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Medicare Advantage Plans in South Dakota


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About Medicare Advantage plans in South Dakota

South Dakota beneficiaries may have several Medicare options available to them, including Medicare Advantage plans. Also known as Medicare Part C, Medicare Advantage plans are another way to get your Original Medicare, Part A and Part B benefits. The difference is that instead of having your benefits administered by the federal program, you’ll get your Medicare coverage through your Medicare Advantage plan instead.

If you’re looking to expand your coverage beyond Original Medicare, Medicare Advantage plans may offer extra benefits outside of what’s covered by Medicare Part A and Part B. While all Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, many plans also cover additional benefits, such as routine dental or vision, hearing, or prescription drugs. Original Medicare doesn’t cover most dental, vision, or hearing services, and you’ll normally need to enroll in a stand-alone Medicare Prescription Drug Plan for help with prescription medication costs.

Medicare Advantage plans are available through private insurance companies that contract with Medicare, so plan availability may vary by location. There are several different types of Medicare Advantage plans available, including:

  • Health Maintenance Organization (HMO) plans: HMOs are a popular managed-care plan that provides health-care services through a provider network. You’ll need to use doctors and hospitals in the plan’s network to be covered (with the exception of emergency care). You’re required to have a primary care doctor and will need to get referrals for specialist care.
  • Preferred Provider Organization (PPO) plans: PPOs are another managed-care option that gives more provider flexibility. These plans have a preferred provider network that you can use, but you also have the option to go out of network as well. Your cost sharing will be higher with non-network doctors. You don’t need to have a primary care doctor and can see specialist doctors without a referral.
  • Special Needs Plans (SNP): These plans tailor benefits to meet beneficiaries with unique health-care needs. There are three types of Special Needs Plans available, targeting those who live in an institution (such as a nursing home); have certain chronic conditions; or have Medicare and Medicaid. These plans may offer specialized benefits to help you better manage your situation.
  • Private Fee-for-Service (PFFS) plans: Similar to Original Medicare, these plans don’t have a provider network. Instead, you’re allowed to use any provider that will accept the PFFS plan’s terms and conditions and agree to provide the health-care service. Keep in mind that you’ll need to have your doctor contract with the plan each time you are treated.

Medicare Advantage Prescription Drug plans in South Dakota

One difference between Original Medicare (Part A and Part B) is that Medicare Advantage plans may cover prescription medications. Also called Medicare Advantage Prescription Drug plans, these plans cover all of your Medicare Part A, Part B, and Part D benefits under a single plan. Remember, you normally have to get Medicare prescription drug coverage separately if you have Original Medicare. If you prefer the convenience of having all of your benefits coordinated through a single Medicare plan, you may want to consider a Medicare Advantage Prescription Drug plan as an alternative to Original Medicare and Medicare Prescription Drug Plans.

Before enrolling in a Medicare Advantage plan that includes prescription drug coverage, it’s important to make sure that all of your current medications are covered by the plan. Each Medicare Advantage Prescription Drug plan may vary when it comes to the specific prescription drugs included in its formulary, or list of covered medications. The formulary may change at any time. You will receive notice from your plan when necessary.

Comparing Medicare Advantage plans in South Dakota

You may want to shop around and compare all available Medicare Advantage plan options in your area, since the availability and cost will vary depending on your county of residence. Some service areas may offer Medicare Advantage plans with premiums as low as $0; however, even if the premium is $0, you must still pay your Medicare Part B premium, along with any cost-sharing expenses required by the Medicare Advantage plan. So it’s always important to look at all plan costs, not just the monthly premium.

As a South Dakota beneficiary, you may have questions about how Medicare works or what type of coverage may fit your situation. If you like, an eHealth licensed insurance agent can help you navigate the different Medicare plan options in your location.

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