Our experienced agents can help you find the best options for you that not only protect you when you have health issues, but also provide preventative care to prolong your life.
Medicare Insurance Options
South Dakota Senior Insurance Agency (SDSIA) is a top provider of affordable and reliable Medicare insurance options for seniors living in western South Dakota.
Medicare Supplement Insurance
Medicare Supplement Insurance (also known as Medigap) is a great addition to your existing Medicare Part A and Part B plan, as it pays for many of the things that those plans don’t, such as deductibles and co-pays.
Is Medicare Supplement Insurance the right choice for me?
Medicare Supplement Insurance is a great option if:
- You have or are planning to enroll in Original Medicare (Parts A and B)
- You want more coverage than Part A and Part B give
- You’d rather pay a monthly, predictable bill than have to pay out of pocket for a large, unexpected medical bill
- You want to see any doctor who accepts Medicare — and you want to see them without a referral
- You like the flexibility and control of buying a separate dental and vision plan
- You want to be able to travel across the world with confidence that you will be covered
- You want the peace of mind that your insurance can’t ever be cancelled, as long as you don’t miss a premium
Medicare Supplement Insurance may not be the right choice for you if:
- You are not planning on enrolling in Original Medicare (Parts A and B)
- Your employer or your union help cover costs that Part A and Part B don’t cover
- You have Medicare Advantage (Part C) or are about to sign up for it
Benefits of Medicare Supplement Insurance
- Choose your doctors and hospitals – no worrying about finding network providers or getting referrals to specialists
- Enjoy coverage when traveling out of the country – benefit is subject to a $250 deductible, 20% coinsurance and a lifetime maximum of $50,000
- Coverage from coast to coast – Medicare Supplement Insurance covers you everywhere in the U.S. that Medicare is accepted.
- Keep your coverage year after year – your coverage won’t be cancelled if premiums are paid on time
When is the best time to buy Medicare Supplement Insurance?
The best time to buy a Medicare Supplement policy is during your Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. During this period, an insurance company can’t use medical underwriting. This means the insurance companies can’t do any of the following because of your health problems:
- Refuse to sell you any Medicare Supplement policy it offers
- Charge you more for a Medicare Supplement policy than they charge someone with no health problems
- Make you wait for coverage to start (most situations)
Learn more about Medicare Supplement Insurance
Compare our most common Medicare Supplement Insurance options to find the right fit for you:
|
Plan F |
Plan G |
Plan N |
|
|
Overview |
Medicare covers a portion of Medicare-approved expenses during doctor visits. Plan F covers the remaining expenses. |
Medicare covers a portion of Medicare-approved expenses during doctor visits. After you pay the Part B deductible ($198 in 2020), Plan G covers the remaining expenses |
Medicare covers a portion of Medicare-approved expenses during doctor visits. After you pay the Part B deductible ($198 in 2020), Plan N will begin paying benefits. With Plan N, you will pay up to a $20 copay with each doctor visit, and up to a $50 copay for emergency room visits |
|
Basic Benefits |
100% |
100% |
After Copay |
|
Skilled Nursing Facility Coinsurance |
100% |
100% |
100% |
|
Medicare Part A Deductible |
100% |
100% |
100% |
|
Medicare Part B Deductible |
100% |
100% |
100% |
|
Medicare Part B Excess Charge |
100% |
100% |
|
|
Foreign Travel Emergency |
100% |
100% |
100% |
Each category in the table above will have a popup when users click on it with the information listed below:
Basic Benefits
- Medicare Part A coinsurance (hospitalization room and board, general nursing, miscellaneous services and supplies that Medicare does not pay for; also pays all of these expenses for 365 days after Medicare coverage ends)
- Medicare Part B coinsurance (physicians’ services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment)
- Hospice care coinsurance when patient meets Medicare’s hospice requirements
- First three pints of blood each year
Skilled Nursing Facility Coinsurance
Pays coinsurance (up to $176 per day in 2020) for days 21-100 for a Medicare approved stay in a skilled nursing facility. Medicare may pay all charges for days 1-20.
Medicare Part A Deductible
Pays the first $1,408 (in 2020) each benefit period for Medicare approved charges for hospitalization, including room and board, general nursing, miscellaneous services and supplies. The benefit period ends once you’ve been out of the hospital and not received other skilled care for 60 consecutive days. If your plan does not have this benefit, you would need to pay the deductible out of pocket.
Medicare Part B Deductible
Pays the first $198 (in 2020) of each calendar year for Medicare-approved charges for physicians’ services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment. If your plan does not have this benefit, you would need to pay the deductible out of pocket.
Medicare Part B Excess Charge
Charges over the amount that Medicare pays for a given service, which can be up to 15% more. Those extra charges would otherwise be billed to you. Some states prohibit doctors that take Medicare patients from charging more than that rate.
Foreign Travel Emergency
Medically necessary emergency care services, beginning the first 60 days of each trip outside the USA. You pay a $250 calendar year deductible, and then the plan pays 80% of charges up to a lifetime maximum of $50,000.
Call us today at (605) 939-4825 to talk about your Medicare Insurance coverage options!
Medicare Advantage Insurance
Looking for a simple, affordable Medicare plan? Medicare Advantage Insurance is the perfect choice for you! Medicare Advantage plans cover everything that original Medicare covers, and typically include Part D prescription coverage and additional benefits such as dental and vision. Premiums as low as $0 per month.
Medicare Advantage Insurance offers the following benefits:
- A convenient all-in-one plan
- Extra coverage for things like dental and vision care
- Little to no monthly premiums
- Only pay copays or co-insurance when using select services
- Prescription drug coverage (Part D) may be included
- Transportation benefit that makes it easy to get to medical appointments
- Over-the-counter allowance that can be spent on a wide variety of health-related products such as non-prescription medications, bandages, vitamins and more
When Can I Enroll in Medicare Advantage?
- You can apply when you first become eligible for Medicare. That's the 7-month period which starts 3 months before your 65th birthday month and ends 3 months after.
- You can apply or switch plans each year during the Annual Enrollment period from October 15 to December 7. If you sign up during this time, your coverage starts on January 1.
- There are a few other exceptions, known as Special Enrollment Period, which includes events like:
- Moving to another area
- Losing your coverage from work
- Learn more about Special Enrollment Periods
Call us today at (605) 939-4825 to talk about your Medicare coverage options!
Medicare Insurance Frequently Asked Questions
Medicare Supplement Insurance plans generally pick up the portion of Medicare approved costs that Medicare does not pay. Medicare Supplement Insurance plans are standardized, meaning each company's plan will pay the same basic benefits. As you shop for a Medicare Supplement policy, be sure to compare the same type of Supplement policy. For example, compare a Plan G plan from one insurance company with a Plan G plan from another insurance company.
Medicare Advantage plans are unique and may have different benefits, as well as different deductibles and cost sharing. Medicare Advantage plans generally have network restrictions.
What if I have a pre-existing condition?
If you have a pre-existing condition, it is particularly important to make sure that you apply at the right time when the window for enrollment in Medicare Supplement Insurance and Medicare Advantage is open. A pre-existing condition is defined as any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan.
- When you first enroll in Medicare Part B, and the first day of the month you turn 65, it starts your initial six-month Open Enrollment period. During that time, no plan can deny you coverage.
- Once you’re out of your initial enrollment period, you could be denied coverage for a Medicare supplement insurance plan due to health reasons, so it is important to get into the right plan for you during your initial Open Enrollment period.
- You cannot be denied coverage for a Medicare Advantage plan during the Annual Enrollment Period from October 15 to December 7 each year, even if you have a pre-existing condition.
What is the monthly premium for Medicare Part B?
The standard Medicare Part B premium for medical insurance in 2020 is $144.60.
Some people will pay less because their Part B premium increased more than the cost-of-living increase for 2020 Social Security benefits.
Some Medicare Supplement Insurance and Medicare Advantage plans will contain a special feature for a free gym membership, but not all do. These are not insurance benefits. (Our Medicare supplement products do not currently include a free gym membership.)
Medicare is split into different Parts. Part A is generally free and Part B has a monthly premium. In addition to Part A and Part B, you may elect to purchase a Medicare Supplement Insurance plan, which will have a monthly premium.
Alternatively, you may elect to enroll in a Medicare Advantage plan. You will still need to pay the Part B premium, and there may or may not be an additional monthly premium for your Medicare Advantage plan.
Here are the specific rules for Part A and Part B of Medicare:
- Part A (Hospital Insurance) – Free to anyone who has paid Federal Insurance Contribution Act (FICA) tax for 10 years or 40 quarters. That’s the federal employment tax you and your employer paid while working. It funds Social Security and Medicare. The rules are slightly different for railroad employees.
You can still get Part A if you haven’t met these requirements but you will pay a premium. There is a 10 percent late penalty if you don’t enroll when you’re first eligible. You have to pay that premium for twice the number of years you could have had Part A, but didn’t sign up
- Part B (Medical Insurance) - Everyone is required to pay a premium for this coverage. The federal government sets the amount each year. You can have it deducted from your Social Security benefits
Generally, Medicare Part B and Medicare Supplement Insurance plan premiums increase each year. Medicare Advantage plans may change premiums and cost sharing each year.
Medicare generally doesn't pay any coverage for care received outside the US. Many Medicare Supplement Insurance plans pay 80 percent of Medicare approved costs after a $250 deductible and up to a lifetime $50,000 limit for emergency care that begins during the first 60 days of each trip. Medicare Advantage plans are based on networks and generally don't pay for any care received outside the US.
With a Medicare Supplement Insurance plan, your premium can increase over time. Your insurance company will notify you in advance of any premium changes.
With a Medicare Advantage plan, changes cannot occur in the middle of a year but can change each calendar year.
With a Medicare Supplement Insurance plan, your benefits will not change over time. Your premium may increase, and if your plan does not cover deductibles, the amount of those deductibles will change annually.
Medicare Advantage plans can be changed each calendar year. You can always switch Medicare Advantage plans during the Annual Enrollment Period from October 15 to December 7 each year.
You may be surprised to learn that government-provided Medicare doesn’t cover 100 percent of health care costs. However, there are coverage options available to you. You can enroll in Medicare and purchase a Medicare Supplement Insurance plan. Alternatively, you can enroll in a Medicare Advantage plan.
The personalized recommendation on this site can help you choose between Medicare Supplement Insurance and Medicare Advantage.
In addition, Part D is the portion of Medicare that provides prescription drug coverage. You can purchase a Part D plan in addition to a Medicare supplement insurance plan, while many Medicare Advantage plans include prescription drug coverage.
Can’t find the answer you need? Contact us for assistance!