There are more than 170,000 Medicare beneficiaries across South Dakota. It’s no surprise that this large group of people may have different values and preferences when it comes to their healthcare. Some may prefer additional health benefits through a Medicare Advantage plan, while others may prefer financial protection through Medicare Supplements. Which South Dakota Medicare plan is right for you?
Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). Part A covers hospital stays, nursing homes, hospice, and home health services, whereas Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and x-rays. Once you are enrolled in Part A and B, you can explore Medicare Advantage, Medicare Supplements, and Part D plans, which offer additional coverage for a small monthly premium.
Most people become eligible for Original Medicare (Part A and B) when they reach their 65th birthday, but there are other ways to qualify. If you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you may be eligible regardless of your age. Lastly, if you have been receiving SSDI (Social Security Disability Insurance), you will be automatically enrolled in Medicare during your 25th-month of SSDI benefits. To qualify for Medicare Advantage, Medicare Supplements, or Part D, you must be enrolled in Original Medicare first. If you have questions regarding your eligibility, click here or give us a call at 833-438-3676.
Beyond Original Medicare, different types of Medicare plans include Medicare Advantage, Medicare Supplements, and Part D. Each type of plan adds some sort of additional coverage beyond Part A and B. Medicare Advantage and Part D plans (plus some Medicare Supplements), can provide prescription drug coverage. It’s crucial you enroll in some type of prescription drug coverage to avoid any late-enrollment penalties down the road.
Roughly 33,000 beneficiaries are utilizing Medicare Advantage (MA) in South Dakota and more than twenty different MA plans across the state offer benefits like hearing, dental, vision, over-the-counter drugs, non-emergency transportation, and group fitness classes like SilverSneakers. Medicare Advantage plans are sold through private insurance companies, and plan availability and costs will vary based on your zip code. A licensed agent can show you all of the plans in your area and help you enroll in the plan with the best price. Click here or call 833-438-3676.
South Dakota Medicare Supplements (Medigap plans) are organized by letter (A, B, C, D, F, G, K, L, M, N), and each plan varies in terms of coverage and price. Medigap plans offer financial benefits like help paying your coinsurance, copayments, and deductibles. Depending on which plan you select, you can have help paying the following:
Medicare Supplements are generally the same regardless of which carrier you enroll with, but pricing will vary based on carrier, zip code, age, gender, and tobacco use. Even though plans are generally the same, you can easily overpay if you don't do your research. Our agents at Medicare Plan Finder can help you enroll in the best plan at the best rate. To schedule an appointment, click here or call us at 833-438-3676.
Part D plans provide prescription drug coverage and work alongside Original Medicare. If you enroll in a Part D plan, your annual deductible will reset each year ($415 in 2019). Plans can vary, and some may waive, reduce, or change the deductible upfront. Once you meet your deductible, your coverage will start. This is known as the initial coverage phase. During this time, you will be responsible for a copay for each prescription drug you purchase based on the plan's drug formulary (list of approved drugs). You will continue to pay these copays until you reach a spending limit ($3,820 in 2019).
Once you reach the spending limit, you will be in the “donut hole” and be responsible for 37% of your generic drug costs and 25% of your brand-name drug costs until your spending reaches $5,100. (Fun fact: the donut hole is going away in 2020!) After this point, you will be in the catastrophic coverage phase, and 95% of your prescription costs will be covered. To learn more about Part D plans in your area, click here.
The cost of Original Medicare is the same no matter which state you live in. If you were employed and paid Medicare taxes for at least 39 quarters, you will not have a premium for Part A. If you only paid Medicare taxes for 30-39 quarters, you’ll pay $240/month in 2019. If you did not pay Medicare taxes for at least 30 quarters, you’ll pay $437/month in 2019. Your Part B premium will be based on your income, but is $135.50/month for most beneficiaries.
Costs for Medicare Advantage, Medicare Supplements, and Part D plans will vary based on your location, carrier, and plan benefits. To find costs specific to your area, click here.
Medicare and Medicaid are both regulated through the Centers for Medicare and Medicaid Services and often easily confused. They each provide health coverage for specific groups of people. However, Medicare is intended for older adults over the age of 65 and people with certain disabilities, whereas Medicaid is intended for low-income individuals and families regardless of age.
It is possible to be eligible for both programs. In fact, there are more than nine million people enrolled in Medicare and Medicaid across the U.S. If you qualify for both programs you will likely be eligible for a Dual Special Needs Plan (DSNP), which is a special type of Medicare Advantage plan that provides extra benefits at lower costs. One large perk of DSNPs is qualifying for a Special Enrollment Period (SEP). Most beneficiaries can only change their plan once a year, but SEPs allow you to get the coverage you need when you need it.
If you qualify for a DSNP you may also qualify for programs like Medicare's prescription drug program, Extra Help, or other Medicare Savings Programs. If you qualify for Extra Help, you won't pay more than $3.40 for generic drugs and $8.50 for brand-name drugs. This can help you save an average of $4,000 a year! Medicare Savings Programs help cover other Medicare-related costs like premiums, deductibles, copayments, and coinsurance.
The South Dakota Area Agency on Aging provides home and community-based service options to individuals over the age of 60 and people with certain disabilities. Each program throughout the state provides information and referral services, access to in-home and community-based services, needs assessments, case management, care plan development, and adult protective services. To learn more about these programs, click here.
You can sign up for Original Medicare through Social Security. You can visit www.SocialSecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday 7 AM to 7 PM, or apply in person at your local Social Security office.
Once you are enrolled in Original Medicare, you can schedule an appointment with one of our agents and discuss Medicare Advantage, Medicare Supplements, and Part D plans. Click here or call us at 833-438-3676.
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