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Blog & resources — page 3
Plain-English Medicare guidance and real South Dakota plan data — written for the people we serve, not for search engines.
Medicare Plan Finder 2026: A Sioux Falls Guide
CMS told every Medicare Advantage organization on August 25, 2025 that the 2026 Medicare Plan Finder would add three real upgrades: provider network search sourced from a vendor called SunFire Matrix, real in-network and out-of-network cost sharing on 30 supplemental benefits (plus 6 brand-new benefit categories) starting October 1, 2025, and a new AI-powered drug search tool for personalized pharmacy pricing. A newly finalized federal rule, CMS-4208-F2, now requires Medicare Advantage organizations to keep that provider directory data current within 30 days of any change, effective November 17, 2025. Nearly 7 in 10 Medicare beneficiaries (69%) didn't compare their coverage during a recent Open Enrollment Period, per KFF's analysis of federal data — a real gap this free government tool is built to close, now with your own doctor's network finally in view. Here's the full guide: what to have ready before you start, a step-by-step walkthrough using a Sioux Falls ZIP code, the complete real 15-plan Minnehaha County roster the tool will show you, how to read the new network and benefit data, the temporary Special Election Period if the tool's directory data was wrong, and a worked example comparing two real $0-premium local plans.
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What Happens When Your Medicare Advantage Plan Doesn't Renew? South Dakota's 2027 Guide
64% of South Dakota's 2025 Medicare Advantage enrollees were in a plan that did not renew for 2026 — the third-highest rate of any state, behind only Vermont and Wyoming — per KFF's March 13, 2026 analysis of CMS data. Nationally, 2.6 million people (13% of MA-PD enrollees) lost their plan for 2026, up sharply from 6% in 2024, as insurers facing thinner margins pared back rural-state offerings. A true non-renewal opens a federal Special Enrollment Period running December 8 through the last day of February, wider than the standard enrollment window, per Medicare.gov. Losing a plan through no fault of your own can also open a Medigap guaranteed-issue right — no health questions — if you apply 60 days before to 63 days after coverage ends, per CMS Publication 02110. Plans must mail the non-renewal notice at least 90 days before the contract year ends, per CMS's own Medicare Communications and Marketing Guidelines. Here's the full guide: the notice timeline, your two real paths forward, the Medigap guaranteed-issue right explained plainly, a worked dollar example of what doing nothing costs, and how stable Sioux Falls' own 15-plan roster looks heading into 2027.
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Medicare Advantage Ads Just Got Looser Rules: What Changed for the 2026 AEP
CMS finalized its Contract Year 2027 Medicare Advantage and Part D rule on April 2, 2026 (Federal Register, 91 FR 17384), and the new marketing provisions apply to all plan marketing starting October 1, 2026 — two weeks before this year's Annual Enrollment Period opens. The 48-hour wait between signing a Scope of Appointment and a one-on-one sales meeting is gone. The 12-hour gap CMS required between an educational event and a marketing event at the same location is eliminated, and agents can now collect a Scope of Appointment right at an educational event. A superlative claim like "best" or "top-rated" no longer has to point to supporting data inside the ad itself, though the ban on misleading claims is unchanged. Sales call recordings only have to be kept 6 years instead of 10. Here's the full guide: every provision that changed and what didn't, why CMS made the change, the history of this rule swinging back and forth since 2018, how to read a Medicare ad like a pro this AEP, and the Sioux Falls angle on all of it.
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Medicare Hearing Aid Coverage in Sioux Falls 2026
Original Medicare has excluded hearing aids from coverage since the program began in 1965, per Medicare.gov, and Congress has not repealed that exclusion despite several Medicare Hearing Aid Coverage Act proposals. What Part B does cover is a diagnostic hearing and balance exam when a doctor orders one for a medical reason, at 20% coinsurance after the 2026 $283 Part B deductible (CMS, Nov. 14, 2025). Nationally, 95% of Medicare Advantage enrollees in individual plans are in a plan offering some hearing exam or hearing aid benefit for 2026, per KFF's own analysis of CMS plan data, but the dollar allowance and network are set plan by plan and can change every year. Since October 17, 2022, adults 18 and older with mild-to-moderate hearing loss can also buy an FDA-regulated over-the-counter hearing aid without a prescription, per the U.S. GAO's review of the new device category. NIDCD data shows disabling hearing loss climbs from 22% at ages 65-74 to 55% at age 75 and older, exactly the population sitting inside Minnehaha County's 39,532 Medicare beneficiaries. Here's the full 2026 guide: what Part B actually covers, the OTC hearing aid option, how a Medicare Advantage allowance really works, Sioux Falls's 15-plan drug-carrying roster, and what to check before you buy.
Read →Does Medicare Cover Leqembi and Kisunla? The New Alzheimer's Drug Coverage Reality, Sioux Falls 2026
Medicare covers Leqembi (lecanemab) and Kisunla (donanemab-azbt) for early-stage Alzheimer's disease under a Coverage with Evidence Development framework CMS finalized April 7, 2022, per CMS's own National Coverage Determination 200.3 — but only through Part B, which means the 2026 Part D $2,100 out-of-pocket cap doesn't apply. Eisai's own July 2026 price list puts a 500mg Leqembi IV vial at $679.60, up from $637.02 at 2023 launch, and Eli Lilly's own investor materials put a full 12-month Kisunla course at $32,000. Run the math on 20% Part B coinsurance and that's roughly $5,300 a year in exposure for Leqembi and $6,400 for a 12-month Kisunla course under Original Medicare alone, with no annual ceiling — a gap a Medigap Plan G supplement or a Medicare Advantage plan's out-of-pocket maximum closes very differently. More than 17,000 South Dakotans 65 and older live with Alzheimer's, per the Alzheimer's Association. Here's the full guide: what's actually covered, the PET scan and registry requirements, real 2026 manufacturer pricing, the Original Medicare vs. Medigap vs. Advantage cost math, and what to ask before treatment starts.
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Your 2027 Medicare Part D Premium May Jump: Here's Why, and What South Dakotans Should Do
CMS confirmed on July 28, 2026 that it will not continue the Part D Premium Stabilization Demonstration into 2027 — the temporary program that had been softening stand-alone drug plan premiums since 2025. The national reference premium CMS uses to calibrate plans rises from $38.99 in 2026 to $41.33 in 2027, a 6% jump, the maximum a single year allows under the Inflation Reduction Act. KFF's independent analysis puts the two-year program's value at roughly $9.8 billion, lowering average monthly premiums by about $26 in 2025 and $16 in 2026 — support that simply isn't there for 2027. That's a national average, not your bill: the only number that matters is the one on your own Annual Notice of Change letter, required by law each September. Here's the full guide: what actually changed and why, the real difference between stand-alone Part D plans and Medicare Advantage drug coverage, three worked examples by how many drugs you take, South Dakota's 2026 plan landscape, and your Annual Enrollment Period action plan (October 15–December 7, 2026).
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Does Medicare Still Cover Telehealth? The Real Rules for Sioux Falls in 2026 and 2027
Medicare telehealth coverage runs through December 31, 2027 — home visits, no geographic restrictions, most services — under the Consolidated Appropriations Act, 2026, per Medicare.gov and HHS.gov. Outpatient mental health telehealth, including audio-only phone sessions, is permanent, separate from that date entirely. What isn't guaranteed is your own Medicare Advantage plan's telehealth benefit: KFF's analysis of CMS plan data found only 48% of Medicare Advantage plans offered a telehealth benefit in 2026, down from 53% in 2025, a real and quiet cut buried in benefit filings most people never read. Flexibilities also briefly lapsed during the federal government shutdown that began October 1, 2025, before Congress reinstated them retroactively on November 12, 2025, a preview of what could happen again before the 2027 deadline. Here's the full guide: the two-track system separating everyday telehealth from permanent mental health telehealth, what changed for 2026 in real numbers, why your Medicare Advantage plan might cover less than Original Medicare, the Sioux Falls and Siouxland access angle, and exactly how to check your own coverage before your next video visit.
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Does Medicare Cover Dementia Care? The Free GUIDE Model Benefit, Sioux Falls 2026
Medicare covers a dementia diagnosis in real detail — a cognitive assessment, a written care plan, doctor visits, medications under Part D — and covers almost none of what a family needs once that diagnosis lands, per Medicare.gov's own coverage rules: no 24-hour home care, no adult day programs, no memory care rent. CMS runs a free, voluntary benefit called the GUIDE Model, started July 1, 2024 as an 8-year test, that pairs a family with a dementia care navigator and reimburses up to $2,500 a year in respite care, but only for people on Original Medicare. We pulled CMS's own August 2026 participant list directly: of 292 organizations nationwide, none is headquartered in South Dakota, though 11 serve the state by telehealth. More than 17,000 South Dakotans 65 and older live with Alzheimer's, per the Alzheimer's Association, and when Medicare's coverage runs out, South Dakota Medicaid's 2026 long-term care limits (a $2,982 monthly income cap, $2,000 in countable resources) become the real backstop. Here's the full guide: what Medicare covers and doesn't, the GUIDE Model explained end to end, what Medicare Advantage changes, and a practical timeline for what to do after a diagnosis.
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Does Medicare Cover the Shingles and RSV Vaccines? The Part B vs. Part D Billing Trap, Sioux Falls 2026
Medicare's shingles vaccine (Shingrix) and RSV vaccine are genuinely $0 under Part D, no deductible and no copay, since the Inflation Reduction Act eliminated cost-sharing for ACIP-recommended adult vaccines on January 1, 2023, per Medicare.gov and CMS. The catch isn't eligibility — it's routing. Flu, pneumococcal, and COVID-19 vaccines run through Part B and can be billed almost anywhere. Shingrix and the RSV vaccine run through Part D instead, and a pharmacy is built to bill that automatically while a doctor's office sometimes isn't, which is exactly where a genuine $0 benefit can turn into a real bill. Without the benefit, the CDC's own 2026 Adult Vaccine Price List puts Shingrix's full 2-dose series at roughly $431 and the RSV vaccine at $290 to $307 a dose. Here's the full 2026 guide: the Part B vs. Part D mechanism explained, who CDC recommends for each vaccine (Shingrix at 50+, RSV at 75+ or 50-74 at increased risk), exactly how to make sure it's billed right the first time, how to unwind a bill that already arrived, and the Sioux Falls plan landscape.
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Does Medicare Cover You Outside the United States? The Foreign Travel Benefit, Sioux Falls 2026
Original Medicare almost never pays for care outside the U.S. — Medicare.gov names exactly three narrow exceptions, and none of them is 'I got sick on vacation.' The real bridge is a specific benefit built into certain Medigap letters: Plans D, G, M, and N pay 80% of billed charges after a $250 annual deductible, up to a $50,000 lifetime maximum, for emergencies starting in the first 60 days of a trip, per Medicare.gov and CMS Publication 02110. Plans A, B, K, and L carry none of it — same exposure as no supplement at all. Medicare Advantage has no federal requirement to cover care abroad. And even the $50,000 cap is smaller than it sounds: CDC Travelers' Health says a remote-area medical evacuation can run past $100,000 without separate evacuation coverage. Here's the full 2026 guide: the three rare exceptions explained, the real math behind the Medigap benefit, which plan letters have it, the honest answer on Medicare Advantage, cruises and cross-border trips, what travel insurance still needs to cover, and South Dakota's guaranteed-issue Medigap window.
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Does Medicare Cover Colonoscopy? What Happens When They Find a Polyp: Sioux Falls 2026
A Medicare screening colonoscopy is $0 by federal rule, per Medicare.gov — no deductible, no coinsurance, once every 10 years at average risk or every 24 months at high risk. But the instant a polyp is found and removed during that same exam, the claim splits: the removal is billed at 15% coinsurance in 2026, confirmed independently by the Federal Register's CY2022 Physician Fee Schedule final rule, CMS Transmittal MM12656, and the American Cancer Society. That rate is a federal phase-down, not a fixed number — it drops to 10% for 2027-2029 and reaches 0% starting in 2030. Stool DNA tests, blood-based tests, and FIT tests are $0 too, but a positive result routes to a follow-up colonoscopy that carries the same rule. Here's the full 2026 guide: the complete screening menu and frequency rules, the PT modifier mechanic explained in plain terms, what to ask before you schedule, how Medigap Plan G or Plan N changes what you owe, and the Sioux Falls plan landscape.
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Medicare Advantage Ghost Networks: What to Do When Your Sioux Falls Directory Is Wrong in 2026
A 2023 U.S. Senate Finance Committee secret shopper study found more than 80% of listed mental health providers across 12 Medicare Advantage plans in six states were unreachable, full, or not actually in-network — and CMS's own 2016-2018 reviews of cardiology, oncology, ophthalmology, and primary care listings found roughly half of all directory locations had at least one error. Starting January 1, 2026, a new CMS rule (CMS-4208-F2) requires Medicare Advantage plans to submit provider directory data straight to CMS, and a brand-new, temporary Special Enrollment Period lets you switch plans in 2026 if you enrolled through Medicare Plan Finder and later found a relied-on doctor wasn't really in-network. Here's the full guide: how often this happens, what it costs you in real out-of-pocket exposure, the exact SEP eligibility rules, a 4-step method to verify any doctor before you enroll, and why it matters even more in a two-hospital-system market like Sioux Falls.
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