Medicare in South Dakota · Plan Year 2026
2026 Medicare Plans in South Dakota
South Dakota has 202,610 Medicare beneficiaries spread across 66 counties, and because Medicare Advantage and Part D plans are approved county by county, no two of those counties see the same list. Statewide for 2026 there are 13 Medicare Advantage plans from 5 carriers (7 at $0 premium), plus 8 Medicare Cost plans that still serve 48 counties. Below is the real CMS data for the whole state, then a link to your county's complete guide.
Page last revised: 2026-07-19 · Plan and enrollment data refreshed: 2026-07-19
By the numbers · statewide
South Dakota Medicare at a glance
Sources: CMS Medicare Advantage/Part D Landscape (PY2026) · CMS Medicare Monthly Enrollment (county), accessed 2026-07-19.
Every plan · 2026
All Medicare Advantage plans sold in South Dakota (2026)
One row per plan, not per county. A plan listed in 45 counties still counts once here. "Counties" shows how much of the state each plan reaches, and "Stability" is the plan's published CMS Overall Star Rating tier, a federal quality measure rather than our opinion. Worth knowing: every standard Medicare Advantage plan sold in South Dakota for 2026 is a PPO, so network flexibility is the statewide baseline.
| Plan | Carrier | Counties | CMS rating | Premium/mo | Out-of-pocket max | Enrollees |
|---|---|---|---|---|---|---|
| Blue Medicare Advantage Enhanced PPO (PPO) Average (CMS 3.5★) | Wellmark Advantage Health Plan | 43 | 3.5★ | $63 | $4,200 | 9,582 |
| Medica Advantage Select (PPO) Average (CMS 3.5★) | Medica | 18 | 3.5★ | $80 | $5,000 | 8,381 |
| Medica Advantage Value (PPO) Average (CMS 3.5★) | Medica | 18 | 3.5★ | $25 | $6,750 | 5,230 |
| Align ChoicePlus (PPO) Average (CMS 3.5★) | Align powered by Sanford Health Plan | 19 | 3.5★ | $0 | $4,900 | 3,563 |
| Aetna Medicare Signature (PPO) Average (CMS 3.5★) | Aetna Medicare | 34 | 3.5★ | $0 | $6,750 | 2,718 |
| Medica Advantage Preferred (PPO) Average (CMS 3.5★) | Medica | 18 | 3.5★ | $176 | $3,300 | 2,607 |
| AARP Medicare Advantage Patriot No Rx SI-MA2 (PPO) Strong (CMS 4★+) | UnitedHealthcare | 45 | 4.5★ | $0 | $6,700 | 2,297 |
| Medica Advantage Solution H8889-009 (PPO) Average (CMS 3.5★) | Medica | 18 | 3.5★ | $0 | $6,750 | 1,521 |
| Aetna Medicare Enhanced Extra (PPO) Average (CMS 3.5★) | Aetna Medicare | 34 | 3.5★ | $0 | $5,000 | 1,118 |
| Align ChoiceElite (PPO) Average (CMS 3.5★) | Align powered by Sanford Health Plan | 19 | 3.5★ | $10 | $3,500 | 861 |
| Blue Medicare Advantage Classic PPO (PPO) Average (CMS 3.5★) | Wellmark Advantage Health Plan | 8 | 3.5★ | $43 | $5,500 | 570 |
| Blue Medicare Advantage Valor PPO (PPO) Average (CMS 3.5★) | Wellmark Advantage Health Plan | 43 | 3.5★ | $0 | $6,750 | 225 |
| Aetna Medicare Eagle (PPO) Average (CMS 3.5★) | Aetna Medicare | 34 | 3.5★ | $0 | $6,750 | 198 |
Sources: CMS Medicare Advantage/Part D Landscape (PY2026) · CMS Medicare Part C & D Star Ratings (2026) · CMS Medicare Advantage Enrollment by State/County/Contract. Premiums shown are Part C premiums; enrollment is summed across the counties each plan serves.
Who South Dakotans actually buy from
Medicare Advantage carriers by statewide enrollment
Enrollment counts are CMS facts, not a ranking of quality. The largest carrier is not automatically the right one for your doctors or your prescriptions.
| Carrier | Plans in SD | Widest county reach | Enrollees |
|---|---|---|---|
| Medica | 4 | 18 counties | 17,739 |
| Wellmark Advantage Health Plan | 3 | 43 counties | 10,377 |
| Align powered by Sanford Health Plan | 2 | 19 counties | 4,424 |
| Aetna Medicare | 3 | 34 counties | 4,034 |
| UnitedHealthcare | 1 | 45 counties | 2,297 |
Source: CMS Medicare Advantage Enrollment by State/County/Contract.
Quality spread
CMS star ratings across South Dakota's plans
CMS rates each contract 1 to 5 stars on quality and member experience. Here is how the 13 plans sold in South Dakota land for 2026.
| CMS Overall Star Rating | Plans | Share of the state's plans |
|---|---|---|
| 4.5★ | 1 | 8% |
| 3.5★ | 12 | 92% |
1 of the 13 plans sold in South Dakota carry a CMS 4★ or higher rating. A 5★ plan would open a year-round Special Enrollment Period, and none is offered in the state for 2026.
The South Dakota specialty
Medicare Cost plans: still 23,600 enrollees here
Medicare Cost plans have nearly vanished from the rest of the country, but South Dakota is one of the last places they thrive. 8 Cost plans from Medica serve 48 of 66 counties, covering about 23,600 residents. The reason they persist is rural: when you go outside a Cost plan's network, Original Medicare picks the bill up instead of you. That is a real difference when the specialist you need is three hours away.
| Cost plan | Carrier | Counties | CMS rating | Premium/mo | Out-of-pocket max | Enrollees |
|---|---|---|---|---|---|---|
| Medica Prime Solution Core (Cost), no drug coverage | Medica | 48 | 3.5★ | $98 | $3,750 | 11,141 |
| Medica Prime Solution Standard (Cost), no drug coverage | Medica | 48 | 3.5★ | — | $5,900 | 8,833 |
| Medica Prime Solution Premier (Cost), no drug coverage | Medica | 48 | 3.5★ | $217 | $3,000 | 2,480 |
| Medica Prime Solution Standard w/Rx (Cost) | Medica | 48 | 3.5★ | — | $5,900 | 653 |
| Medica Prime Solution Core w/Rx (Cost) | Medica | 48 | 3.5★ | $98 | $3,750 | 396 |
| Medica Prime Solution Premier w/Rx (Cost) | Medica | 48 | 3.5★ | $217 | $3,000 | 97 |
| Medica Prime Solution Thrift w/Rx (Cost) | Medica | 48 | 3.5★ | $49 | $6,750 | 0 |
| Medica Prime Solution Thrift (Cost), no drug coverage | Medica | 48 | 3.5★ | $49 | $6,750 | 0 |
Source: CMS Medicare Advantage/Part D Landscape (PY2026) · CMS Medicare Advantage Enrollment by State/County/Contract. Plans without Part D drug coverage are paired with a stand-alone Part D plan.
Where Advantage plans do not reach
15 South Dakota counties have no Medicare Advantage plan
For 2026, no standard Medicare Advantage plan is sold in these counties: Bennett, Faulk, Grant, Hand, Hughes, Hyde, Jones, Lyman, Mellette, Oglala Lakota, Potter, Stanley, Sully, Todd, Tripp. That is not a dead end. Residents there use Original Medicare, usually with a Medicare Supplement (Medigap) policy to cover the gaps and a stand-alone Part D plan for prescriptions, or a Medicare Cost plan where one is offered. Medigap is also the portable option: it travels with you anywhere in the country that takes Medicare, which is why it fits ranchers, snowbirds, and anyone who drives to Sioux Falls or Rapid City for care.
What Original Medicare leaves you owing (why Medigap exists)
| Medicare gap (2025) | What you owe without a supplement |
|---|---|
| Part A hospital deductible | $1,632 per benefit period, not per year |
| Hospital days 61 to 90 | $408 per day |
| Skilled nursing, days 21 to 100 | $204 per day |
| Part B annual deductible | $257 per calendar year |
| Part B coinsurance | 20% of the approved amount, with no annual ceiling |
Medigap plans are federally standardized, so Plan G from one company covers exactly what Plan G from another covers. Only the price and the service differ. 8 standardized plans are available to new enrollees. See the full letter-by-letter comparison in our South Dakota Medigap guide →
Sources: CMS 2025 Medicare Parts A & B Premiums and Deductibles (Fact Sheet) · CMS — Choosing a Medigap Policy (Publication 02110).
Health profile · why plan choice matters here
Chronic conditions among South Dakota adults
CDC PLACES model-based prevalence, weighted across county populations. These are the conditions that decide whether a plan's drug formulary, specialist network, and out-of-pocket maximum actually fit you.
Source: CDC PLACES: Local Data for Better Health, County (crude prevalence).
CMS 5★ hospitals in South Dakota
- SANFORD USD MEDICAL CENTER, Sioux Falls · CMS 5★ overall hospital rating
- SIOUX FALLS VA MEDICAL CENTER, Sioux Falls · CMS 5★ overall hospital rating
- AVERA HEART HOSPITAL OF SOUTH DAKOTA, Sioux Falls · CMS 5★ overall hospital rating
- VA BLACK HILLS HEALTHCARE SYSTEM, Fort Meade · CMS 5★ overall hospital rating
- AVERA ST BENEDICT HEALTH CENTER - CAH, Parkston · CMS 5★ overall hospital rating
Another 7 South Dakota hospitals hold a CMS 4★ rating. Before you enroll, the question is not which hospital is best rated. It is whether yours is in the plan's network.
See the plans in your South Dakota county
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Largest Medicare markets
South Dakota's biggest Medicare counties
| County | Medicare beneficiaries | MA plans (2026) | $0-premium | Avg CMS rating | |
|---|---|---|---|---|---|
| Minnehaha | 40,327 | 8 | 6 | 3.63 | 2026 guide → |
| Pennington | 29,973 | 8 | 3 | 3.63 | 2026 guide → |
| Lincoln | 12,156 | 8 | 6 | 3.63 | 2026 guide → |
| Brown | 8,470 | 1 | 1 | 4.5 | 2026 guide → |
| Lawrence | 8,290 | 8 | 3 | 3.63 | 2026 guide → |
| Codington | 6,653 | 5 | 2 | 3.7 | 2026 guide → |
| Meade | 6,488 | 8 | 3 | 3.63 | 2026 guide → |
| Brookings | 5,946 | 12 | 7 | 3.58 | 2026 guide → |
| Yankton | 5,868 | 6 | 5 | 3.67 | 2026 guide → |
| Davison | 4,804 | 10 | 6 | 3.6 | 2026 guide → |
| Beadle | 3,985 | 4 | 4 | 3.75 | 2026 guide → |
| Union | 3,825 | 6 | 5 | 3.67 | 2026 guide → |
Want every county in one sortable table, with plan counts and enrollment side by side? See the full South Dakota county data hub →
All 66 counties
Find your county's 2026 Medicare guide
Each county page carries its own CMS plan tables, premiums, star ratings, local enrollment, health data, and hospitals, because that is the level Medicare is actually sold at.
- Aurora
- Beadle
- Bennett
- Bon Homme
- Brookings
- Brown
- Brule
- Buffalo
- Butte
- Campbell
- Charles Mix
- Clark
- Clay
- Codington
- Corson
- Custer
- Davison
- Day
- Deuel
- Dewey
- Douglas
- Edmunds
- Fall River
- Faulk
- Grant
- Gregory
- Haakon
- Hamlin
- Hand
- Hanson
- Harding
- Hughes
- Hutchinson
- Hyde
- Jackson
- Jerauld
- Jones
- Kingsbury
- Lake
- Lawrence
- Lincoln
- Lyman
- Marshall
- McCook
- McPherson
- Meade
- Mellette
- Miner
- Minnehaha
- Moody
- Oglala Lakota
- Pennington
- Perkins
- Potter
- Roberts
- Sanborn
- Spink
- Stanley
- Sully
- Todd
- Tripp
- Turner
- Union
- Walworth
- Yankton
- Ziebach
Choosing a plan in South Dakota: what actually matters
- Your county decides your list. Plans are approved county by county, so a neighbor 20 miles across the line can have options you cannot buy. Start from your county page, not a national ad.
- Distance is a coverage question. In a state this rural, the specialist, the cancer center, and the heart program are often in Sioux Falls or Rapid City. Check the network before the premium.
- Cost plans deserve a real look. 23,600 South Dakotans are in one. Going out of network falls back to Original Medicare instead of your wallet.
- Medigap travels. If you split the year between here and somewhere warmer, or you live in one of the 15 counties with no Advantage plan, a supplement plus a Part D plan is usually the cleaner fit.
- Prescriptions decide more than people expect. The statewide average Part D deductible is $432, but formulary tiers differ plan to plan. The same drug can be cheap on one and expensive on the next.
- Special Needs Plans exist in 53 counties. If you have both Medicare and Medicaid, or you live in a nursing facility, a D-SNP or I-SNP may beat everything above.
South Dakota Medicare questions, answered
How many Medicare Advantage plans are available in South Dakota for 2026?
13 distinct standard Medicare Advantage plans are sold across South Dakota for 2026, offered by 5 carriers, 7 of them at a $0 Part C premium. No single county gets all of them: availability runs from 1 to 12 plans depending on where you live, and 15 of the 66 counties have no standard Medicare Advantage plan at all.
How many South Dakotans are on Medicare?
CMS counts 202,610 Medicare beneficiaries across South Dakota's 66 counties (2025). About 75,793, roughly 37%, are in Medicare Advantage, a Medicare Cost plan, or other non-Original-Medicare coverage; the rest stay on Original Medicare, usually paired with a Medigap supplement and a stand-alone Part D plan.
What does a Medicare Advantage plan cost in South Dakota in 2026?
Across the 13 plans sold statewide, the average Part C premium is $31/month and 7 plans charge $0. The average in-network out-of-pocket maximum is $5,527 (the highest is $6,750), and the average Part D drug deductible across counties is $432. You keep paying your Part B premium with any Medicare Advantage plan.
Why are Medicare Cost plans such a big deal in South Dakota?
Medicare Cost plans have all but disappeared nationally, but they are still a major South Dakota option: 8 Cost plans from Medica serve 48 of the state's 66 counties, with about 23,600 South Dakotans enrolled. Unlike Medicare Advantage, a Cost plan lets you use Original Medicare when you go outside the plan's network, which matters in a rural state where specialists are often out of town. They deserve a side-by-side look before you sign anything.
Which counties in South Dakota have no Medicare Advantage plans?
For 2026, 15 of South Dakota's 66 counties have no standard Medicare Advantage plan for sale: Bennett, Faulk, Grant, Hand, Hughes, Hyde, Jones, Lyman, Mellette, Oglala Lakota, Potter, Stanley, Sully, Todd, Tripp. Residents there typically use Original Medicare with a Medigap supplement and a stand-alone Part D plan, or a Medicare Cost plan where one is offered. Each county page shows exactly what is available locally.
Does Big Sioux Benefits help people outside the Sioux Falls area?
Yes. We are licensed in South Dakota and work statewide by phone and video, and in person around the Sioux Falls metro and Siouxland. Our help is free to you. Licensed agents are paid by the carriers, not by clients. We compare the plans we offer against your doctors, your prescriptions, and your budget.
Talk to a South Dakota Medicare advisor
Free, no pressure. Statewide by phone or video, in person around Sioux Falls.