Unlike Part C Medigap Plans (Medicare Advantage Plans), Medicare beneficiaries with Medicare Supplement plans still enjoy all the benefits of original Medicare (Part A and Part B), but they have the peace of mind of fewer medical expenses to pay out of pocket.
What Are Medicare Supplement Plans in South Dakota
Signing up for Original Medicare will give you extensive coverage for many hospital and medical expenses. The usual amount of approved Medicare expenses paid by original Medicare is 80%. Some services you need may not be covered at all. Finding the best Medicare Supplement for you and enrolling in it will likely cover most of the out-of-pocket expenses that Medicare does not pay. These include:
- Coinsurance for Medicare A (In-patient care in a hospital, mental health center, or skilled nursing facility (SNF)
- Coinsurance for Medicare Part B (Usually 20% of Medicare-approved charges once the Part B deductible is paid
- The first three pints of blood transfusion
- Copayment or coinsurance for Hospice care under Medicare A
Be aware that if you are married, both you and your spouse will need to sign up for a separate Medigap policy that best fits your individual needs.
Medigap offers certain standardized benefits. This means that Medigap coverage sold by different private insurance companies must cover the same basic benefits. Also, if you enroll for Medigap coverage in an insurance plan, let’s say Plan G, in one state, it must provide the same basic benefits it would in a different state.
Some states allow individuals with disabilities or End Stage Renal Disease (ESRD) to sign up for a supplement plan along with basic Medicare benefits. Be sure to check with the Medicare office in your state for further information as needed.
The most comprehensive of the Medicare Supplement plans is Medicare Part F. This is the only plan that covers the cost of the Medicare Part B deductible. Unfortunately, this plan is no longer available to recipients signing up after 2019. Those who enrolled in Medigap prior to 2020 can keep Plan F or transfer to it from the plan they originally signed up for.
Some people choose a Medicare Advantage plan to help cover out of pocket costs. Medicare Advantage plans are provided by private insurance companies and subsidized by Medicare. You cannot sign up for a Medicare Supplement if you are enrolled in a Medicare Advantage plan.
Medicare Supplement Plans in South Dakota: Enrollment Statistics
Almost 172,000 South Dakota residents are enrolled in some form of Medicare coverage.
Approximately 79% (132,218 South Dakota residents) have Medicare Original coverage according to statistics reported in January 2018.
Information released by America’s Health Insurance Plans (AHIP) reveals that 51.6% of South Dakota Medicare recipients had Medicare Supplement coverage in 2015.
Medigap plans are available statewide. Many Medicare enrollees who chose Medigap plans are from the five largest counties in the state, which include:
- Minnehaha County
- Pennington County
- Lincoln County
- Brown County
- Brookings County
Statistics released by the Centers for Medicare and Medicaid (CMS) revealed the following:
- The number of Medicare recipients in South Dakota has increased from 143,069 to 168,167 between 2012 and January 2018
- In 2012, 92,811 South Dakota residents were enrolled in Medicare health plans that offered prescription drug coverage, Part D. That number increased to 116,365 by January 2018
- 68% of South Dakota residents enrolled in a Prescription Drug Plan (Part D Medicare) have access to lower rates than they paid in 2017
Best Medicare Supplement Plans in South Dakota
Like most states in the United States, South Dakota has ten different Medicare plans to choose from. These include Medicare A, B, C, D, F, G, K, L. M, and N.
Each of these plans is standardized. This means that the benefits under a plan will be the same regardless of what county or state the recipient was in when enrolling. There is also no difference based on what insurance company provides the policy.
The three most popular plans in the state are Plan F, Plan G, and Plan N. Health plans F and G are almost identical, with the main difference being that Plan F pays the Part B yearly deductible ($198 in 2020) and Plan G does not.
Monthly premiums are likely to be less with Plan G. It covers 20% of all Medicare-approved costs after the 80% is paid by Medicare.
The yearly deductible for Plan B will not be covered, but the difference in the costs of monthly premiums should more than make up for this difference. It helps pay for in-patient hospital expenses, skilled nursing facilities, and Hospice care.
Plan N offers an alternative with even lower monthly premiums, but there will be a $20 copayment for doctor visits and a $50 copayment for Emergency Room services. The Part B yearly deductible will not be covered. Part B excess charges (the amount charged over the usual Medicare-approved fee) will not be covered.
Many people feel Part N is still a good option for reducing overall out-of-pocket health care costs.
When Can I Enroll in a Medigap Plan in South Dakota
The first opportunity you will have to choose a Medigap plan will be at the time of initial enrollment in Medicare. This initial enrollment period begins three months before the month of your 65th birthday, includes your birthday month, and extends for the following three months.
You can use the first three-month period to contact a Medicare agent and/or a representative from an insurance company to discuss your options and find the best plan for your budget and needs.
This initial enrollment period is especially important if you have health problems because you will not be turned down for the policy of your choice at this time.
Choosing the Medicare Part you want might be a good starting place. Your agent can then help you find the insurance company that will provide that coverage for the best price.
If you do not choose a Medigap policy during your initial enrollment, you have another chance during the annual Open Enrollment Period (OEP) between October 15 and December 7.
During either of the above enrollment periods, you can enroll without having a physical exam or needing an underwriter. You will have guaranteed acceptance. If you miss these opportunities and try to enroll outside an enrollment period, you may have to pay more or can even be turned down for coverage.
There may be special circumstances when you will qualify for guaranteed issue rights, such as when you lose your insurance at the time of job loss. Contact a Medicare agent for advice if this happens to you.
Medicare Advantage Plans in South Dakota Open Enrollment Period
Each year between January 1 and March 31, there is a Medicare Advantage Enrollment period for Medicare recipients who wish to enroll in a Medigap or Advantage plan or change to a different plan.
This is a good time to choose and enroll in a Prescription Drug plan (Part D) if your policy does not have drug coverage.
Medicare Advantage Plans in South Dakota
Talk to your Medicare agent about Medicare Advantage Plans to see if this might be a good option for you. Advantage plans put great emphasis on preventive care in order to prevent more serious health issues in the future.
You can choose a private fee-for-service plan, a PPO, or an HMO. Each has unique benefits and restrictions, so you will need to consult a Medicare agent to find the best fit for your needs.
Advantage plans also offer certain extra ‘advantages’ that you will probably not find with most Medigap policies. Some extra benefits include dental, vision, and hearing coverage that will vary according to the specific plan you choose.
All basic Medicare coverage will be included in your Medicare Advantage plan, as well as coverage for home health services, skilled nursing facility care, and usually drug coverage.
South Dakota Medicare Resources
Good luck in your search for the best Medicare health coverage for you.
Be sure to contact a Medicare representative who can help you avoid pitfalls and find the optimal Medicare policy for your budget and healthcare needs.
Ask your representative for information on life insurance policies when you call.
