get with Original Medicare (Parts A and B). This means you get inpatient services (Part A) and outpatient services (Part B) in a single policy. Prescription drug coverage is offered through Medicare Part D, though you can find MA plans that offer drug coverage.

Over 90 percent of Medicare Advantage plans offer additional coverage, such as:

  • Dental care
  • Drug coverage
  • Fitness programs
  • Hearing aids
  • Vision services

Remember that, even if you join a Medicare Part C plan, you still have to pay your Part B premium.

South Dakota Medicare Advantage plans with prescription drug coverage

Medicare Advantage Prescription Drug (MA-PD) plans combine Medicare Parts A, B, and D into a single policy.

If you do not get creditable prescription drug coverage (comparable to Medicare) elsewhere, it is best to sign up for a standalone Part D plan or an MA-PD plan. Otherwise, you risk paying lifelong late fees. If you want your drug coverage through an MA plan, make sure it is designated as an MA-PD.

How do you qualify for Medicare Advantage in South Dakota?

As long as you have signed up for Original Medicare, you qualify for Medicare Advantage. If you are an American citizen or a permanent legal resident, you become eligible for Medicare once you turn 65. You are only enrolled automatically if you started receiving Social Security benefits at least 4 months before you turn 65.

You may also be automatically enrolled if you qualify for Medicare before you turn 65, during your 25th month of receiving Railroad Retirement Board (RRB) or Social Security disability benefits.

When can you sign up for a Medicare Advantage plan in South Dakota?

There are a few times you are able to enroll in a Medicare Advantage plan in South Dakota:

  • Initial Enrollment Period (IEP): Your IEP is specific to you and begins three months before the month of your 65th birthday and lasts for the following three months.
  • General Enrollment Period (GEP): From January 1 through March 31, you can enroll in Original Medicare if you missed your IEP. You can sign up for an MA plan immediately after, between April 1 and June 30.
  • Medicare Annual Enrollment Period (AEP): If you are currently enrolled in Medicare, you can switch to Medicare Part C from October 15 through December 7.
  • Medicare Advantage Open Enrollment Period (OEP): Active Medicare Advantage enrollees can use the OEP (January 1 to March 31) to switch MA plans or go to Original Medicare. If these changes result in a loss of drug coverage, they may also sign up for Medicare Part D.

Missing these periods means you must qualify for a Special Enrollment Period (SEP).

Types of Medicare Advantage plans in South Dakota

Medicare Advantage plans come in specific options:

  • Health maintenance organizations (HMOs): Joining an HMO means you must choose a primary care physician and get referrals for any specialist visits. They have a provider network, with any non-emergency, out-of-network visits rarely being covered.
  • Preferred provider organizations (PPOs): These plans require no referrals, no primary care doctors, and allow you to receive out-of-network services for a higher cost.
  • Private fee-for service (PFFS): With set costs for covered services, these plans are similar to PPOs in that they also allow you to see out-of-network providers for a higher cost. They require no primary care physician or specialist referrals.
  • Special needs plans (SNPs): Membership for these plans are limited to those with chronic conditions, dual eligibility in Medicare and Medicaid, or people who require in-home care.

How to choose a Medicare Advantage Plan in South Dakota

There are several factors to consider as you compare Medicare Advantage plans. First and foremost is cost; calculate how your copays, deductible, and monthly premium will add up throughout the year to get a better idea of how much it will actually cost.

You also need to think about the coverage you need and how that might be affected by a provider network. Make sure your plan's benefits are the best you can get for your budget, and always check the formulary of an MA-PD plan. Check to see if the doctors and labs you currently visit are in-network, and if not, how close the network providers are.

Thankfully, Medicare publishes ratings for MA plans based on a number of metrics that allow you to see both what the plan offers and how others feel about it.

The easiest way to find and compare Medicare Advantage plans in South Dakota is with our Find a Plan tool. All you have to do is enter your location information and you're free to review all the plans in your area.

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