Medicare Advantage Helps Meet the Needs of South Dakota’s Aging Population
by Bill Cohen, MD
South Dakota’s older population is growing—and quickly. According to projections by a state demographer and South Dakota State University professor, adults over the age of 65 will surpass 20% of our state’s population by 2030. To ensure our communities can meet the complex needs of this growing part of our population, access to affordable, high-quality, comprehensive health care is critical.
That is why programs like Medicare Advantage are so important. Medicare Advantage is the public-private form of Medicare that more than half of all eligible Medicare beneficiaries choose to enroll in because of the broad range of health care services, support programs, and supplement benefits it provides.
Through Medicare Advantage, patients can access dental, vision, and hearing services not covered by traditional Medicare—as well as some more innovative offerings like fitness and wellness programs, nutrition benefits, and preventative care. Moreover, with capped annual out-of-pocket costs, Medicare Advantage patients often end up paying less in medical expenses than those enrolled in traditional Medicare.
Given the vital role this program plays in serving some of our nation’s most vulnerable, at-risk patients, it should be something that lawmakers on both sides of the aisle can agree is worth protecting. Yet, under Biden Administration, the Centers for Medicare & Medicaid Services (CMS) imposed years of consecutive cuts to program, threatening benefits and increasing premiums for patients.
Importantly, CMS’ Advance Notice released in the final days of the Biden Administration seems to be an attempt to do the right thing, albeit a little late and not quite enough to make much of a difference. In their Advance Notice for 2026, CMS proposed a very slight payment increase. While this is mildly welcome news after the years of cuts Medicare Advantage has endured, there is still more work for lawmakers to do to ensure the long-term success of this vitally important program – with healthcare costs on the rise, and a lot of damage already done by previous years’ cuts. The Republican trifecta must recognize the reality that seniors and their families are looking to them to help protect and strengthen Medicare Advantage—not just in 2026, but for years to come.
Polling in the run-up to Election Day 2024 shows how important this program is to those who use it to access the health care services they need. 86% of Medicare Advantage beneficiaries would be less likely to vote for a Member of Congress who supported cutting funding for MA.
Regardless of who takes the lead, all our lawmakers should be working to keep Medicare Advantage strong so the program can continue to grow along with our aging population. Particularly for states like South Dakota, where our older population is growing at a rapid
Medicare Advantage is absolutely necessary to ensure access to high-quality, affordable, and reliable health care for those who need it most.
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Dr. Bill Cohen is a board-certified pain relief specialist and founder of American Pain Relief Institute.
When I started to research my options when I went on Medicare, I took a long look at Medicare Advantage plans. They entice people in with low premiums and “added benefits.”
There are a few things they don’t tell you. These problems are chronic problems of the profit-seeking healthcare segment. Besides limited networks and all other sorts of restrictions youi have to trust that a profit-seeking insurer would screw you down on payment. They have to. Every dollar they spend on your health care is a dollar that is not a profit on their quarterly reports. And shareholders typically care a lot more about their enhanced value than they are helping cure your disease.
I don’t have one problem at all with companies making a profit. That’s part of what makes the world go round. But if I’m relying on a program for a certain long-term health care solution, I would prefer to plant that future solidly on a plan that can’t be yanked out from under me at the whim of an insurance company MBA.
So in the final analysis, you should do what make the most sense to you. I just prefer to take the safer option that may cost a few bucks more, but that has the security that I need in retirement.
What the author failed to mention is private hospitals in SD are not renewing contracts with Medicare Advantage plans. Why? Because they don’t pay claims. We recently received an invoice for services that were provided almost 3 years ago. When we called the providing facility as to why so long of delay, we were told because your advantage plan just paid the claim. Small town pharmacies have the same problem, extremely long delays in paying claims.
Maybe the “good” doctor should do a bit more research?
Advantage plans are great for persons without major chronic problems. Also for veterans as a safety net for their VA coverage
I work in healthcare and I do not believe that Medicare Advantage plans are a good deal. If you have a crystal ball that could look a year out and you knew you wouldn’t be ill in the next year it would be a cost saver. Last I knew crystal balls are hard to find.
I have dealt with these managed plan for over 30 years. Over 30 years old I had a stroke patient that FHP insurance gave me 7 days to rehab. This patient couldn’t move his right side and couldn’t speak. Let me tell you his family didn’t think it was a great deal when he was out of his 7 days. He did not have access to his 100 days of Medicare extended stay care at the nursing home where he was.
Today, we see patients in the small community hospital where I work that are cut off from services that Traditional Medicare would pay.
I guess I am not a betting girl with my health and I will never ever recommend a managed care plan.
Seems to me Russian roulette with your health is foolhardy and I do t recommend it.
I hope that people see how plans like H…..a that play on their vulnerability during commercials on their favorite old time shows like Gunsmoke see the light. The biggest hospitals in SF will not accept this insurance. Maybe not such a good deal???
I hope anyone with an aged loved one does their due diligence.