Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) | Last updated October 8, 2026
Sioux Falls has the most Medicare Advantage choices in South Dakota, but Wellmark is leaving Medicare Advantage for 2027, and the state’s average premium is about $56.04.
Sanford Health and Avera Health anchor local care, so check which plans include your hospital system.
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Wellmark leaves MA.
SD average premium about $56.04.
Check Sanford and Avera access.
Nationally, the average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).
The Annual Enrollment Period is October 15 to December 7, 2026.
Key Takeaway
Which Medicare Advantage plans you can pick depends on your county. Medigap and Part D plans are sold statewide.
| Feature | HMO | PPO |
|---|---|---|
| Out-of-network care | Not covered except emergencies and urgent care | Covered at a higher cost |
| Referrals for specialists | Usually required | Usually not required |
| Premiums | Usually lower | Usually higher |
| Out-of-pocket maximum | In-network limit | In-network limit plus a higher combined limit |
| Best for | Lower costs, local care | Flexibility, travel, keeping specific doctors |
Sioux Falls Plans May Include
Hospital and medical coverage matching Original Medicare Part A and B
Part D prescription drug coverage on most plans
Routine dental, vision and hearing benefits
Fitness programs and over-the-counter allowances
Telehealth visits and care coordination programs
A yearly out-of-pocket maximum on every plan
Benefits are not offered by every plan. They differ by plan and county and may change for 2027. Review the Evidence of Coverage for each plan before enrolling.
Nationally, large insurers are trimming PPOs and pulling plans from some counties for 2027. In Sioux Falls, read your Annual Notice of Change, and if you received a non-renewal letter, choose a new plan before December 31, 2026.
| Insurer | Key 2027 Changes |
|---|---|
| UnitedHealthcare | 852 plans (846 last year); about 140 counties lose standard plans; exiting Wyoming; 34 PPOs eliminated |
| Humana | 861 plans, compared with 887; exiting Minnesota and 57 counties; 37 PPOs eliminated; about 600,000 members losing their plans |
| Aetna (CVS Health) | 654 plans (compared with 642); standard plans withdrawn from 123 counties; exiting Maryland and New Hampshire; 20 PPOs eliminated; 29 C-SNPs introduced |
| HCSC (including HealthSpring) | Down from 948 counties to roughly 478; exiting CT, KS, MT, NY, OR, UT and D.C.; 48 PPOs dropped |
| Centene (Wellcare) | Standard plans removed from 344 counties; exiting Hawaii, Oklahoma and Tennessee |
| Elevance (Anthem) | Standard plans removed from 56 counties; exiting South Carolina |
| Devoted Health | Entering CT, MI, NH, NJ and NY; adding 342 counties |
Source: company announcements and CMS 2027 landscape data reported by Becker’s on October 1, 2026. For 2027, Wellmark, Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of Mississippi are exiting Medicare Advantage as well.
Wellmark
Leaving MA.
$56.04
Average 2027 SD premium.
Guaranteed issue: when your Medicare Advantage plan exits your area, you can generally purchase certain Medicare Supplement plans with no health questions asked, up until 63 days after that coverage ends.
Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.
The trade-off is that Medicare Advantage plans generally rely on doctor and hospital networks and may call for referrals or prior authorization for certain services. Each Medicare Advantage plan sets a yearly out-of-pocket maximum for covered medical care, something Original Medicare lacks. You still pay your Part B premium, along with the plan’s premium if there is one.
Advantages
Often a low or $0 premium
A yearly out-of-pocket maximum
Drug coverage usually included
Dental, vision and hearing benefits may be included in many plans
One card and one plan
Tradeoffs
Networks; except for emergencies, HMOs require in-network care
Prior authorization and referrals are common
Copays add up if you use a lot of care
Plans and networks can change every year
Moving to Medigap later may involve health questions
If Original Medicare is your preference, a Medicare Supplement (Medigap) plan covers some or all of what Medicare leaves unpaid and lets you use any U.S. provider that accepts Medicare. Since benefits are standardized by plan letter, compare what insurers charge for the same letter.
| Plan | What You Pay | Best For |
|---|---|---|
| Plan G | The Part B deductible; once it’s met, Medicare-approved costs are covered | Most complete coverage for new enrollees |
| Plan N | Part B deductible, Part B excess charges, and copays of up to $20 for some office visits and up to $50 for some ER visits | Lower premium, accepts small copays |
| High-Deductible Plan G | A yearly deductible, then coverage like Plan G | Healthy people who want the lowest premium |
Plan letter determines Medigap benefits, which are standardized. Prices differ by insurer, age, ZIP code and tobacco use.
Be aware: once your six-month Medigap Open Enrollment Period has passed, and without a guaranteed issue right, insurers in most states may ask health questions and turn you down or charge you more.
$700
Maximum 2027 Part D deductible, up from $615.
$2,400
2027 Part D out-of-pocket cap, up from $2,100.
About $36
CMS average standalone Part D premium for 2027, an increase of under $1.
$7
Projected 2027 average for the drug portion of a Medicare Advantage premium, a decrease from $11.32.
If you keep Original Medicare in Sioux Falls, add a standalone Part D plan. Compare plans with your exact drugs and pharmacies using the 2027 Part D plan finder.
A non-renewal notice should have reached you in early October if your plan won’t be available in your county for 2027. Coverage doesn’t end immediately; it runs through December 31, 2026, which gives you time to decide.
If Your Plan Is Ending
Review your non-renewal letter. It verifies that your plan is ending and lays out your choices.
Write down your doctors and drugs. Comparing replacement plans requires them.
Compare your 2027 plan choices. Look at networks, drug coverage and the out-of-pocket maximum, not only the premium.
Pick a plan by December 31 to avoid a gap. If you enroll during Annual Enrollment by December 7, your coverage starts January 1, 2027.
Rely on your Special Enrollment Period if necessary. If your plan is ending, you generally have until the end of February 2027 to make a choice.
If you take no action: on January 1, 2027, you go back to Original Medicare, and you will have no drug coverage unless you pick a Part D plan. Being without drug coverage may result in a late enrollment penalty.
Medigap rights: if your Medicare Advantage plan exits your area, you generally get a guaranteed issue right, lasting up to 63 days after your coverage ends, to purchase certain Medicare Supplement plans with no health questions.
How to Compare
Review your Annual Notice of Change. It spells out every 2027 change to the plan you have now.
Verify your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 network.
Review your prescriptions. Verify every drug, the tier it falls on and any step therapy or prior authorization rules.
Look at the full annual cost. Total up the premium, usual copays and drug costs, and review the out-of-pocket maximum.
Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.
Sign up by December 7. Coverage under your new plan begins January 1, 2027.
| Enrollment Period | Dates | What You Can Do |
|---|---|---|
| Annual Enrollment Period | October 15 to December 7, 2026 | Join, change or drop a Medicare Advantage or Part D plan effective January 1, 2027 |
| Medicare Advantage Open Enrollment | January 1 to March 31, 2027 | In Medicare Advantage, you can change to another plan or go back to Original Medicare one time |
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Medicare and choose your first plan |
| Special Enrollment Periods | Varies | Switch plans after events such as a move, a loss of other coverage or your plan exiting your area |
Annual Enrollment is when most people make changes. If you like your current plan, no action is needed; it renews on its own. Even so, review your Annual Notice of Change, since networks, premiums, copays and drug lists can all change on January 1.
Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around the members they serve, and many come with care coordinators. In 2027, SNPs are one of the few places large insurers are adding plans, even while cutting PPOs.
| Type | Who Qualifies | What Is Different |
|---|---|---|
| Dual Special Needs Plan (D-SNP) | People with both Medicare and Medicaid | Coordinates both programs; costs are often very low, with extra benefits |
| Chronic Condition SNP (C-SNP) | People who have qualifying conditions like diabetes, heart failure or chronic lung disease | Doctors, drugs and programs designed around the condition |
| Institutional SNP (I-SNP) | People who live in a nursing home or need that level of care at home | Care delivered where the member lives |
When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.
Turning 65 Checklist
Enroll in Part A and Part B, unless you have qualifying employer coverage and decide to postpone Part B
Choose between Medicare Advantage and Original Medicare plus Medigap
Enroll in a drug plan, or a Medicare Advantage plan that includes drugs, to avoid a late Part D penalty
If you go with Medigap, purchase during your six-month Medigap Open Enrollment Period
When your income and savings are limited, two programs can greatly lower your Medicare costs:
Medicare Savings Programs
Run by your state Medicaid office
May cover your Part B premium, and in some cases deductibles and coinsurance
Income and asset limits vary by state
Extra Help (Part D)
Run by Social Security
Lowers Part D premiums, deductibles and copays
Those enrolled in a Medicare Savings Program qualify automatically
If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.
Sioux Falls’s State Health Insurance Assistance Program, South Dakota’s State Health Insurance Assistance Program (SHIP), offers free, unbiased Medicare counseling. You can also call 1-800-MEDICARE any time or compare plans with a licensed agent at no cost.
Free Help Comparing Plans
Available any time: Medicare Plan Finder on Medicare.gov
1-800-MEDICARE (1-800-633-4227), reachable 24 hours a day on all seven days of the week
Your State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling
A licensed agent or insurance broker, who can compare plans across several insurers for free
Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.
Check Every Line
Your 2027 premium and deductible
Doctor, specialist and hospital stay copays
The out-of-pocket maximum
Updates to your formulary, drug tiers and coverage rules
Whether your doctors, hospitals and pharmacy stay in network
Updates to dental, vision, hearing and other extras
The Annual Notice of Change must reach members by September 30. It is the most useful single document you receive each fall, since it spells out exactly how your plan will change on January 1.
Outside of the fall and early-year windows, changing plans generally requires a Special Enrollment Period. Typical reasons include:
You May Qualify If
Your plan is leaving your area or ending
You move outside your plan’s service area
You lose employer or union coverage
Your Medicaid status changes, or you qualify for a Medicare Savings Program or Extra Help
You want to join a 5-star plan, once a year
Every Special Enrollment Period has a separate time limit, so move as soon as the event occurs.
Prior authorization is required by most Medicare Advantage plans for certain services, including some surgeries, advanced imaging, skilled nursing stays and some drugs. While your doctor usually submits the request, ask whether a scheduled service needs approval so you are not caught off guard by a denial.
You or your doctor can appeal a denied request. Medicare rules give plans deadlines for decisions, and those deadlines are shorter when a wait could seriously harm your health.
Emergency and urgent care are covered by every Medicare Advantage plan anywhere in the U.S., whether in or out of network, and an emergency does not require prior approval. Routine care while traveling is different: HMOs generally do not cover it, and PPOs cover out-of-network care at a higher cost.
If you’re away from home for months each year, ask every plan how it covers care where you stay. This is among the most frequent reasons people change plans partway through the year.
You have the right to appeal if your plan denies a service, a drug or payment for care. The denial notice from the plan explains the process. Appeals have several levels, beginning with the plan and moving on to independent reviewers.
If your issue isn’t about coverage, such as wait times or customer service, you can file a grievance with your plan. For help, you can also reach out to 1-800-MEDICARE or your State Health Insurance Assistance Program.
Of the major figures, only the Part B premium is not published alongside the plans. CMS typically announces it in November. Projections in the 2026 Medicare Trustees Report put the 2027 standard premium at about $209.50 a month and the deductible at about $292, up from $202.90 and $283 in 2026. You continue paying it even with Medicare Advantage.
Miss the Annual Enrollment deadline and your current plan automatically renews for 2027, including the changes listed in your Annual Notice of Change. Medicare Advantage members get one more opportunity, from January 1 to March 31, 2027, to change Medicare Advantage plans or go back to Original Medicare and join a Part D plan.
Many Medicare Advantage plans may cover telehealth for some services, at times with a lower copay than an in-person office visit. It is handy for follow-ups and minor problems, but you still need to confirm that your regular doctors are in network.
Each fall, Medicare gives every Medicare Advantage and Part D plan a rating of 1 to 5 stars, based on factors such as preventive care, how well chronic conditions are managed, member complaints, customer service and accuracy of drug pricing. You can see the ratings in Medicare Plan Finder.
Using Star Ratings
Ratings of 4 stars or more are generally a good indicator of quality and service
A special enrollment period lets you move into a five-star plan once during the year
A new plan may not have a rating yet, and that alone isn’t a bad sign
Ratings reflect the plan as a whole, not how well it covers your particular doctors and drugs
The Bottom Line
Sioux Falls offers Medicare Advantage, Medigap and Part D choices for 2027. Compare plans in your county and enroll during Annual Enrollment, October 15 to December 7, 2026.
Yes, Wellmark Blue Cross Blue Shield, which serves Iowa and South Dakota, is exiting Medicare Advantage for 2027. Sioux Falls members in a Wellmark Medicare Advantage plan should receive a non-renewal notice and will need to pick new coverage, either another Medicare Advantage plan or Original Medicare with a Medigap policy and Part D plan.
Coverage under your ending Sioux Falls plan continues through December 31, 2026, and you will get a written non-renewal notice. You can enroll in a new plan during Annual Enrollment or a Special Enrollment Period, and you generally have a guaranteed issue right to buy certain Medigap plans within about 63 days after coverage ends.
The Annual Enrollment Period runs October 15 to December 7, 2026, and any plan you pick then starts January 1, 2027. If you end up in a Medicare Advantage plan, you also get one more chance to switch between January 1 and March 31, 2027 during Medicare Advantage Open Enrollment.
South Dakota has one of the higher average Medicare Advantage premiums for 2027, at about $56.04 a month, compared with a national average of about $12. Actual premiums vary by plan, so compare the specific options available in the Sioux Falls area.
You can choose another Medicare Advantage plan offered in your county, or switch to Original Medicare with a Medigap policy and a standalone Part D plan. Leaving members generally get a guaranteed issue right to buy certain Medigap plans, which can make the second route easier.
Generally yes, if you act in time. Losing Medicare Advantage because your plan is ending usually gives you a guaranteed issue right to buy certain Medigap plans, typically within 63 days after coverage ends, without medical underwriting.
That varies by plan and must be confirmed before you enroll. Look up your doctors in each 2027 plan’s provider directory and call their offices to verify, since networks differ even between plans from the same insurer.
Yes, Original Medicare and Medigap do not include drug coverage, so you would need a standalone Part D plan. The 2027 Part D deductible is $700 and the out-of-pocket cap is $2,400, and low-premium options are widely available.
Yes, Wellmark’s exit does not end Medicare Advantage in the area, though the choices will be different. Which insurers and plan types are offered varies by county, so compare plans by ZIP code during Annual Enrollment to see what remains.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.