Medicare in South Dakota: Quick Facts
| Medicare Beneficiaries | 200,000 |
|---|---|
| Medicare Advantage Plans Available | 10 |
| Average MA Plan Premium | $5.80/month average premium |
| Average MA Star Rating | 3.7 / 5.0 stars |
| Part D Plans Available | 20 |
| Average Medigap Plan G Premium | $112/month |
| Medicaid Expansion Status | Expanded (138% FPL) |
| Medicaid Nursing Home Income Limit | $2,982/month |
Medicare Options in South Dakota
South Dakota residents on Medicare have three primary coverage paths: Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Supplement (Medigap) insurance paired with a Part D prescription drug plan. With 200,000 Medicare beneficiaries, South Dakota is a mid-sized Medicare markets, which means fewer plan options but often more personalized service.
Medicare Advantage in South Dakota
South Dakota has 10 Medicare Advantage plans available, with an average star rating of 3.7 out of 5.0. The average monthly premium across all MA plans in the state is $5.80/month average premium. Medicare Advantage plans in South Dakota typically include prescription drug coverage, dental, vision, and hearing benefits not available through Original Medicare.
2026 Medicare Advantage Star Ratings in South Dakota
CMS rates Medicare Advantage plans on a 1–5 star scale based on quality measures including preventive care, managing chronic conditions, member experience, and customer service. Plans rated 4 stars or higher receive bonus payments from CMS, which they typically pass on to members through lower premiums or enhanced benefits. The average MA plan star rating in South Dakota is 3.7 stars.
| Star Rating | What It Means | Bonus Payments |
|---|---|---|
| 5 Stars | Excellent — top-performing plan | Yes — highest bonus |
| 4.5 Stars | Above average quality | Yes |
| 4 Stars | Good quality | Yes |
| 3.5 Stars | Average quality | No |
| 3 Stars or below | Below average — consider switching | No |
Medicare Part D in South Dakota
South Dakota has 20 standalone Part D prescription drug plans available. In 2026, the maximum out-of-pocket cap for Part D drugs is $2,100 — a major change from prior years that eliminates catastrophic drug costs. The maximum Part D deductible is $615.
2026 Part D Key Numbers for South Dakota Residents
| 2026 Part D Limit | Amount |
|---|---|
| Out-of-pocket maximum | $2,100/year |
| Maximum deductible | $615/year |
| National base beneficiary premium | $38.99/month |
| Late enrollment penalty (per month uncovered) | 1% × $38.99 |
| Coverage gap (“donut hole”) | Eliminated as of 2025 |
Medicare Supplement (Medigap) in South Dakota
Medigap Plan G is the most popular Medicare Supplement plan in South Dakota, with an average monthly premium of $112. Plan G covers the Part A deductible ($1676 in 2026), Part B coinsurance (20% of all covered services), skilled nursing facility coinsurance, and foreign travel emergency coverage. The only cost Plan G does not cover is the Part B deductible ($240 in 2026).
Medigap Plan Comparison for South Dakota
| Plan | Part A Deductible | Part B Coinsurance | SNF Coinsurance | Estimated Monthly Premium |
|---|---|---|---|---|
| Plan G (most popular) | Covered | Covered | Covered | $112/month |
| Plan N | Covered | Covered (with copays) | Covered | $92/month |
| Plan F (pre-2020 enrollees only) | Covered | Covered | Covered | $129/month |
| Plan K (high-deductible) | 50% covered | 50% covered | 50% covered | $50/month |
Medicaid in South Dakota
South Dakota has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.
Medicaid Income Limits in South Dakota (2026)
| Medicaid Program | Income Limit (Single) | Notes |
|---|---|---|
| Nursing Home / Institutional Medicaid | $2,982/month | Nearly all income goes toward cost of care |
| HCBS Waiver (home-based care) | $2,982/month | Recipient keeps income for living expenses |
| Regular Medicaid (Aged, Blind, Disabled) | $994/month | For seniors and disabled individuals |
Medicare Savings Programs in South Dakota
Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries pay their premiums, deductibles, and copays. South Dakota residents may qualify for one of four programs based on income:
| Program | Individual Income Limit | Couple Income Limit | Benefit |
|---|---|---|---|
| QMB (Qualified Medicare Beneficiary) | $1,255/month | $1,704/month | Pays Part A and B premiums, deductibles, and copays |
| SLMB (Specified Low-Income MB) | $1,478/month | $1,992/month | Pays Part B premium only |
| QI (Qualifying Individual) | $1,660/month | $2,239/month | Pays Part B premium only, limited slots |
| QDWI (Qualified Disabled Working) | $4,945/month | $6,659/month | Pays Part A premium for working disabled under 65 |
SSDI Recipients and Medicare in South Dakota
Social Security Disability Insurance (SSDI) recipients in South Dakota automatically become eligible for Medicare after a 24-month waiting period from their disability onset date. This means that if you were approved for SSDI in South Dakota, your Medicare coverage begins in month 25 of your disability. During the 24-month waiting period, South Dakota residents may qualify for Medicaid to bridge the coverage gap.
Leave a Reply