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Medicare in South Dakota

October 6, 2016

As a Medicare beneficiary in South Dakota, you might want to take note of the choices you have in relation to how you receive your Medicare benefits. There’s Original Medicare, Part A and Part B, which is administered by the federal government’s Centers for Medicare & Medicaid Services (CMS). You can complement the coverage you receive from Original Medicare by enrolling in a stand-alone Medicare Part D Drug Plan and/or purchasing a  Medicare Supplement (Medigap) plan, which covers some of the “gaps” in Original Medicare. Furthermore, you may choose to receive Medicare benefits through an alternative means, by enrolling in a Medicare Advantage plan, with or without Medicare prescription drug coverage. If you choose a Medicare Advantage plan or a stand-alone Medicare Prescription Drug Plan, you are receiving Medicare benefits from a private Medicare-approved insurance company, rather than directly from the government program. Similarly, Medicare Supplement plans are offered by insurance companies. You can learn more about these options below.

Original Medicare for South Dakota beneficiaries

Original Medicare, Part A (hospital insurance) and Part B (medical insurance) is available for all United States citizens age 65 or older, as well as those age 65 or older who’ve been a legal permanent U.S. resident for at least five years. People under age 65 may be eligible for Medicare in South Dakota (as in all states) if they have certain qualifying disabilities.

In South Dakota, as in other states, if you’re under 65 and have a disability, you’re automatically enrolled in Part A and Part B after you have been receiving Social Security or Railroad Retirement benefits for 24 months. If you have certain health conditions, such as end stage renal disease (permanent kidney failure) or ALS (also called Lou Gehrig’s disease) you can get Medicare benefits at the time you receive Social Security or Railroad retirement benefits.

Not every beneficiary is enrolled in Medicare automatically. Some South Dakota residents may have to apply manually, and this can be done by visiting your local SSA office, or by registering online. You can also enroll over the phone:

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. Representatives are available Monday through Friday, 7AM to 8PM.
  • If you worked for a railroad, call the RRB at 1-877-772-5772. TTY users should call 1-312-751-4701. Representatives are available Monday through Friday, from 9AM to 3:30PM.

Whether you are automatically enrolled or enrolled manually, you should receive your red, white, and blue Medicare card in the mail approximately three months before your coverage begins. This is accompanied by a “Welcome to Medicare” packet that will help familiarize you with the program.

Medicare plan options in South Dakota

You may choose to enroll in a Medicare plan in addition to Original Medicare, or you may choose to get your Medicare benefits through Medicare Advantage as described below. The following plan types are available from private, Medicare-approved insurance companies. As such, costs may vary by the company offering the plan and by the coverage included in the plan. You may have a number of choices among insurers and plan types that are available where you live in South Dakota.

Medicare Part C, also known as Medicare Advantage, refers to Medicare coverage  offered by private insurance companies that have contracted with the Medicare program.  By enrolling in a Medicare Advantage plan you receive your Medicare Part A and Part B benefits through the plan (with the exception of hospice care, which continues to be covered by Medicare Part A). These plans provide at least the same amount of coverage as Original Medicare, Part A and Part B, and may include additional benefits, like dental care, routine vision, and prescription drug coverage. By enrolling in a Medicare Advantage plan that includes prescription drug coverage (Medicare Advantage Prescription Drug plan), you receive your health and prescription drug coverage from a single plan. Benefits can vary by plan. To enroll in a Medicare Advantage plan, you must already be enrolled in Medicare Part A and Part B, and reside in the plan’s coverage area. You will also continue paying your Medicare Part B premium because you remain enrolled in the Medicare program no matter how you choose to receive your benefits.

You can get more information about by clicking Medicare Advantage in South Dakota.

Medicare Part D is the federal program for prescription drug coverage. It’s available from either a Medicare Advantage plan that provides drug coverage (Medicare Advantage Prescription Drug plan) or as a stand-alone Medicare Part D Prescription Drug Plan. Most prescription costs are not covered by Part A and Part B, which makes this type of coverage worth considering. Every Medicare plan offering prescription drug coverage includes a formulary, or a list of drugs covered by that plan. Covered prescription drugs in the formularies  may vary among plans and they may change. (If you enroll in a Medicare plan that provides prescription drug coverage, the plan will notify you of changes in its formulary, as necessary.) Because of the differences in cost and coverage among Medicare plans offering prescription drug coverage, it is beneficial to compare all plans in your area. Keep in mind you may enroll in a Medicare Advantage Prescription Drug plan if you have Part A and Part B. You may enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Part A and/or Part B. To learn more, you may want to refer to Medicare Part D in South Dakota.

If you decide to stay in Original Medicare (Part A and Part B), you may also have another option, which is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. To learn more, see Medigap in South Dakota.

South Dakota resources for Medicare beneficiaries

Before you enroll in a Medicare plan, you may want to consider all of your options so that you can make an informed decision. Medicare beneficiaries in South Dakota can access Medicare.gov’s list of available resources relating to health care. The Medicare-specific options are available below. If you have any questions, don’t hesitate to use these resources to get the answers you need.

  • State Health Insurance Assistance Program |Website
  • National Institute on Aging Information Center |Website

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