What is Medicare?

Medicare is federal health insurance for people 65 or older, some younger people with disabilities, and people with End-Stage Renal Disease. Created in 1965

Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources.

*As required by Medicare to say: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.*

Original Medicare

Part A (Hospital)

  • Premium -> $0 Most people won’t pay a premium for Part A
  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Home health care
  • Hospice care

Part B (Medical)

  • Premium: the standard Part B premium is $174.70/month (2024)
    • Or higher depending on income
  • Services from doctors and other health care providers
  • Durable Medical equipment
  • Some preventive services and immunizations

Original Medicare doesn’t cover everything.

  • Prescription drugs
  • Long-term care
  • Most dental care
  • Routine vision care
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care
  • Medical care overseas

3 Ways to Insure in South Dakota

Medicare Supplements Plans or Medigap Plans

  • Plans work with Original Medicare. All claims go to Medicare first.
  • Plans fill the gaps that Original Medicare leaves behind.
    • Deductibles, coinsurance, copayments
  • Plans have Monthly Premiums
  • Plans are sold by private insurance companies.
  • Plans are standardized. All plans with the same letter have the same coverage.
    • Costs vary by plan and Company.

Medicare Advantage Plans or Part C

  • Claims no longer go to Original Medicare but to a Private Insurance company
  • Medicare pays an approved private Insurance company to administrate your Medicare benefits. These companies take on your risk and process all claims. These companies must follow rules set by CMS or Medicare.
  • You must be enrolled in Medicare parts A and B to participate in a Medicare Advantage plan program. You remain in the Medicare program with all rights and protections.
  • Can be charged different out-of-pocket costs. Vary from plan to plan.
  • Can’t be charged more than Original Medicare for certain services, such as:
    • Chemotherapy, dialysis, and skilled nursing facility (SNF) care.
  • May choose a plan with extra benefits like Dental, Vision, Hearing, OTC (over the counter), gym membership benefits, and Prescription Drug coverage.
  • Have a yearly limit on out-of-pocket costs. Vary from plan to plan.
  • Members have access to a network of doctors and hospitals. Networks and service areas vary from plan to plan. It is important to understand.

Medicare Cost Plans

Medicare Cost Plans are health plans offered by approved private insurers that contract through the federal government to provide a full Medicare benefit package. Similar to Medicare Advantage plans in that enrollees have access to a network of doctors and hospitals. May be best described as a hybrid plan. Benefits include:

  • Works with Medicare Part A and Part B.
  • Premiums are not age or gender based
  • Ability to change plans as needed
  • No medical underwriting
    • Eligibility includes NOT having End Stage Renal Disease (ESRD)
  • Extra benefits such as eye exams, hearing exams and fitness club memberships. Reimbursements for Dental benefits, Eyewear, and Hearing aids.
  • Only available in certain Counties.

Part D Prescription Drug Plans – Stand Alone (PDP)

  • An optional benefit available to all people with Medicare, There may be a penalty for enrolling late
  • Run by private companies that contract with Medicare
  • Premiums vary with plans
  • Provided through
    • Medicare prescription drug plans (PDPs)
    • Medicare Advantage Prescription Drug Plans
    • Some other Medicare health plans (e.g. Medicare Cost Plans)
  • Plans cover drugs on the Formulary (list of covered drugs)
  • Stages of drug coverage include:
    • Deductible
    • Copay/coinsurance or cost sharing
    • Coverage gap
    • Catastrophic

Enrollment Periods. When can I join?



Months Before

birthday icon

Month of 65th Birthday



Months After

This is the best time of year to make changes.


arrow right
arrow down



Supplement Plan


Cost Plan


Medicare Advantage
(Part C)


Part D

Medicare Advantage Open Enrollment Period (OEP)


arrow right
arrow down



Allows those enrolled in a Medicare Advantage plan to make a one-time election to change to:

  • a MA-PD or MA-Only plan
  • Original Medicare with or without a stand-alone Medicare Part D plan
  • Add or drop Medicare Part D coverage if currently enrolled in a Medicare Advantage plan
  • Enroll in Medicare Cost-only
  • Enroll in Medicare Cost with Medicare Part D
  • enroll in Medicare Cost with Stand-alone Medicare Part D

Medicare Advantage
(Part C)

There are many reasons you may qualify for a Special Election Period. These life events can happen throughout the entire year.

Generally, you must stay enrolled in your plan for the entire year. But when certain events happen in your life, like if you move or lose other insurance coverage, you may qualify for a Special Enrollment Period. You may be able make changes to your plan mid-year if you qualify.


arrow right
arrow down




  • Moving out of service area
  • Losing employer coverage
  • Working past 65
  • Qualifying for extra help with Part D coverage

Cost Plan


Medicare Advantage
(Part C)


Part D

Apply for Medicare Part D Extra Help program

The Extra Help program helps people with limited income and resources lower or cut Part D costs.

Medicare Part D provides drug coverage. The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. You can apply for Extra Help any time before or after you enroll in Part D.

Apply for Extra Help online

The level of help you get depends on your income and assets. You’ll have to provide information about your financial situation.

Start Application

Finish Existing Application

Set up an appointment

Available in most U.S. time zones Monday – Friday 8 a.m. – 7 p.m. in English and other languages

Call +1 800-772-1213

Tell the representative you want to set up an appointment to apply for Part D Extra Help.

Call TTY +1 800-325-0778 if you’re deaf or hard of hearing.

Learn more about Extra Help

Visit Medicare.gov for more information about the Extra Help program.