Medicare
Medicare 101: What is Medicare?
Deborah Meyer
What is Medicare? A Rural Guide for South Dakota, North Dakota, and Wyoming
Written by the Meyer family team at Spearfish Insurance Brokerage — licensed Medicare agents serving South Dakota, North Dakota, and Wyoming, rated 4.8 stars on Google, with thousands of clients served across the region.
If you’re new to Medicare, or you’re helping a parent figure it out, this guide breaks down the basics in plain language, with a focus on what actually matters if you live in rural South Dakota, North Dakota, or Wyoming. This is the first post in our Medicare series. Next up, we’ll walk through exactly how and when to enroll, so keep an eye out for that one.
What Is Medicare?
Medicare is federal health insurance that Americans pay into through payroll taxes during their working years. It’s available to people 65 and older, as well as younger people with certain disabilities, including end-stage renal disease and Lou Gehrig’s disease (ALS).
The Four Parts of Medicare
Part A: Hospital Insurance
Part A covers facility-based and inpatient care — hospital stays, skilled nursing facilities, and related services. It’s funded through payroll taxes and is premium-free for anyone who worked at least 40 quarters (10 years). Because there’s no cost to having it, nearly everyone enrolls in Part A at 65, regardless of whether they’re still covered through an employer plan.
Part B: Medical Insurance
Part B covers the provider side of care — doctor visits, outpatient services, tests, preventive checkups, and prescriptions administered in a hospital or clinic setting (like injections or infusions).
The standard Part B premium for 2026 is $202.90 per month. Higher earners pay more under a rule called IRMAA (Income-Related Monthly Adjustment Amount), which kicks in once modified adjusted gross income exceeds $109,000 for a single filer or $218,000 (2026 limits) for a married couple filing jointly, based on tax returns from two years prior.
Not everyone enrolls in Part B right at 65. If you have “creditable coverage” through an employer, you can often delay Part B until that coverage ends. If you have both Medicare and an employer plan at the same time, which one pays first depends on the size of the employer:
- 20 or more employees: the employer plan pays first, Medicare pays second.
- Fewer than 20 employees: Medicare pays first, the employer plan pays second.
- This matters more than people realize in our region, since many small businesses across the Dakotas and Wyoming have fewer than 20 employees, which flips the standard order.
In addition to employer coverage, retirees may be covered under additional government-sponsored sources, such as VA (Veterans Affairs) Benefits, CHAMPVA, TRICARE, TRICARE For Life, BENEFEDS, FEDVIP, FEHB, and more. Retirees with coverage under one of these programs may still qualify for additional benefits under a Medicare plan, such as Part B giveback allowances, a fallback network of doctors, dental, and more. Contact us to hear your options.
Part C: Medicare Advantage
Medicare Advantage rolls your Part A and Part B benefits into a single plan, typically through a private insurer. These plans often bundle in Part D prescription drug coverage and may include extras like vision, dental, hearing, over-the-counter allowances and fitness benefits. Advantage plans come with a network of providers, copays, and a maximum out-of-pocket cap.
If you’ve had an employer or individual health plan in the past, Advantage plans will likely feel familiar — networks, pre-authorizations, and other administrative steps that mirror the plans many people already know.
The rural angle: because our region has relatively few hospital systems, most are generally in-network across the major plans available here. Network restriction isn’t the concern it is in bigger cities. The real challenge is distance. A local agent can help you identify which in-network providers are actually closest to you, which matters more than which plan technically covers the most providers on paper.
It’s also worth knowing: Medicare is complex, and Advantage plans add another layer of decisions on top of it. That’s exactly why having a local agent who knows your region matters. At Spearfish Insurance Brokerage, we know the plans, the providers, and how they all fit together across North Dakota, South Dakota, and Wyoming. You never pay more to work with an agent — premiums are identical whether you enroll directly with the carrier or through us. We work by phone, by email, and in person at our office, for your entire Medicare journey, not just enrollment.
Part D: Prescription Drug Plans
Part D plans are offered by private insurance companies and often vary by county. We offer one-on-one appointments to review each client’s specific prescriptions and preferred pharmacy, to make sure they’re matched to the plan that fits.
Because there are so many Part D plans available in our area, we use a specialized comparison tool that lets us plug in someone’s exact medications and pharmacy and estimate their total cost, premium plus out-of-pocket drug costs, across every available plan. That means our clients know they’re getting the lowest total cost, not just guessing.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans let you see any provider in the country who accepts Medicare, no networks, no pre-authorizations, none of the administrative steps that come with Advantage plans. The tradeoff is a generally higher monthly premium. But Plan G, the most popular Supplement option, carries an annual deductible under $300, so anyone with ongoing medical needs often comes out ahead despite the higher premium. There's also a high-deductible Plan G available at a much lower rate with similar benefits.
A few things to know about Supplements:
- Medicare always pays first, and the Supplement simply covers what Medicare doesn’t. That clears up a lot of confusion about what’s actually covered.
- Pricing is typically based on age, gender, and household discounts rather than county.
- Supplements don’t include drug coverage. You’ll need a separate standalone Part D plan alongside a Supplement for drug coverage.
Medicare Cost Plans
Cost plans were once a popular option in rural areas, though they’ve been phasing out county by county over the years. Where they still exist, people appreciate the flexibility: you can actually switch between plans month to month, starting with a lower premium and higher copays, then moving to a richer plan later in the year if your medical needs change.
This kind of plan flexibility is exactly the type of detail most people don’t know exists, which is why working with a local agent who tracks what’s available county by county makes a real difference.
Protecting Yourself from Medicare Fraud
People in rural communities often carry a strong spirit of trust. It's one of our strongest character traits. Unfortunately, this also makes us a target. Call centers based far outside the region buy lists of phone numbers and, at best, try to sell plans, especially dental, vision, and other add-on products, that aren’t even accepted by providers here. Clients end up paying for coverage they can’t actually use. At worst, these call centers run scams where they sign up Medicare Beneficiaries for plans without their consent.
A few tips to protect yourself:
- Never give your Medicare number over the phone unless you already trust the caller, ideally your own agent. Medicare will never call you out of the blue asking for your Medicare or Social Security number.
- Treat your Medicare number like a credit card number. Only share it with your doctor, pharmacy, or a trusted agent.
- Medicare won’t show up at your home uninvited or enroll you over the phone unless you called them first. Any unsolicited visit or call offering to sign you up on the spot is a red flag.
- Review your Medicare Summary Notices regularly to make sure you weren’t billed for services you never received.
Frequently Asked Questions
When can I enroll in Medicare?
You’re generally first eligible starting three months before you turn 65, but enrollment timing has some important nuances. We cover this in full detail in our next post on how to enroll.
How do I enroll in Medicare?
Enrollment can happen automatically or require an active application, depending on your situation. We walk through the exact steps in our next post in this series.
How do I set up a Social Security account (ssa.gov)?
Setting up your account is a key first step for managing your benefits. We’ll walk through this step by step in our upcoming post on how to enroll.
How do I pay for Medicare?
Part A is usually premium-free. Part B premiums are typically deducted directly from your Social Security check if you’re already collecting benefits; otherwise, you’re billed quarterly. Part C, Part D, and Supplement premiums are paid directly to the private insurance company you choose.
Will my providers and prescriptions be covered?
It depends on which path you choose. Supplement plans cover any provider nationally who accepts Medicare, while Advantage plan coverage depends on the specific network. Prescription coverage varies plan by plan under Part D or a bundled Advantage plan. This is exactly why checking your specific drugs and providers against actual plans matters, and why working with a local agent who can run those comparisons takes the guesswork out of it.
Areas We Serve
Spearfish Insurance Brokerage is based in Spearfish, South Dakota, and most active in the counties closest to home: Lawrence, Meade, Butte, Pennington, Custer, Fall River, Stanley, Hughes, Jones, and Jackson counties in South Dakota, along with Crook and Weston counties in Wyoming.
Beyond our core area, we serve thousands of clients across every county in South Dakota, North Dakota, and Wyoming. We have deep client relationships and plan knowledge across that footprint.
About Your Local Agents
Deborah Meyer has been a licensed insurance agent since 2001, with over 20 years of experience. She is a National Social Security Advisor and a prominent educator on Medicare and Social Security throughout the region, having served roughly 10,000 clients across South Dakota, North Dakota, and Wyoming.
Mark Meyer has been licensed for two years, bringing a corporate leadership background into the family business. He holds an MBA from the Stern School of Business at NYU and has already helped close to 1,000 clients.
Kaylee Rust has been licensed for three years and is an insurance expert in her own right. We hear it all day when we answer our phones: "I'm calling for Kaylee."
Together, our team is rated 4.8 stars on Google, reflecting the trust we’ve built with clients across South Dakota, North Dakota, and Wyoming.