Medicare in Madison · Lake County, South Dakota · Plan Year 2026
2026 Medicare Plans in Madison, SD
Medicare Advantage plan availability is set at the county level, so Madison residents choose from the Lake County lineup: 8 Medicare Advantage plans for 2026, 6 with a $0 premium, and 13% rated CMS 4★ or higher. Another 8 Medicare Cost plans — a South Dakota specialty — serve the county too. Madison itself is home to 6,158 residents (Census ACS 2023). Below: the city profile, the county's real CMS numbers, and a live tool for your ZIP.
Page last revised: 2026-07-19 · CMS plan data refreshed: 2026-07-19 · Census data retrieved: 2026-08-18
Madison by the numbers
Madison at a glance — and the Lake County Medicare market it belongs to
Sources: U.S. Census Bureau ACS 5-Year Estimates (2023), places — retrieved 2026-08-18 · CMS Medicare Advantage/Part D Landscape (PY2026) · CMS Medicare Monthly Enrollment (county).
Why Madison's plan list is really Lake County's plan list
CMS approves and prices Medicare Advantage, Cost, and Part D plans county by county — there is no such thing as a city-level plan menu. Every Madison address in Lake County sees the same 2026 lineup as the rest of the county, and moving one county over can change the list entirely. That is why the deep data — every plan, premium, out-of-pocket maximum, star rating, and enrollment count — lives on our county Complete Guide:
Lake County, SD: every 2026 plan, premium & rating →
Home of Dakota State University in the Lake County lakes region, an hour northwest of Sioux Falls — close enough that care patterns often span both markets.
What Lake County neighbors actually chose
Most-enrolled Medicare Advantage plans available in Madison
County-level CMS enrollment facts, not a recommendation — the right plan depends on your doctors, drugs, and budget.
- Blue Medicare Advantage Enhanced PPO (PPO) (PPO) — 150 county enrollees
- Align ChoicePlus (PPO) (PPO) — 42 county enrollees
- Aetna Medicare Signature (PPO) (PPO) — 32 county enrollees
- AARP Medicare Advantage Patriot No Rx SI-MA2 (PPO) (PPO) — 23 county enrollees
- Aetna Medicare Enhanced Extra (PPO) (PPO) — 13 county enrollees
Source: CMS Medicare Advantage Enrollment by State/County/Contract (counts under 11 suppressed by CMS).
A South Dakota specialty
Medicare Cost plans for Madison residents
South Dakota is one of the few states where Medicare Cost plans are still common. They combine plan benefits with a safety valve: outside the network, care simply falls back to Original Medicare rates. Lake County has 8 Cost plans for 2026 from Medica, with 585 county enrollees. Full details are on the Lake County guide.
Quality, in CMS's own numbers
How Madison's available plans are rated
| CMS rating | Plans | % of Lake County plans |
|---|---|---|
| 4.5★ | 1 | 13% |
| 3.5★ | 7 | 88% |
The average CMS rating across the 8 plans available to Madison residents is 3.63. Per-plan ratings, premiums, and out-of-pocket maximums are in the full Lake County tables.
Hospitals serving Madison (Lake County)
- MADISON REGIONAL HEALTH SYSTEM — Madison · not yet rated by CMS
See your Madison plans now
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When Madison residents can enroll
- Initial Enrollment Period — the 7-month window around your 65th birthday. Medicare 101 →
- Annual Enrollment Period — October 15 to December 7 each year, for 2027 coverage decisions.
- Medicare Advantage Open Enrollment — January 1 to March 31, one switch allowed if you already have an MA plan.
- Special Enrollment Periods — after life events like moving counties, losing employer coverage, or qualifying for Extra Help.
Thinking about a Medigap supplement instead? Your 6-month Medigap open enrollment window starts with Part B — the details, including South Dakota's own rules, are in our South Dakota Medigap guide and Medicare answers.
Madison Medicare questions, answered
How many Medicare Advantage plans are available in Madison, SD for 2026?
Medicare Advantage service areas are approved by CMS at the county level, so Madison residents choose from the Lake County lineup: 8 standard Medicare Advantage plans for 2026, 6 of them with a $0 Part C premium. Another 4 Special Needs Plans serve residents who qualify. 8 Medicare Cost plans also serve the county.
Why does Madison use Lake County's Medicare plan list?
Because CMS approves and prices Medicare Advantage, Cost, and Part D plans county by county, not city by city. Every Madison address inside Lake County sees the same 2026 plan menu as the rest of the county — that's a CMS rule, not an agency choice. The full county data lives on our Lake County Complete Guide.
What does a Medicare Advantage plan cost in Madison for 2026?
Across the 8 plans sold in Lake County, the average Part C premium is $9.16/month and 6 plans charge $0. The average in-network out-of-pocket maximum is $5,568.75 (highest: $6,750). You still pay your Part B premium with any plan, and the right plan depends on your doctors and drug list, not the premium alone.
Where can I get free Medicare help in Madison?
Big Sioux Benefits works with Madison residents by phone and video (and in person across the Sioux Falls area) — free, because licensed agents are paid by carriers, not by you. For all options beyond the plans we offer, contact Medicare.gov, 1-800-MEDICARE, or SHIINE, South Dakota's free SHIP counseling program.
Sources, citations, and methodology
- U.S. Census Bureau, American Community Survey 5-Year Estimates (2023), tables B01003 (population), B01002 (median age), B19013 (median household income), B25003 (housing tenure) — incorporated places, South Dakota — retrieved 2026-08-18
- CMS Medicare Advantage/Part D Landscape (PY2026) — accessed 2026-07-19
- CMS Medicare Part C & D Star Ratings (2026) — accessed 2026-07-19
- CMS Medicare Advantage Enrollment by State/County/Contract — accessed 2026-07-19
- CMS Medicare Monthly Enrollment (county) — accessed 2026-07-19
- CMS Hospital Compare — Overall Star Ratings — accessed 2026-07-19
Methodology: city population, median age, median household income, and homeownership are U.S. Census Bureau ACS 5-year estimates (2023) for Madison city, South Dakota. All plan counts, premiums, out-of-pocket maximums, star ratings, and enrollment figures are county-level facts computed from the CMS PY2026 Landscape source files for Lake County — because CMS defines Medicare Advantage service areas by county, they apply to every Madison address in the county. Content is prepared by the Big Sioux Benefits Data Desk and reviewed against the cited files; plan details change — verify with a licensed agent before enrolling.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov or 1-800-MEDICARE for all options.
Keep exploring
- Lake County, SD Complete Guide → — every 2026 plan, premium, and rating behind this page.
- South Dakota statewide Medicare guide (2026) — all plans, carriers, and the counties with none.
- South Dakota Medigap (Medicare Supplement) guide — the other half of the decision.
- All areas we serve — every SD county and city guide.
Talk to a licensed Medicare advisor who knows Madison
Free, no pressure — we compare the plans we offer against your doctors, drugs, and budget.