Understood Care
Coverage data 2024. Plan networks change - we confirm exactly what your plan covers before any work begins.
Kristina Mabry Care Advocate Kristina helps patients and caregivers untangle Medicare, from a denied claim to a benefit nobody mentioned, with a check-in every week while a case is open.
Makenna Cardona Care Advocate From the first call, Makenna is the same person every time: no call center, no starting over, and no handoffs.
Amanda Ledwich Care Advocate Amanda works one-to-one with Medicare members on bills, denials, appointments, and benefits, and stays on the case until it is resolved.
Free Medicare counseling, paid family caregiver programs, and 2026 plan options in South Dakota. Call SHINE at 1-800-536-8197 to get help today.
Across the Sioux Falls metro, care runs through Sanford USD Medical Center and Avera McKennan Hospital & University Health Center, the flagship hospitals of the state's two largest health systems, along with Avera Heart Hospital of South Dakota and, for veterans, the Sioux Falls VA Medical Center, with Avera Dells Area Hospital in Dell Rapids and Sanford Canton-Inwood Medical Center in Canton closer to home, so referrals, prior authorizations, and bills pile up from Sioux Falls, Brandon, Harrisburg, and Tea to Dell Rapids and Canton. Understood Care is a virtual service: phone, video, and secure messaging. For Sioux Falls members that means no waiting room and no travel, whether the problem is a confusing hospital bill, a denied claim, a referral that went nowhere, or a parent in Minnehaha County who needs someone watching their whole picture. Your advocate is the same person every time, follows up every 7 days while your case is active, and still checks in monthly after it is resolved. Many Sioux Falls Metro families also use South Dakota's HOPE Waiver home care and Medicare Savings Programs alongside Medicare; we handle the Medicare side.
Sioux Falls is younger than the state average (13.7% are 65+, versus 17.6% statewide), which can make Medicare-savvy help harder to find locally. Medicare Advantage runs high here: 44.4% of the 40,343 beneficiaries in Minnehaha County chose MA plans in 2025, above South Dakota's 37.4%. That means more prior authorizations, more network questions, and more denials worth appealing. About 4,190 neighbors are dual-eligible for Medicare and Medicaid, the group South Dakota Medicaid and the state's Medicare Savings Programs reach.
Of 10 Medicare-certified homes, 2 rate 4+ CMS stars and 2 rate just 1 star, a spread an advocate helps families navigate. Highest-rated nearby:
About 8,787 Sioux Falls households are a person 65+ living alone, and that is exactly who a dedicated advocate keeps from falling through the cracks. 9.3% of senior households here have no vehicle (about 1,672 households), which is why a fully virtual advocate, plus Medicare-covered ride benefits where plans include them, matters. 3 Medicare-certified home health agencies are based in Sioux Falls (avg patient-care quality 4/5); we help compare them and get orders in place. Setting up home care, meal delivery, and transportation is core advocate work, covered by Medicare.
About 7.1% of Sioux Falls seniors live below the poverty line (South Dakota: 9.3%), and many more qualify for help they never claim: Extra Help with Part D costs and South Dakota's Medicare Savings Programs. Checking every one of those is standard advocate work. 28.4% of seniors here live with a disability, where equipment orders and prior authorizations pile up fastest. The federal government lists 3 primary-care shortage designations in Minnehaha County, so appointment hunting is a real problem an advocate takes over. Specialized care nearby: 3 Medicare-certified dialysis facilities (avg 4.3/5 CMS stars) and 4 hospice providers.
Sioux Falls, South Dakota · Minnehaha County · served virtually statewide
From CMS Care Compare (6 Medicare-certified hospitals in the area; a sample below). ER medians below are CMS-reported; South Dakota's statewide median is 112 minutes. Billing disputes, discharge planning, and referral follow-ups with these systems are everyday advocate work:
South Dakota's Medicare Savings Programs, run by the Department of Social Services, help a person with monthly income under $1,816, or a couple under $2,455 (2026 limits, including a $20 income disregard), with savings within the federal resource limit (apply at a local DSS office, online, or call 1-877-999-5612). Many Sioux Falls seniors qualify, along with federal Extra Help for drug costs, and never claim it; South Dakota has no state drug assistance program of its own, so Extra Help matters more here. On Medigap, South Dakota has no birthday rule, but it does give people on Medicare because of a disability the same six-month open enrollment as people turning 65: apply within six months of enrolling in Part B and an insurer must sell you any Medicare supplement policy it offers. Medigap questions go to the South Dakota Division of Insurance at 605-773-3563. Free SHIINE counseling is at 1-888-854-5321. The full, sourced rundown is on our South Dakota patient advocacy hub.
South Dakota Medicaid's HOPE Waiver lets a parent who needs a nursing home level of care get help at home, and its Structured Family Caregiving service pays a stipend, with coaching, to a principal caregiver who lives with the parent. For parents who do not qualify for Medicaid, the state's Long Term Services and Supports in-home services can bring homemaker help, personal care, respite, and meals. South Dakota has no PACE program. Meanwhile a parent's Medicare paperwork piles up. That split is exactly where an advocate fits: you handle the caregiving, we handle the Medicare side. Dakota at Home, at 1-833-663-9673, is the front door for local help. See how home care, the Medicare Savings Programs, and Medicare fit together on our South Dakota hub.
Compassionate caregiver support for respite, Medicare benefits, stress, coordination, transport, bills, and applications so you can care with confidence.
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Plain-language guide to Medicare flex card HUD income rules for seniors in public housing, Section 8, and project-based housing, including what to do if your rent went up because of a flex card and when to report a Medicare food card to the housing authority.
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Learn how to talk to caseworkers, case managers, and patient advocates so you get the right help. Use scripts, questions to ask, and follow up tips for benefits, home care, and community services.
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Three doors, all worth knowing. For free counseling on plans, enrollment, and Medicare Savings Program applications, SHIINE (Senior Health Information and Insurance Education) at 1-888-854-5321. For local services such as in-home help, meals, caregiver support, and Structured Family Caregiving, Dakota at Home, South Dakota's aging and disability resource center, at 1-833-663-9673, which connects you with providers serving Minnehaha County, or the national Eldercare Locator at 1-800-677-1116. And for one dedicated advocate who does the ongoing work with you, bills, denials, appointments, and benefits, Understood Care, covered by Medicare for most members: call (646) 904-4027 or get started online.
Yes. Medicare has paid for professional healthcare navigation (Principal Illness Navigation and Community Health Integration services) since January 2024. Part B covers about 80% and a Medigap plan typically covers the rest. We check your coverage and tell you exactly what, if anything, you will owe before your first session.
Per CMS enrollment data for 2025, Minnehaha County had 40,343 Medicare beneficiaries: 17,913 on Medicare Advantage plans (44.4%) and 22,431 on Original Medicare, with about 4,190 dual-eligible for both Medicare and Medicaid. Understood Care advocates work with both: Original Medicare covers it, and we confirm Medicare Advantage coverage plan by plan before any work begins.
Per the US Census Bureau's American Community Survey, about 27,006 of Sioux Falls's 197,642 residents are 65 or older (13.7%), within a county of roughly 27,318 seniors (Minnehaha County). Most become Medicare-eligible at 65, and every one of them has the same federal benefits an advocate helps put to work.
Per CMS Timely & Effective Care data (period ending 09/30/2025), the median ER visit at Sanford Usd Medical Center runs about 207 minutes, and local hospitals range 110 to 207 minutes; South Dakota's statewide median is 112 minutes. An advocate cannot shorten an ER line, but avoiding the ER for non-emergencies is advocate work: same-week appointments, urgent-care routing, and follow-up coordination.
No. Understood Care is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Sioux Falls as anywhere else in South Dakota's 66 counties. When the right specialist means hours on the road, an advocate you can reach without the trip is often the practical option; if leaving home is hard, that is exactly the situation the service is built for.
Advocates work virtually and are matched to you, not to a zip code. You get one dedicated advocate with their direct phone, email, and text (One Advocate, For Life), and they work with South Dakota's programs, free SHIINE counseling, the state's under-65 Medigap open enrollment, the Medicare Savings Programs, Medicaid home care through the HOPE Waiver, Structured Family Caregiving, and the local services that apply in Minnehaha County.
For in-home care through South Dakota Medicaid, the main path for older adults is the HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence), for people 65 and older, or 18 and older with a qualifying disability, who need a nursing home level of care, within Medicaid's income and resource limits. Its Structured Family Caregiving service pays a stipend, with coaching, to a principal caregiver who lives with the participant. For people who do not qualify for Medicaid, the Department of Human Services' Division of Long Term Services and Supports offers state in-home services such as homemaker help, personal care, respite, and meals to people 60 and older, or 18 and older with a disability, who cannot get the same service through another program, including in Minnehaha County; a copay may apply. South Dakota has no PACE program. To start, call Dakota at Home at 1-833-663-9673. Families we serve in Sioux Falls Metro use these programs. Our advocacy is billed through Medicare, so for dual-eligible families the split works well: you run the caregiving, and your parent's advocate handles the Medicare side.
In South Dakota we are in-network for Original Medicare (traditional fee-for-service Medicare). Together that covers roughly 64% of South Dakota's Medicare beneficiaries. Market-share data: 2024. Plan networks change, so we confirm exactly what your plan covers before any work begins.
Sioux Falls Metro
Brandon · Harrisburg · Tea · Dell Rapids · Canton · All of South Dakota
Local figures: US Census Bureau American Community Survey (2023, 5-year), CMS Medicare Monthly Enrollment (2025), and CMS Care Compare, retrieved 2026-10-28. Statewide program facts were last verified on 2026-10-28; sources are listed on the South Dakota hub, and the full county tables are on South Dakota Medicare by the numbers. Understood Care is an independent private advocacy service and is not affiliated with any government agency or any hospital named above.