Newsroom · Dual-Eligible

D-SNP plans in Sioux Falls for 2026: which are stable, which carry risk

Four Dual-Eligible plans. Two carriers. Star ratings from 4.5 down to 3.5 — and that gap is the whole story for a DSNP member.

Medicare ATX Data Desk

Published June 12, 2026 · 11 min read · Sourced from CMS.gov

For 2026, Sioux Falls (Minnehaha County) has 4 Dual-Eligible Special Needs Plans from just 2 carriers. UnitedHealthcare's two plans hold a 4.5★ CMS rating; Aetna's two hold 3.5★. All four cost $41.50/month on paper — which Medicare's low-income subsidy pays in full for full-dual members, so your net premium is $0. The premiums are identical. What's not identical is how stable each plan is, and whether your hospital stays in-network next year.

Every figure below comes from the CMS PY2026 landscape, the 2026 CMS star ratings, CMS plan-detail files, and CMS Hospital Compare. Here's how to read the risk.

Why this matters more for DSNP members

South Dakota counts 122,936 people on Medicaid as of February 2026, and Minnehaha County is the state's largest Medicare market with 39,532 beneficiaries. The people who sit in both programs — dual-eligibles — are exactly who a D-SNP is built for. But a D-SNP ties your Medicare and Medicaid benefits together through one private plan, so when that plan changes its network, its drug list, or its contract status, it touches more of your care at once. The stakes of picking the right one — and noticing when it's at risk — are simply higher.

The four D-SNP plans, side by side

Here's every D-SNP available in Minnehaha County for 2026, with the CMS Overall Star Rating that doubles as a stability signal. "Stability tier" is CMS's published rating in plain language — not our opinion.

Source: CMS Medicare Advantage / Part D Landscape (PY2026) & CMS Medicare Advantage & Part D Star Ratings (2026). *$0 net = the $41.50 Part D premium is paid in full by Medicare's Low-Income Premium Subsidy for full-dual members.

Reading the star ratings: the stability gap

The two UnitedHealthcare D-SNPs share an identical premium with the two Aetna plans — but a full point of star rating separates them. Visually:

The UnitedHealthcare plans break down to a 4.5★ Part C (medical) and 4.0★ Part D (drug) score; the Aetna plans are 3.5★ on both. None of these is a low performer — but the rating is the single best public predictor of whether a plan stays steady. A plan that sits below 3 stars for three consecutive years can be terminated by CMS, and lower-rated plans are the ones more likely to restructure benefits or exit a market. A higher star rating is, quite literally, a stability buffer.

The risk you can't see on a brochure: "coordination-only" status

All four Sioux Falls D-SNPs are classified by CMS as coordination-only D-SNPs — the least-integrated category, where the plan coordinates with Medicaid but doesn't fully merge the two programs. CMS has been steadily tightening the rules around D-SNPs and pushing the market toward more integrated designs. That doesn't mean these plans disappear next year, but it's a structural reason to expect benefit and contract changes over time — and a reason to re-check your plan every single enrollment period rather than letting it auto-renew.

The two-carrier concentration problem

Statewide, those same 4 D-SNPs come from only 2 organizations, covering 51 of South Dakota's counties. In Sioux Falls that means your D-SNP choice is effectively UnitedHealthcare or Aetna. If either carrier pulled its D-SNP from the county, half of all dual-eligible options would vanish at once — and you'd be relying on a Special Enrollment Period to land somewhere new. Thin markets like ours leave less room for error, which is the whole reason to have the comparison done carefully and early.

The institutional plans (and why "no rating" is its own flag)

Beyond the four D-SNPs, Sanford Health offers 2 Institutional Special Needs Plans (I-SNPs) for residents of nursing homes and similar facilities:

• Great Plains Medicare Advantage (HMO I-SNP) — Sanford Health, $12.00/mo, CMS rating: not enough data yet
• Great Plains Medicare Advantage Gold (HMO I-SNP) — Sanford Health, $72.00/mo, CMS rating: not enough data yet

Both are brand-new contracts, which is why CMS shows "not enough data available" instead of a star rating. New isn't bad — but it means there's no track record to lean on, so a member or family choosing one is accepting more unknowns about service and stability than a long-running, rated plan carries.

Hospital changes: the network is set year by year

"Plan changes" aren't only about premiums — the most disruptive change for a DSNP member is usually a network change. A plan can add or drop a hospital or health system between plan years, and Sioux Falls is split between two competing systems:

Source: CMS Hospital Compare — Overall Star Ratings.

Because Sanford and Avera are rivals, the hospital you use can decide which D-SNP is right for you — and a plan that covers your system this year isn't guaranteed to next year. Before you enroll or stay put, the non-negotiable step is confirming your hospital, clinics, and doctors are in that exact plan's network for the coming year. That single check prevents the most common — and most expensive — DSNP surprise.

What it means for you

For 2026, the data points to a clear playbook for a Sioux Falls dual-eligible:

1. Don't auto-renew blind. Read the Annual Notice of Change your plan mails each fall — it lists exactly what's changing for next year.
2. Weigh the star rating, not just the $0 premium. All four D-SNPs are $0 net for full-duals, so the 4.5★ vs 3.5★ gap and the network are what actually separate them.
3. Confirm your hospital and doctors are in-network for the new year — Sanford vs Avera is the deciding fork here.
4. Check your drug list. Each plan carries a $615 Part D deductible on its enhanced tiers; your specific medications decide real cost.
5. Know your rights. Dual-eligible members get extra Special Enrollment Periods to switch — you're not locked in if your plan changes or leaves.

See the live local data on our Sioux Falls Medicare plans page, read the full county roster in Medicare Advantage in Sioux Falls for 2026, or the statewide picture in 2026 Medicare Advantage in South Dakota.

How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references the CMS plan landscape, CMS star ratings, hospital quality data, and Medicaid enrollment in real time — built by Strategic AI Architects. This article is for education, not advice; your exact plan, costs, and eligibility should be confirmed with a licensed agent. We take no payment from any carrier to feature a plan.