Medicare 101
What Is Medicare?
Medicare is the federal health insurance program for people age 65 and older, and for some younger people with disabilities or specific conditions like ALS or End-Stage Renal Disease. It's built from four parts — A, B, C, and D. Parts A and B together are called "Original Medicare" and come from the government; Part C (Medicare Advantage) and Part D (prescription drugs) are private plans, sold by insurers the government approves, that round out your coverage. About 205,533 South Dakotans are Medicare-eligible (CMS PY2026; verify current figures on Medicare.gov), and we help residents across the Sioux Falls area sort out which pieces they need.
The four parts, defined
Part A is hospital insurance — inpatient stays, skilled nursing after a hospital stay, hospice, and some home health. Part B is medical insurance — doctor visits, outpatient care, lab work, preventive screenings, and durable medical equipment. Part C, or Medicare Advantage, is a private plan that bundles Parts A and B (and usually Part D) into one package. Part D is standalone prescription drug coverage. Most people use either Original Medicare (A and B) plus a drug plan, or a single Medicare Advantage plan that combines it all.
Original Medicare vs. Medicare Advantage
These are the two roads after you enroll. Original Medicare lets you see any provider in the country that accepts Medicare, with no networks — many people add a Medicare Supplement (Medigap) policy and a standalone Part D drug plan to fill the gaps. Medicare Advantage replaces that bundle with one private plan that uses a provider network, caps your yearly out-of-pocket spending, and often adds dental, vision, and hearing extras. Neither is automatically better; the right road depends on your doctors, prescriptions, travel, and budget.
What Medicare doesn't cover
Original Medicare leaves real gaps. It generally won't pay for routine dental, vision, or hearing care, and it does not cover long-term custodial care — help with daily activities like bathing or dressing in a nursing home or at home. There's also no built-in cap on your share of costs under Original Medicare alone, which is one reason people pair it with a supplement. Knowing these gaps up front helps you decide which added coverage, if any, the plans we offer make sense for you.
How South Dakota actually uses Medicare
The numbers tell a useful story. Of roughly 205,533 Medicare-eligible South Dakotans, about 47,971 — close to 23% — are enrolled in a Medicare Advantage plan, while another 113,372 carry a standalone Part D drug plan (CMS PY2026; verify current figures on Medicare.gov). In plain terms, most people in the state still use Original Medicare, often paired with a Medigap policy and a separate drug plan, rather than an all-in-one Advantage plan. That split is exactly why it pays to compare both paths instead of assuming one is standard.
Sioux Falls area: how it plays out locally
Around Sioux Falls, the two big health systems — Sanford and Avera — anchor most people's care decisions. With Original Medicare, both are broadly accessible because nearly all providers accept Medicare. With a Medicare Advantage plan, your doctors and hospital need to be in that plan's network, so the local question becomes "does my plan include my Sanford or Avera providers?" We serve South Dakota plus nearby northwest Iowa and southwest Minnesota, and we check that fit for each person before anything is decided.
How to get started
Start by confirming when you're eligible (most people at 65) and whether you'll keep working past 65 with employer coverage, which can change your timing. Then weigh the two roads — Original Medicare with a supplement and drug plan, or a Medicare Advantage plan from the plans we offer. There's no fee to talk it through with us, and no pressure. Our job is to translate the parts into plain English and help you make a confident choice for your situation.
Questions, answered
Is Medicare free?
Not entirely. Part A is usually premium-free if you or your spouse paid Medicare taxes for at least 40 quarters (about 10 years). Part B always carries a monthly premium, set by the government and higher for upper incomes. Medicare Advantage and Part D plan premiums vary — some Advantage plans have a $0 plan premium, but you still pay your Part B premium and any copays or deductibles. (Verify current figures on Medicare.gov.)
Is Medicare the same as Medicaid?
No. Medicare is federal health insurance based mainly on age — most people qualify at 65 regardless of income. Medicaid is a joint federal-and-state program based on limited income and resources. The names sound alike, but they're separate. Some people qualify for both at once, which is called being "dual-eligible" and can unlock additional help with costs. We can check which programs you may qualify for.
What are the four parts of Medicare in simple terms?
Part A is hospital coverage, Part B is doctor and outpatient coverage, Part C (Medicare Advantage) is a private all-in-one plan that bundles A and B and usually drug coverage, and Part D is prescription drug coverage. A helpful memory trick: A and B are the government's "Original Medicare," while C and D are private plans that add to or repackage it. Most people end up using either A+B plus Part D, or a single Part C plan.
Do I have to do anything to get Medicare at 65?
It depends. If you're already drawing Social Security before 65, you're usually enrolled in Parts A and B automatically and get your card in the mail. If you're not yet drawing Social Security, you have to sign up yourself during your enrollment window. Either way, choosing your added coverage — a drug plan or a Medicare Advantage plan — is a separate, active decision. We help Sioux Falls area residents handle both at no cost.
What's the difference between Original Medicare and Medicare Advantage?
Original Medicare (Parts A and B) is government coverage with no networks — any provider that accepts Medicare works, nationwide — and many people add a supplement and a drug plan. Medicare Advantage (Part C) is one private plan that bundles your coverage, uses a provider network, caps your yearly out-of-pocket costs, and often adds dental, vision, and hearing. Among the plans we offer we compare both paths against your doctors and prescriptions before you decide.
How many people in South Dakota have Medicare?
About 205,533 South Dakota residents are Medicare-eligible (CMS PY2026; verify current figures on Medicare.gov). Of those, roughly 47,971 are enrolled in a Medicare Advantage plan and about 113,372 carry a standalone Part D drug plan. Those figures show that Medicare is a huge part of life across the state — and that most people still use Original Medicare rather than an all-in-one Advantage plan. We help residents across the Sioux Falls area and Siouxland find their place in that picture.
Do most South Dakotans choose Medicare Advantage or Original Medicare?
Most still use Original Medicare. Only about 23% of Medicare-eligible South Dakotans — roughly 47,971 of 205,533 — are in a Medicare Advantage plan (CMS PY2026; verify current figures on Medicare.gov), which means the majority pair Original Medicare with a Medigap policy and a standalone Part D plan. There's no single "right" choice; the lower-premium Advantage path and the broader-freedom Original Medicare path each fit different people. We compare both against your doctors and budget.
What is a Medicare Supplement, or Medigap?
A Medicare Supplement, often called Medigap, is a private policy that pays your share of Original Medicare's costs — deductibles, copays, and coinsurance — with no network, so you can use any provider that accepts Medicare. It doesn't include drug coverage, so people usually add a standalone Part D plan alongside it. Medigap is the path many South Dakotans choose for predictable costs and nationwide provider freedom. We compare the standardized plans we offer so you get the same coverage for less.
Does Medicare cover prescription drugs?
Not on its own. Original Medicare (Parts A and B) generally doesn't cover most prescriptions you fill at a pharmacy — that's what Part D is for. You can get Part D as a standalone plan alongside Original Medicare, or built into a Medicare Advantage plan. For 2026, Part D has a standard $615 deductible and caps your out-of-pocket drug costs at roughly $2,100 a year (CMS PY2026; verify current figures on Medicare.gov). We match your drugs to the plan that covers them most affordably.
When should I start learning about Medicare?
Ideally about three to six months before you turn 65, since your Initial Enrollment Period opens three months before your birthday month. Starting early gives you time to compare Original Medicare versus Medicare Advantage, check that your Sanford or Avera doctors and your prescriptions are covered, and enroll so coverage begins the day you're eligible. If you're already past 65 or still working, it's not too late — we'll figure out your exact window with you at no cost.
Talk to a local Sioux Falls advisor
Free, no pressure — we compare your options for you.