Overall, South Dakota has nearly 172,000 residents enrolled in Medicare, as of November 2018. Majority of the residents of South Dakota become eligible for Medicare based on age i.e. after they turn 65 years old. In South Dakota only 12% of beneficiaries become eligible for Medicare based on their disability. Beneficiaries who wish to receive Medicare benefits directly from the federal government can opt for Original Medicare. medicare beneficiaries residing in South Dakota have few choices to receive Medicare coverage and other benefits available. Some of the Medicare options available for South Dakota residents are discussed below.
Original Medicare in South Dakota
Quite a significant percentage of Medicare beneficiaries of South Dakota receive their Medicare benefits through Original Medicare, which is a federal government health insurance program. This health insurance program is designed for eligible American citizens and permanent legal residents of age 65 or older. Residents younger than 65 years of age are also eligible is they receive disability benefits or have certain health conditions. Original Medicare comprises of Part A, hospital insurance, and Part B, medical insurance. Medicare Part A coverage generally includes skilled nursing care, inpatient hospital care, hospice care, along with limited home health care whereas Medicare Part B coverage includes outpatient treatment, physician services, and diagnostic tests like laboratory and radiology services, preventive medical services, durable medical equipment, and limited home health services.
Residents of age 65 or older of South Dakota, who have been a legal permanent U.S. residents for at least five years are considered eligible for original Medicare. People under 65 may also be eligible for Medicare, who have certain qualifying disabilities. Such people are automatically enrolled in original Medicare if they have been receiving Social Security or Railroad Retirement benefits for 24 months. People with certain health conditions like end stage renal disease or Lou Gehrig’s disease can also receive Medicare benefits at the time when they receive Social Security or Railroad retirement benefits. Though not every beneficiary get automatically enrolled in Medicare, as some of the residents of South Dakota may need to apply manually by visiting their local SSA office, or by registering online or they can enroll over the phone.
Medicare Part C or Advantage Plans
There are several Medicare options available for beneficiaries in South Dakota and Medicare Part C or Advantage plan is one of them. Medicare Part C is an alternative way of receiving Original Medicare benefits with the only difference that instead of receiving benefits from federal government they will receive coverage through medicare Advantage plan offered by private insurance companies having contract with Medicare. Around 20% Medicare beneficiaries in South Dakota are enrolled in Medicare Advantage plans. All Medicare Part C plans are required to provide the same level of coverage as Original Medicare. In addition to this, the plans may also cover additional benefits like routine dental or vision, hearing, or prescription drugs. People looking to enroll in Medicare Advantage in South Dakota should first be enrolled in Original Medicare and they should also reside in the plan’s coverage area. People also need to continue paying their Part B premium irrespective of the fact that how they choose to receive their benefits. There are different Medicare Advantage plans that may vary by location. Some of the Medicare Part C plans available in South Dakota include:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Special Needs Plans (SNP)
- Private Fee-for-Service (PFFS) plans
People looking to shop for Medicare Advantage plans in South Dakota should compare all the available options, as the availability and cost of Medicare Part C plans varies depending upon their state and county. Medicare Part C plan premium offering the same coverage and benefits can vary in different counties of the South Dakota state.
Medicare Advantage Prescription Drug Plan
Medicare Advantage plans that cover prescription drug coverage are called Medicare Advantage Prescription Drug plans. This plan covers all of the Medicare Part A, Part B and Part D benefits under a single plan. This plan is ideal for individuals who wish to have convenience of having all their benefits coordinated through a single Medicare plan, as people enrolled in Original Medicare have to separately enroll in Medicare Part D to receive prescription drug coverage. However this plan suits to individuals who are interested in receiving prescription drug benefits with their Medicare Advantage plan. By enrolling in this plan people receive health and prescription drug coverage from a single plan, though benefits can vary by plan. Before enrolling in Medicare Advantage Prescription Drug plan, it is vital for the people to make sure that all their current medications are covered by the plan, because every Medicare Advantage Prescription Drug plan varies in terms of specific prescription drugs included in its formulary or list of covered medications. These plans are offered by Medicare-contracted private insurance companies.
Medicare Part D Plans
Since Original Medicare does not include prescription drug cost, therefore people enrolled in Original Medicare need to enroll in Medicare Part D to receive prescription drug coverage. Medicare Part D plan works alongside the Original Medicare plan. Medicare Part D is offered by private insurance companies having contract with Medicare, so costs and availability of every plan might differ between insurance companies, and location. In order to be eligible for Medicare prescription drug coverage, people need to be enrolled in Medicare Part A or Part B and they should also be living in the plan’s service area of the Medicare Plan offering prescription drug coverage. People looking to enroll in this plan can enroll during the Initial Enrollment period for Part D, which is also the period when they first become eligible for Medicare, starting three months before they turn 65, include their birthday month and three months after the birthday month, which is a total of seven months period.
Every Medicare Part D plan has its own formulary or list of covered medications, and this formulary include coverage of specific generic and brand name prescription drugs. However all the Part D plans need to cover at least two prescription drugs from each category such as anti-psychotics, anti-depressants, immunosuppressants, anti-convulsant, antineoplastic (cancer), and anti-retroviral (HIV/AIDS) categories. People should keep in mind that if they fill a precsription that is not included in their plan’s formulary, then they have to bear the full cost of the medication. Therefore, people are advised to check the formulary before enrolling in a Medicare Precsription Drug plan.
Medicare Supplement Insurance Plans in South Dakota
With Original Medicare covering only health and hospital expenses beneficiaries have to pay out-of-pocket expenses on their own. Thus, to cover gaps in Original Medicare like deductibles, co-insurance and co-pays beneficiaries can obtain Medicare Supplement plans. Residents of South Dakota enrolled in Medicare Part A and Part B are eligible to enroll in this plan that covers the out-of-pocket expenses of Original Medicare. In South Dakota, there are 10 standardized Medigap plans, labeled by the letters A through N (Medigap Plans E, H, I and J are no longer sold). Offered by private insurance companies, the plans with the same letter offer same benefits, though some insurance carriers may offer additional benefits. Standardized Medicare Supplement plans available in South Dakota provides coverage for Medicare-approved out-of-pocket costs such as:
- Skilled nursing facility care coinsurance
- Hospice care coinsurance or copayment
- Part B coinsurance or copayment, excess charge and deductible
- Blood, first three pints
- Emergency care while traveling abroad
- Part A coinsurance and hospital costs up to 365 days extra after Medicare benefits get exhausted
South Dakota residents can enroll in a Medicare Supplement insurance plan usually during their Medigap Open Enrollment Period, which start from the first day of the month in which they turn 65 years old as well as they enrolled in Medicare Part B. During the six month Open Enrollment Period, residents can enroll without any fear of coverage denial or higher monthly premiums due to any health conditions. Residents will obtain the coverage if they live in the plan’s service area.