South Dakota Medicare insurance offers coverage for citizens older than 65, but workers with specific disabilities may also be eligible. The US government funds Medicare, but South Dakota also helps Medicare beneficiaries living here, with its various educational and funding agencies.
Medicare starts with Part A and Part B, which makes up what is also known as Original Medicare. There is usually no premium for Part A, while Part B requires a premium of just $134 a month for beneficiaries who earn less than $85,000 year. However, there are also deductibles, coinsurances, and copayments that make up the out of pocket expenses for Medicare beneficiaries.
Part A covers the hospital insurance part of the coverage, and this includes inpatient hospital and psychiatric care. Part B is for Medical insurance, which covers medically necessary treatments and durable medical supplies, among others.
For those with Original Medicare looking for additional coverage, they can obtain supplemental “Medigap” policies. Medigap offers coverage for other health care services that are not covered by Part A and Part B. A common supplemental plan is called Medicare Part D, and it covers Medicare prescription drugs. Other plans may even help cover the cost of out of pocket expenses.
These Medigap plans can be purchased from companies that have been authorized by Medicare. These plans also come with a premium separate from the premium or premiums required by Original Medicare.
Medicare Part C refers to a more comprehensive plan that provides the same coverage as Original Medicare, plus additional benefits similar to what can be found in Medigap policies. This type of plan is called the Medicare Advantage Plan and contains Medicare Part A, Part B, Part D, and extra coverage for additional healthcare services.
A sizable number of Medicare beneficiaries in South Dakota are unable to afford the Medicare expenses due to lack of funds. However, the state government offers Medicare Savings Programs (MSPs) to help those in need. To determine individuals and married couples who need the most financial assistance, eligibility requirements include limits on income and assets.
The program with the most benefits and the most stringent income limits is the MSP for Qualified Medicare Beneficiaries. This QMB program requires that an individual’s income not exceed $1,032 per month while the combined income of a married couple who are living together must be less than $1,392. This program pays for practically every Medicare expense. It pays for the premiums for Medicare Part A and Part B, along with the deductibles, copays, and coinsurance.
In contrast, the MSP for Specified Low-Income Medicare Beneficiaries pays only for the premium for Part B. This is still substantial, as these premiums can total up to $1,608 per year. To benefit from the SLMB program, an individual cannot earn more than $1,234 a month. For married couples, the monthly income limit is $1,666.
The program for Qualified Individuals (QI) also pays for only the Part B premium. It is also not a guaranteed benefit, as the funding for the program is more limited. This is why applications are only granted on a first-come, first-served basis. The QI program requires an individual to earn less than $1,386 a month. Married couples cannot have a combined income of more than $1.872 to qualify for QI.
The QMB, SLMB, and QI programs all require an additional cap on resources as well. The limits only consider savings and checking accounts, stocks, and bonds. It does not count the value of the home the beneficiary is living in, nor the car owned by the beneficiary. For an individual, the asset limit is a total of $7,560, and for a married couple it is $11,340.
Qualifying for QMB, SLMB, or QI programs also automatically qualify the beneficiary for the “Extra Help” or Low Income Subsidy (LIS) program. This helps pay for all or part of the costs of Medicare Part D.
The MSP for Qualified Disabled and Working Individuals (QDWI) pays for the premium for Part A only. An individual’s limits are $4,132 a month for income and $4,000 for assets. For married couples, the income limit is $5,572 per month, and the asset limit is $6,000.
For Medicare beneficiaries to better understand the guidelines and benefits, they can call the Senior Health Information & Insurance Education (SHIINE) for information. They also offer free and unbiased counseling.