Medicare offers healthcare coverage to South Dakota residents age 65 or older, or to those South Dakota residents that suffer from certain medical disabilities. In 2016, 147,000 people are enrolled in Medicare in South Dakota, accounting for 17.3% of the population in South Dakota. In 2009 an average of approximately $8,148 was spent per Medicare enrollee in South Dakota, about 21.39% lower than the national average of $10,365. Between 2015 to 2030 the senior population in South Dakota is expected to increase by an estimated 44.61% according to calculations based off of the 2000 Census. Therefore the number of individuals enrolled in Medicare in the state is also projected to grow.
Medicare beneficiaries, their families, and their caregivers that reside in South Dakota can receive free, one-on-one, and unbiased counseling from a program called Senior Health Information and Insurance Education (SHINE). Another program called the South Dakota Senior Medicare Patrol (SMP) aims to educate and empower individuals to recognize, prevent, and report instances of possible healthcare billing errors, abuse, fraud, and/or waste.
When you are eligible for Medicare you may sign up for Original Medicare (Part A & Part B), which cover hospital services and medical services, respectively, or you may enroll in a Medicare Advantage Plan (Medicare Part C). If you sign up for Original Medicare you also have the option to purchase a separate or stand alone prescription drug plan (Part D). Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. For most Medicare beneficiaries, Part A is already paid through paycheck deductions during their working years (or their spouse's) but most Medicare beneficiaries pay premiums for Part B unless they qualify for financial assistance. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a stand alone prescription drug plan to go with their Original Medicare coverage. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Most Medicare Advantage plans also include additional health benefits such as vision, dental, or hearing coverage and you have the option to purchase a Medicare Advantage plan with prescription drug coverage (MAPD) in almost all states.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in South Dakota is $111.68, 78.75% greater than the national average of $62.48. 8.78% of 2017 Medicare Part C insurance plans in South Dakota have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $399, but in South Dakota the average annual drug deductible for Medicare Part C insurance plans with drug components is $157.43. 40.58% of 2017 Medicare Part C insurance plans with a drug component in South Dakota have a $0 annual drug deductible.
- All 2017 Medicare Part C insurance plans without a drug component in South Dakota have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in South Dakota is $4247.86. 48.08% of 2017 Medicare Advantage plans in South Dakota had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in South Dakota was 4.4 stars in 2017.
- Among South Dakota's 2017 Medicare Advantage plans with CMS star ratings:
- 85.74% earned a score of 4 or 4.5 stars
- 14.26% earned a score of 3 or 3.5 stars
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation