South Dakota's best Medicare Advantage plans offer limited options based on CMS star ratings, premiums, maximum out-of-pocket costs and coverage features. Align powered by Sanford Health Plan leads the state for PPO plans with a $33 average monthly premium and $4,200 average MOOP, earning a 3.5 CMS star rating. The state lacks HMO and HMO-POS options, making PPO plans the primary choice.
Best Medicare Advantage Plans in South Dakota (2026)
Updated: January 28, 2026
Advertising & Editorial Disclosure
Key Takeaways
Four insurers offer nine PPO-only Medicare Advantage plans across South Dakota, with no HMO or HMO-POS options available statewide. Monthly premiums range from $26 to $205.
Align powered by Sanford Health Plan beats competitors in the Mount Rushmore State's PPO market with 3.5-star ratings and low premiums.
Make sure your doctors accept the plan, check your prescription drug coverage and compare monthly costs to yearly out-of-pocket limits before you choose a plan.
Best Medicare Advantage Companies in South Dakota
| Align powered by Sanford Health Plan | 3.50 | $33 | $4,200 | Align ChoiceElite (PPO) |
| Aetna | 3.50 | $26 | $5,875 | Aetna Medicare Enhanced Extra (PPO) |
| Wellmark Advantage Health Plan | 3.50 | $76 | $4,404 | Blue Medicare Advantage Classic PPO (PPO) |
| Medica | 3.50 | $103 | $5,017 | Medica Advantage Select (PPO) |
Medicare Advantage plans differ from Original Medicare by bundling hospital, medical, and prescription drug coverage through private insurers. These Part C plans must cover everything Original Medicare does while typically adding benefits like dental, vision, and hearing care.
- CMS Star Ratings: Plans receive ratings from 1 to 5 stars based on quality, performance, and member satisfaction. Higher ratings mean better care, with 4-star and 5-star plans delivering superior service and outcomes.
- Monthly premiums: You'll pay the standard Part B premium plus any additional plan costs. Many Medicare Advantage plans charge no extra premium, though your total cost depends on coverage level and location.
- Maximum out-of-pocket (MOOP) limits: These caps protect you from high medical expenses by limiting your annual spending on covered services. Once you reach your MOOP, the plan pays 100% of covered care for the rest of the year.
- Drug coverage: Most plans include prescription drug benefits with a formulary listing covered medications. Check that your drugs are included and understand any prior authorization requirements or usage restrictions.
Sanford Health Plan
MoneyGeek Rating
4.7/ 5
4.9/5Affordability
5/5Quality
2.7/5Availability
CMS Star Rating
3.50Plan Types
PPO
Aetna Medicare
MoneyGeek Rating
4.5/ 5
4/5Affordability
5/5Quality
5/5Availability
CMS Star Rating
3.50Plan Types
PPO
Wellmark of South Dakota
MoneyGeek Rating
4.3/ 5
4/5Affordability
5/5Quality
2.5/5Availability
CMS Star Rating
3.50Plan Types
PPO
MEDICA
MoneyGeek Rating
4.0/ 5
3.4/5Affordability
5/5Quality
2.7/5Availability
CMS Rating
3.5Plan Types
PPO
WHY CHOOSE A PPO PLAN?
PPO plans cost more than other Medicare Advantage options, but they're worth it if you value complete healthcare freedom. You'll pay higher premiums but can see any specialist without referrals and visit out-of-network doctors when needed, though staying in-network saves money. These plans work best for South Dakota residents who travel frequently, want unrestricted access to specialists, or have established relationships with specific doctors they don't want to change.
How to Choose the Best South Dakota Medicare Advantage Plan
South Dakota offers multiple Medicare Advantage plans with different networks, costs and supplemental benefits. Your choice affects what you pay and which doctors you can see.
- 1Confirm Your Doctors and Hospitals Are In-Network
Insurance company acceptance differs from individual plan acceptance. Verify each doctor and hospital participates in the specific Medicare Advantage plan you're considering. Call billing departments with the exact plan name. Networks vary across products from the same insurer.
- 2Compare Total Costs, Not Just Premiums
Calculate total annual spending by counting expected doctor visits and multiplying by each plan's copay rate. Add prescription costs. Sum specialist fees for the year. Free premiums mean nothing if copays drain your budget.
- 3Check Prescription Drug Coverage
Check every medication you currently take on each plan's drug list during shopping. Some prescriptions require authorization approval before coverage begins, delaying refills by several days.
- 4Review Star Ratings and Quality Metrics
Medicare rates South Dakota plans using a 1 to 5 star system based on quality, service and member outcomes. Plans with 4 or 5 stars process claims more efficiently and resolve billing disputes faster.
- 5Compare Extra Benefits
Supplemental benefit packages separate South Dakota Medicare Advantage plans beyond basic coverage. Some plans add gym memberships, hearing aid benefits or monthly allowances for drugstore purchases. Choose what matches your needs.
- 6Check Out-of-Pocket Maximums
Annual spending caps limit your costs when expensive health events happen. Hit your out-of-pocket maximum and South Dakota Medicare Advantage plans cover remaining expenses through year end. Lower caps provide stronger financial protection but increase monthly premiums.
How Much Does Medicare Advantage Cost in South Dakota?
Medicare Advantage costs in South Dakota depend on provider. PPO plans are they only plan type available in the state with a median monthly premium of $55 and an average of $63, plus out-of-pocket maximums averaging $4,989.
| PPO | $55 | $63 | $4,989 |
Best South Dakota Medicare Advantage: FAQ
Get answers about Medicare Advantage enrollment processes, what's covered and enrollment timing for South Dakota residents.
How do you get a Medicare Advantage plan in South Dakota?
First enroll in Medicare Part A and Part B, then compare South Dakota plans on Medicare.gov or contact insurers directly. Enroll during Annual Enrollment (October 15-December 7) or during other qualifying periods.
What does Medicare Advantage cover?
Medicare Advantage plans cover everything Original Medicare does, plus most include prescription drugs and extras like dental, vision, and fitness benefits.
What's the difference between Medicare Advantage and Medicare Supplement?
Medicare Advantage replaces Original Medicare with bundled private insurance coverage, while Medicare Supplement (Medigap) works alongside Original Medicare to cover deductibles and copays.
When is open enrollment for Medicare Advantage in South Dakota
In South Dakota, Medicare Advantage open enrollment occurs October 15 through December 7 annually. Current enrollees can also switch plans January 1 to March 31.
Our Methodology: How We Ranked South Dakota's Best Medicare Advantage Plans
Our analysis of Medicare Advantage plans in South Dakota uses a scoring methodology that emphasizes affordability and quality. We evaluate three key factors to help you find plans that offer the best value for your health care needs. These factors include Affordability (50%), Star Ratings (40%), and Availability (10%), which together create a comprehensive picture of each plan's overall value.
- Affordability (50%): Cost accounts for half of our overall score because it affects your budget. We evaluated monthly premiums for Part C and Part D coverage combined (30% weight) and in-network maximum out-of-pocket limits (20% weight). Plans with lower premiums and MOOP amounts score higher since they reduce your total annual health care spending.
- Star Ratings (40%): CMS star ratings measure plan quality across categories like care effectiveness, customer service and member satisfaction. The Overall Star Rating combines both Part C (medical coverage) and Part D (prescription drug) ratings on a scale from 1 to 5 stars. Plans with higher ratings earn better scores in our analysis.
- Availability (10%): We score providers based on how many states they operate in, including Washington, D.C. Providers with broader geographic availability score higher because they're more likely to maintain coverage if you move and often have more resources for customer support and plan improvements.
This scoring system helps you compare plans objectively while accounting for what matters most: what you'll pay and the quality of care you'll receive.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.