Medicare Advantage
Why Medicare Part B and Part D penalties last a lifetime in Sioux Falls
Minnehaha County has 21 Medicare Advantage plans for 2027. Compared with 2026, 6 plans are not coming back, 5 are new, and 15 continuing plans changed in some way you should check before December 7, 5 of them under a new name. This guide covers what those numbers mean for Sioux Falls, not which plan to pick.
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SIOUX FALLS, S.D. — For most people turning 65 in Sioux Falls, signing up for Medicare feels like one more errand on a busy list. But two of Medicare's deadlines are different: miss them, and the penalty can follow you every month for the rest of your life.
Key takeaways
- Medicare's Part B and Part D late-enrollment penalties are permanent, adding extra cost to your monthly premium for as long as you have that coverage.
- Your Initial Enrollment Period lasts seven months, covering the three months before, the month of, and the three months after your 65th birthday.
- Skipping Part B without other qualifying coverage adds 10% to your premium for every full 12 months you could have had it but didn't, though working past 65 with employer coverage of 20 or more employees lets you delay without penalty.
- Going 63 or more days without Part D or other creditable drug coverage can add 1% of the national base beneficiary premium to your Part D premium for each month you went without it.
Here's a plain-English guide to the Part B and Part D late-enrollment penalties — what they are, who they apply to, and how to sidestep them.
Why these two penalties are different
Most Medicare deadlines give you a second chance. The Part B (doctor visits, outpatient care) and Part D (prescription drug) late-enrollment penalties do not. They are added to your monthly premium — permanently — for as long as you have that coverage.
That's the piece a lot of people miss. It isn't a one-time fine. It's a lifetime add-on.
When you're supposed to sign up
Your Initial Enrollment Period is a seven-month window: the three months before the month you turn 65, your birthday month, and the three months after. That's your clean, no-penalty window.
If you're already collecting Social Security, you'll usually be enrolled in Part A and Part B automatically. If you're not — which is more and more common as people work past 65 — you have to enroll yourself. That's where mistakes happen.
The Part B penalty, explained
If you don't sign up for Part B when you're first eligible, and you don't have other qualifying coverage, Medicare adds 10% to your Part B premium for every full 12-month period you could have had it but didn't.
Two 12-month gaps? That's 20% added to your premium every month. Forever.
There's one big exception. If you're still working at 65 and covered by a qualifying employer health plan (generally an employer with 20 or more employees), you can delay Part B without a penalty. When that job coverage ends, you get a Special Enrollment Period of up to 8 months to sign up.
COBRA and retiree coverage do not count as active employer coverage for this purpose. That trips up a lot of people. If you retire and go on COBRA at 64 or 65, sign up for Part B anyway.
The Part D penalty, explained
Part D works on the same idea but with different math. If you go 63 or more days in a row without either Part D or other "creditable" drug coverage after your Initial Enrollment Period, you can owe a penalty when you finally sign up.
The penalty is 1% of the "national base beneficiary premium" for each month you went without — added to your Part D premium every month you have the coverage.
"Creditable coverage" is drug coverage that Medicare considers at least as good as a standard Part D plan. Employer plans, VA benefits, and TRICARE often qualify. Your plan should send you a notice every year telling you whether it's creditable — keep that letter.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Minnehaha County
(MA penetration in Minnehaha County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
What's actually changing in 2027
Even if you don't take drugs today, Part D has changed in ways worth knowing about:
- Out-of-pocket cap for covered drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more for covered prescriptions that year.
- Maximum Part D deductible is $615 in 2026 and $700 in 2027.
- The old coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
- The Medicare Prescription Payment Plan lets you spread your drug costs into even monthly payments across the year instead of paying a big bill at the pharmacy counter. It's optional and free to opt into.
- IRMAA — an income-based surcharge on Part B and Part D premiums — kicks in above $109,000 in income for a single filer in 2026 (higher for joint filers). It's based on your tax return from two years earlier.
Nothing above is a plan feature. Those are the program rules that apply to every Medicare beneficiary.
What Sioux Falls residents should know locally
Medicare plan availability is set at the county level. Sioux Falls is in Minnehaha County, where residents choose among the Medicare Advantage and stand-alone Part D plans offered in that county. A small slice of the metro sits in Lincoln County, which has its own plan list. If you move — even across a county line — your plan options can change.
For an apples-to-apples look at what's offered where you live, the plan finder at medicare.gov lets you enter your ZIP code and see the current-year options for your county.
Key dates to circle
- Initial Enrollment Period: the 7 months around your 65th birthday.
- Annual Enrollment Period: October 15 – December 7 each year. This is when anyone with Medicare can join, switch, or drop a Part D or Medicare Advantage plan.
- Medicare Advantage Open Enrollment: January 1 – March 31, for people already in a Medicare Advantage plan who want to switch once.
- General Enrollment Period: January 1 – March 31, for people who missed their Initial Enrollment. Coverage starts the month after you sign up — but the penalty may still apply.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
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The parts of Medicare
Good to know
Frequently asked questions
I'm 66 and still working with good employer insurance. Do I have to sign up for Part B?
I don't take any prescriptions. Can I skip Part D?
Does COBRA count as coverage that delays my Medicare deadlines?
- CMS — MA/Part D Landscape & Plan Finder data
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.