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into a Part D plan, when you have Part Aand/or Part B, during Part D OpenEnrollment (Oct 15-Dec 7) and otherspecific circumstances.You can buy a Medigap policy from anyinsurance company and/or their locallife/health agent who is licensed to sell inSouth Dakota by the Division of Insurance(DOI). This guide lists the rates forcompanies that responded to our requestfor information for 2021. Companies maychange their prices at any time, if approvedby the South Dakota DOI. Call the insurancecompanies or agents directly to obtain themost current rates. Telephone numbers,websites and rates are listed in this guidefor companies selling Medigap plans inSouth Dakota.CHANGES IN MEDIGAP POLICIESMedigap plans C, F and F High Deductiblewill no longer be sold in the United Statesafter December 31, 2019. New federal lawprohibits the sale of Medigap plans thatcover Part B deductible to newly eligibleMedicare beneficiaries on or after January1, 2021. Anyone who has a Plan C, F, or FHigh Deductible prior to December 31,2019, is grandfathered in and will not needto make any change. They will continue intheir respective plan for as long as they paythe premium on time.WHAT TYPES OF MEDIGAP POLICIESARE AVAILABLE?Medigap plans are nationally standardizedand include plans A, B, D, G, (also a HighDeductible G), K, L, M and N. Companieschoose which plans they wish to offer ineach state. Standardized means a Plan Afrom one company must offer the samebenefits as Plan A from all other companies,and so forth for each respective plan.Anyone who purchases a Medigap plan onor after January 1, 2021, will be required topay the Part B deductible ( 198 in 2021).It is expected starting in 2020, a HighDeductible Plan G will be offered in additionto a regular Plan G. Insurance companieswill decide if they wish to offer these plans.Each Medigap plan offers specific benefitsand coverage listed in the chart at the endof this guide. Cost is usually the mostsignificant difference between Medigappolicies with the same letter sold bydifferent insurance companies but somemay offer discounts or other incentives.Consumers who have Medigap plans C, F, orF High Deductible are not expected to seesignificant premium increases in the nearfuture even though the pool of memberswill eventually decrease. Part B deductibleamount will increase over time but is notexpected to be dramatic in any given year.3

WHEN CAN I SIGN-UP FOR AMEDIGAP POLICY?WHAT IS A LOOK-BACK PERIOD?Coverage for a pre-existing condition can beexcluded by the plan only if the conditionwas first diagnosed within 6 months beforethe Medigap plan started. This is called the“Look-Back” period for Medicare coveredservices, Original Medicare will still coverthe condition even if the Medigap policywon’t, but you are responsible for theMedicare co-insurance or co-payments.After 6 months the Medigap policy willcover the recently diagnosed pre-existingcondition. Be sure to find out prior topurchase if your desired plan has a lookback clause.The best time to purchase a Medigap policyis during your Medigap Open Enrollmentperiod also known as Guarantee RightPeriod. This period begins when you firstenroll and start paying for Medicare Part B.The key to guarantee issue right is whenyou begin paying for Part B, whether onMedicare due to a disability, turning 65 andbeginning Medicare, or when you or spouseno longer have employer group healthcoverage, even if you are older than 65.The Open Enrollment Period starts whenyou enroll in Medicare Part B and ends 6months later. If you or your spousecontinues working past age 65 and you arecovered by creditable employer grouphealth coverage by you or spouse, you donot have to enroll in Part B at that time.If you apply for a Medigap policy after the 6month window of when Part B begins, youwill go through health underwriting and thecompany can legally refuse coverage.Every new Medicare beneficiary who is age65 or older with Part A and B has aguaranteed right to buy a Medigap policyduring “Open Enrollment.” An insurancecompany cannot reject you and it cannotcharge you more than anyone else your agefor any policy it sells.4

Is there a rate increase each year?WHAT IF I KEEP WORKING PAST AGE65 AND KEEP EMPLOYER HEALTHINSURANCE?Are there major complaints of thecompany?If you are on your spouse’s employer healthinsurance and you turn 65, or if youcontinue working past 65 and are on youremployer health insurance, be sure to talkto the health insurer to see how it workswith Medicare. You do not have to enroll inpart B nor get a Medigap policy whenturning 65 if you already have crediblecoverage, which includes a prescriptiondrug plan.What is the financial or customer servicerating?You cannot predict what your health statuswill be 15-25 years from when you firstobtain a Medigap plan. The most popularplans in South Dakota have included PlansF, G, N, and C.CAN I CHANGE MY MEDIGAP POLICY?In the above case, your 6 month issue rightfor a Medigap plan begins when you or yourspouse retire or stop working and you nolonger have employer health coverage, andyou have enrolled and started paying foryour Medicare Part B premium.Unless you move to another state, or theinsurance company no longer sells theMedigap policy in your state, you can keepthe same company and policy for the rest ofyour life. You may apply for anotherMedigap policy at any time if you choose.However, after the 6-month OpenEnrollment has expired, companies willlikely require applicants to go throughunderwriting, a process where a person’shealth history is reviewed and variousmedical tests will be conducted. Thecompany will pay for the reviews and testsbut may deny plan acceptance for anyhealth reason. DO NOT CANCEL yourcurrent Medigap policy until you areofficially accepted by the new company andhave the policy in-hand.WHICH PLANS ARE BEST FOR ME?This really varies by person! Considerthese:Which insurance benefits are mostimportant to you?What is the monthly premium?Level of risk for future medical expensesyou are willing to accept?Some companies MAY offer their own OpenEnrollment opportunities where a Medigappolicy can be issued or changed to anyonewho applies during that timeframe withoutany health underwriting.What are the member services?Are discounts or incentives offered?What plan do family or friends have?5

Attained-age rated. The premium is based on yourcurrent age, the age you haveattained, resulting in your premiumincreasing as you get older. Theymay be the least expensive at first,but they can eventually become themost expensive. Premiums may alsogo up because of inflation and otherfactors.The cost of the Medigap policy may alsodepend on whether the company offersdiscounts, such as: discounts for women,non-smokers, people who are married,those who pay yearly, pay premiums usingelectronic funds transfers or other reasons.HOW DO INSURANCE COMPANIESSET PRICES FOR MEDIGAP POLICIES?Each insurance company decides how it willset the price, or premium, for its Medigappolicies. It is important to ask how aninsurance company prices its policies as itaffects how much you pay now and in thefuture. Medigap policies can be priced in 3ways and the company can change itsmethod:Community-rated, also called no-agerated. Generally the same monthlypremium is charged to everyone whohas the Medigap policy in ageographic area, regardless of age.Premiums may go up because ofinflation and other factors but notbecause of your age.Issue-age rated, also called entry agerated. The premium is based on the age youare when you buy, or are issued, theMedigap policy. Premiums are lowerfor people who buy at a younger ageand won’t change as you get older.Premiums may go up because ofinflation and other factors but notbecause of your age.CAN MY MEDIGAP INSURANCECOMPANY DROP ME?In most cases, a Medigap insurancecompany cannot drop you because thepolicy is guaranteed renewable. Yourinsurance company can only drop you if oneof these happens: You are delinquent in paying yourpremium. You were not truthful on the Medigapapplication. The insurance company becomesbankrupt or insolvent or no longer sellspolicies in your state through no fault ofyour own. You then have the right to buyMedigap Plan A, B, D, K, or L sold inSouth Dakota by any insurancecompany without any insurancehealth underwriting. NOTE: If this is the case, you must geta new policy within 63 calendar daysfrom the date your coverage ended.6

with your company regarding the travelbenefit if you have a SELECT policy. If youhave an emergency procedure, such as aninjury while vacationing or have emergencygallbladder removed while in another state,you are taken to an emergency room fortreatment. Emergency cases are coveredwith your SELECT plan.Both Standard and Preferred policies coverthe same Medicare benefits according tothe standardized letter of the plan. Forexample, Plan A Standard covers the samebenefits as Plan A Preferred but at twodifferent premiums. You previously readhow a company sets prices by communityrated, attained-age rated, and issue-agerated. A company can charge differentamounts for a Standard or Preferred policybased upon individual company criteria.Preferred Medigap policies are when youhave Part A, are enrolled in Part B duringyour Medigap Open Enrollment Periodwithin 6 months of turning 65 OR over theage 65 when you or spouse retire and youno longer have credible group healthcoverage AND you have enrolled in Part Bwithin the past six months. You may alsoqualify if you meet a special enrollmentperiod which is very limited in scope.Preferred policies are priced at lower ratesthan Standard rates.WHAT ARE THE DIFFERENCESBETWEEN SELECT, STANDARD, ANDPREFERRED MEDIGAP PLANS?Medicare SELECT is a type of Medigappolicy sold in some states, including twocompanies in South Dakota. These plansfollow the same rules as the standardpolicies but require you to use hospitalswithin its network to be eligible for fullinsurance benefits. Avera Health Plans andSanford Health Plans both offer SELECTpolicies which are the lowest cost policieseach health system offers. Electiveprocedures or those planned in advance,such as a hip surgery, are to be conductedat a network hospital unless a travel benefitoption is offered where a procedure can behandled at a non-network hospital. CheckCriteria for Standard Medigap policies varyby company and it would be best to find outwhat criteria the company uses. Thevariable criteria can include but are notlimited to tobacco use, height-weightcharts, degree of health risk or whether aperson is beyond open enrollment andchanging companies.7

down because of the disability, providedthe company offers plans to beneficiariesunder age 65. Another 6-month openenrollment period will apply when thedisabled Medicare beneficiary turns 65.DO I NEED A MEDIGAP POLICY IF IHAVE RETIREE, VA, OR OTHERCOVERAGE? Retiree Plans – Each retiree plan isdifferent and offers different benefits. Itis important to check with the retireeplan to determine the exact benefits.Typically, a retiree plan and asupplement are not needed at the sametime. Retiree plans are NOT guaranteedrenewable, meaning the coverage canbe changed or dropped at any time byyour former employer. Federal Employee Health Benefits(FEHB) For Retirees – Retiree FEHBtypically works like a Medigap plan.Medicare will pay primary and FEHB willpay secondary. There is usually no needto have both FEHB and a Medigap plan. VA Benefits – If the veteran receivescare outside the VA system and doesn’tmeet the Choice Program eligibility,enrolling in Part A and B and getting aMedigap plan would be an option. TheVA is required to bill private veteran’snon service-connected conditions.Generally, VA cannot bill Medicare but itcan bill Medigap plans for coveredservices. TRICARE for Life and CHAMPVA for Life– Both TRICARE for Life and CHAMPVAFOR Life act like a Medigap plan.Beneficiaries do not need to enroll in aseparate Medigap plan.CAN I KEEP THE SAME DOCTOR?Medigap plans do not place limits on thedoctors or hospitals you can choose unlessyou have a SELECT Plan. You simply chooseany provider that accepts Medicareassignment and your Medicare Supplementplan will pay as stated in your policy.BENEFICIARIES WITH DIABILITIESMedicare beneficiaries under age 65 with adisability or End State Renal Disease haveaccess to Medigap policies.Upon enrolling in Medicare Part A and PartB, a disabled beneficiary has a 6-monthopen enrollment period to purchase aMedigap policy. This is guaranteedcoverage with no health underwriting. Thatperiod begins the day Part B coveragebecomes effective and ends 6 months later.The disabled beneficiary cannot be turned8

beyond what Medicare approves for aspecific procedure or doctor office visit. Adoctor is allowed to charge up to 15percent higher if she or he does not acceptMedicare assignment. Both Plan F and Gwill pay 100 percent of any excess chargesyou may incur. However, you can preventany excess charges by selecting only doctorswho accept Medicare assignment.IS IT HARD TO FILE CLAIMS?Filing a claim is not hard. Most Medigapinsurance plans use a very easy and mostlyautomated claims process. Typically yourMedigap insurance company is linkeddirectly to Medicare so there is rarely aneed for you or your doctor to file a claimfor outpatient services.WHAT IS A MEDICARE SUMMARYNOTICE (MSN)?It is a notice people with Original Medicarereceive in the mail every 3 months for theirMedicare Part A and Part B coveredservices. The MSN shows all services orsupplies providers and suppliers billed toMedicare during the 3-month period, theamount Medicare paid to each and themaximum amount you may owe theprovider either through your Medigap planor out of pocket. Keep your receipts andbills and compare them to your MSN to besure you got all the services, supplies orequipment listed. If an item or service isdenied, call your provider’s office to makesure they submitted the claim correctly. Ifnot, the office may resubmit. If youdisagree with any decisions made, you canfile an appeal.WHAT ARE MEDICARE PART B EXCESSCHARGES?If you are on Medicare and happen to go toa doctor who does not accept Medicareassignment (full payment by Medicare) thedoctor is allowed to have an “excesscharge.” This is the amount above and9

MEDIGAP TERMS AND DEFINITIONSTERMDEFINITIONAssignmentAn agreement by your doctor, provider, or supplier to accept payment directly fromMedicare for services rendered in the amount approved by Medicare, without billing youmore than your Medicare deductible and coinsurance.CoinsuranceThe percentage of the cost you pay for a covered health care service after meeting yourdeductible. For example, you may pay 25% for each drug or 20% for durable medicalequipment.CopaymentThe set dollar amount you pay for each drug on a tier level or a doctor visit. For example,you may pay a lower copayment for generic drugs than brand name drugs.CrossoverAutomatic submission from Medicare to a Medicare Supplement insurance company forprocessing a Medigap Plan’s portion of a claim.DeductibleThe amount you must pay each year for your Part A, B, or D, before your Medigap planpays its share of your costs. Depending on the Medigap plan you select, it may eliminatedeductible costs you have for Parts A and B, but it will not reduce any deductible found inyour Part D Prescription drug plan.Guaranteed Issue RightsRights you have when insurance companies are required by law to sell or offer you aMedigap policy. In these situations, an insurance company cannot deny you a Medigappolicy, or place conditions on a Medigap policy, such as exclusions for pre-existingconditions and cannot charge you more for a Medigap policy, because of a past or presenthealth problem.Medicare Part C PlansMedicare Part C Plans (Medicare Advantage and Medicare Cost Plans) are NOT MedigapPlans/Medicare Supplement Plans. They are private health insurance plans, like HMOs orPPOs, with a network of doctors, health care providers and hospitals, which can provideyour basic Medicare coverage. Plans have an annual out-of-pocket deductible and mayinclude some coverage for drugs, dental, vision and hearing.10

2021 SOUTH DAKOTA MEDIGAP PROVIDERSA list of licensed insurance companies who sell Medicare Supplement plans in South Dakota for 2021 and volunteered theirinformation follows. Because prices can change at any time with approval by South Dakota Division of Insurance, alwayscheck rates with the company or agent and get specific questions answered prior to purchasing a plan. Don’t forget to haveyour prescription drug plan checked annually during Part D Open Enrollment: October 15 – December 7. Make anappointment at your SHIINE office.The charts list the monthly premiums for the standardized plans each company offers in South Dakota; organizedalphabetically then by policy type. For means of comparison, charts detail rates for a male, non-smoker in 5-year increments.Most policies have lower rates for females and non-smokers. Other company discounts and incentives are listed per policytype. “ 65” refers to beneficiaries on Medicare due to disability and younger than 65. Several companies have maximumrates starting at a certain age, for example 80.Example format:INSURANCE COMPANYInsurance Company NamePhoneWeb addressPOLICY TYPEAGEA TANDARDIZED MEDICARE SUPPLEMENT PLANS – MONTHLY PREMIUMSDGG(HD) RateF(HD)COMMENTS/DISCOUNTSPRICING METHODDiscounts

2021 SOUTH DAKOTA MEDIGAP PROVIDERSINSURANCE COMPANYAARP United HealthcareInsurance P Membership RequiredSTANDARDSTANDARDIZED MEDICARE SUPPLEMENT PLANS – MONTHLY PREMIUMSDGG(HD) KLMNCFAGEAB 6565707580859095 273 105 115 189 189 189 189 189 420 144 158 260 260 260 260 260 517 143 157 257 257 257 257 257F(HD)COMMENTS/DISCOUNTS 180 59 65 107 107 107 107 107 306 107 117 192 192 192 192 192 388 121 133 219 219 219 219 219 537 184 202 332 332 332 332 332 542 186 204 335 335 335 335 335COMMUNITY RATEDElectric funds transfer discountAnnual payer discountNon-smoker discount 164 54 59 97 97 97 97 97 278 97 107 175 175 175 175 175 353 110 121 199 199 199 199 199 489 167 184 302 302 302 302 302 493 169 185 304 304 304 304 304COMMUNITY RATEDElectric funds transfer discountAnnual payer discountNon-smoker discount 130 49 54 67 80 82 82 82 221 90 100 122 145 150 150 150 281 103 114 139 165 171 171 171 391 158 173 213 252 260 260 260 394 159 175 214 254 262 262 262COMMUNITY RATED24-hour nurse healthlineelectric funds transfer discountVision discountsNon-smoker discount**Plan F and C are not available if your Part B start date is on or after 1/1/2021AARP United HealthcareInsurance P Membership RequiredPREFERRED 6565707580859095 248 95 105 172 172 172 172 172 382 131 144 236 236 236 236 236 470 130 143 234 234 234 234 234**Plan F and C are not available if your Part B start date is on or after 1/1/2021AARP United HealthcareInsurance P Membership RequiredSTANDARD 6565707580859095 198 84 92 113 135 139 139 139 305 123 135 166 196 203 203 203 376 122 134 164 195 201 201 201**Plan F and C are not available if your Part B start date is on or after 1/1/202112

2021 SOUTH DAKOTA MEDIGAP PROVIDERSINSURANCE COMPANYAmerican ContinentalInsurance CompanyAn Aetna ANDARDIZED MEDICARE SUPPLEMENT PLANS – MONTHLY PREMIUMSDGG(HD) KLMNCFAGEAB 6565707580859095 188 142 161 188 207 221 232 240 237 179 203 237 261 278 293 303 155 117 132 155 170 182 191 198 144 109 123 144 159 169 178 184 276 214 240 276 298 317 332 342F(HD)COMMENTS/DISCOUNTS 85 66 74 85 91 97 102 105ATTAINED AGENon-smoker discountOne-time Policy Fee: 20 perapplicationFor additional charges: FinalExpense, Cancer and HeartAttack or Stroke, Dental, Vision,Hearing (DVH) or HospitalIndemnity Flex**Plan F, F(HD), and C are not available if your Part B start date is on or after 1/1/2021Assured Life Association1-800-667-2937STANDARD 6565707580859095 172 130 144 172 199 221 236 243 186 141 155 186 142 239 255 262 123 93 103 123 142 158 169 174 241 182 201 241 278 309 330 340Assured Life Association6030 Greenwood Plaza BlvdSuite 100Greenwo

WHAT IS A MEDICARE SUPPLEMENT POLICY? Medicare Supplement Insurance, or Medigap, is sold by private insurance companies and their designated agents throughout South Dakota. Original Medicare (Parts A and B) pays about 80 percent of Medicare's authorized expenses including hospital, doctor bills, lab tests and more. Medigap plans help pay all or a