Newsroom · Sioux Falls

Medicare Advantage in Sioux Falls for 2026: all 15 plans, ranked by what actually matters

Eleven Medicare Advantage plans, four Medica Cost plans, two health systems, and one $0 premium that isn't really free.

Medicare ATX Data Desk

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

Sioux Falls is the largest Medicare market in South Dakota — 39,532 beneficiaries in Minnehaha County alone — and yet the menu of plans is smaller and more deliberate than you'd find in a big coastal metro. There are no HMO Advantage plans here. There are no dozens-of-carriers price wars. There are five carriers, a tight set of plans, and two hospital systems that don't overlap. In a market this compact, choosing the right plan matters more, not less, because there's little room to course-correct.

Below is every drug-carrying Medicare plan available in Minnehaha County for 2026, pulled directly from the CMS PY2026 landscape files, with the 2026 CMS star ratings, CMS Hospital Compare data, and CDC health figures. No invented numbers, no "call for pricing."

The full 2026 roster — all 15 plans

Here is the complete list. "Stars" is the CMS Overall Star Rating, which doubles as a stability signal. "—" means a brand-new plan with no rating yet.

Source: CMS Medicare Advantage / Part D Landscape (PY2026) & CMS Medicare Advantage & Part D Star Ratings (2026), Minnehaha County. D-SNP premiums are paid in full by Medicare's low-income subsidy for full-dual members.

The 5 standard Medicare Advantage PPOs

These are the plans most Sioux Falls beneficiaries actually choose between — open to anyone with Medicare in the county, no special eligibility required:

The two $0-premium options — Aetna Medicare Signature and Sanford's Align ChoicePlus — anchor the value end. Align ChoicePlus is notable for a lower $350 drug deductible than Aetna's $615, which can matter more than the premium if you take regular medications. At the top, Wellmark's Enhanced PPO charges $80/month for a richer benefit set. All five carry the same 3.5★ CMS rating, so the deciding factors are your doctors, your drugs, and the deductible — not the star score.

The 4 Dual-Eligible D-SNPs

If you have both Medicare and Medicaid, you qualify for a Dual-Eligible Special Needs Plan — and these are where the star ratings diverge sharply:

The two UnitedHealthcare Dual Complete plans hold 4.5★ — the highest rating in the county — while Aetna's two sit at 3.5★. For full-dual members, the $41.50 premium is paid entirely by Medicare's low-income subsidy, so your net cost is $0. We go deep on the cancellation and network risks for these plans in our dedicated Sioux Falls D-SNP analysis.

The 2 Institutional I-SNPs (and why "unrated" is a flag)

Sanford's Great Plains offers two Institutional Special Needs Plans for residents of nursing homes and similar facilities. Both are brand-new contracts, which is why CMS shows no star rating yet:

• 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.

New isn't bad — but with no track record, a family choosing one is accepting more unknowns about service and stability than a long-running, rated plan carries. These plans are only relevant if you or a loved one lives in a qualifying facility.

The 4 Medica Cost plans — a different animal

The four highest premiums on the roster all belong to Medica Prime Solution — and they're not Medicare Advantage at all. They're Medicare Cost plans, an older product that lets you fall back on Original Medicare for out-of-network care:

Premiums run from about $59 to $335 a month. For a frequent traveler or snowbird who wants Original Medicare's freedom plus a drug benefit, that premium can be worth it. For a stay-local beneficiary who'll use Sanford or Avera anyway, an Advantage PPO usually covers the same care for a fraction of the cost. Knowing which camp you're in is the whole game.

What a "$0 premium" really costs

The most common mistake we see is choosing on premium alone. A $0 premium covers exactly one thing — the monthly fee. Here's what it doesn't cover:

One genuinely good piece of 2026 news: the Part D out-of-pocket maximum is now $2,100, so no matter which plan you pick, your annual drug spending is capped. That makes the formulary tier of your specific drugs — not the headline premium — the thing that decides your real cost.

Sanford vs Avera: the network fork that decides everything

Sioux Falls health care runs through two competing systems, and your plan's network is the bridge between you and them:

Source: CMS Hospital Compare — Overall Star Ratings.

Sanford USD Medical Center holds a 5-star CMS rating and Avera McKennan a 4-star — both strong. But here's the wrinkle: Sanford runs its own Medicare plans (Align and Great Plains), so its plans naturally favor the Sanford network. If your doctors are at Avera, that changes which plans make sense for you. The non-negotiable step before enrolling is confirming your specific physicians and hospital are in-network for the coming plan year.

Cross the Big Sioux and the math changes

Medicare Advantage availability is set county by county, and the Iowa side has more of it. Sioux County, Iowa has 21 plans for 2026 — nearly double the Sioux Falls metro — with 6 at $0 premium. If you live near the state line, comparing both sides can genuinely expand your options. See our northwest Iowa plans page for the live data.

Your health picks the plan

Premium and network only get you halfway. The deciding factor is whether your conditions and medications are well-covered. In Minnehaha County, CDC data shows real chronic-condition load:

Source: CDC PLACES: Local Data for Better Health, County 2023 (2023).

How to choose in a small market

1. Confirm your health system and doctors — Sanford or Avera — are in the plan's network for 2026.
2. Check each plan's drug formulary and tier for your exact prescriptions. The deductible ($300–$615 here) and tier placement matter more than the premium.
3. Weigh premium against the out-of-pocket maximum and the extra benefits (dental, vision, hearing, OTC). A premium plan can cost less overall.
4. Don't assume $0 is best. Two plans are $0-premium, but the right plan for you might carry a premium and save you more.
5. If you're near the border, compare the Iowa plans too.

How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references the CMS plan landscape, 2026 star ratings, hospital quality data, and CDC health data in real time — built by Strategic AI Architects. Every figure here is from a public federal dataset. This is education, not advice; confirm your plan, costs, and eligibility with a licensed agent. We take no payment from any carrier to feature a plan.