Health Plan RadarIn this article we rank South Dakota Medicare Advantage plans based on our evaluation of government 5-star quality scores.
Read more →Blue Medicare Advantage Enhanced PPO (PPO)
by Wellmark Advantage Health Plan
2026 Medicare Advantage plan available in South Dakota
Plan ID H5900-004-0
Additional coverage:
RxHearingVisionDental
Medicare Advantage PPO 3.5 Overall
Monthly plan premium $80 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $4,200 / yr
Drug deductible $300 / yr
3.5 Overall Government Star Rating 2026 · out of 5 stars
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Plan Overview
Blue Medicare Advantage Enhanced PPO (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in South Dakota and offered by the health insurance company Wellmark Advantage Health Plan. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.
Plan Name Blue Medicare Advantage Enhanced PPO (PPO)
Insurance Carrier Wellmark Advantage Health Plan
Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type PPO
Cost Summary
Blue Medicare Advantage Enhanced PPO (PPO) has a monthly premium cost of $80 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $4,200. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $80 / mo
Health portion of premium $63
Drug portion of premium $17
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $4,200 / yr
Primary doctor visit $0 copay
Specialist visit $30 copay
ER visit $120 copay
Ambulance $325 copay
Additional Benefits and Coverage
Blue Medicare Advantage Enhanced PPO (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Medicare Advantage Enhanced PPO (PPO) includes coverage for hearing, vision, dental.
Part D Prescription Drug Coverage Yes
Dental Yes
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Not covered
Over-the-counter drug benefits Not covered
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Not covered
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $10 copay
Out-of-network: $10 copay
Specialist visit In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Lab services In-network: $0 copay
Out-of-network: $5 copay
Out-of-network: $5 copay
Diagnostic radiology services (like MRI) In-network: $125 copay
Out-of-network: $175 copay
Out-of-network: $175 copay
Outpatient x-rays In-network: $10 copay
Out-of-network: $20 copay
Out-of-network: $20 copay
Emergency care $120 copay
Urgent care $45 copay
Hospital Services
Inpatient hospital coverage In-network:
Tier 1
$460 per stay
Out-of-network:
$600 per stay
Tier 1
$460 per stay
Out-of-network:
$600 per stay
Outpatient hospital coverage In-network: $30-$200 copay
Out-of-network: $40-$300 copay
Out-of-network: $40-$300 copay
Skilled nursing facility
Skilled nursing facility In-network:
Tier 1
$0 per day for days 1-20
$200 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$230 per day for days 21-100
$0 per stay
Tier 1
$0 per day for days 1-20
$200 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$230 per day for days 21-100
$0 per stay
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $325 copay
Out-of-network: $325 copay
Out-of-network: $325 copay
Therapy services
Occupational therapy visit In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Physical therapy & speech & language therapy visit In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Mental health services
Outpatient group therapy with a psychiatrist In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Outpatient individual therapy with a psychiatrist In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Outpatient group therapy visit In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Outpatient individual therapy visit In-network: $30 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Diabetes supplies In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic $0.00 copay $0 copay
Generic $5.00 copay $0 copay
Preferred Brand 20% coinsurance $0 copay
Non-Preferred Drug 25% coinsurance $0 copay
Specialty Tier 29% coinsurance $0 copay
Part B drugs
Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Blue Medicare Advantage Enhanced PPO (PPO) earned an overall rating of 3.5 stars — the same as South Dakota's state average of 3.5 stars.
Rating category This plan State average
Overall star rating ★ 3.5 3.5
Health plan quality
Summary rating of health plan quality ★ 3.5 3.5
Staying healthy: screenings, tests & vaccines ★ 4.0 3.5
Managing chronic (long-term) conditions ★ 3.0 2.9
Member experience with health plan ★ 4.0 4.0
Member complaints & changes in performance ★ 4.0 3.9
Health plan customer service ★ 3.0 3.0
Drug plan quality
Summary rating of drug plan quality ★ 4.0 3.6
Drug plan customer service ★ 5.0 4.7
Member complaints & changes in performance ★ 4.0 3.9
Member experience with the drug plan ★ 3.0 3.5
Drug safety & accuracy of drug pricing ★ 4.0 3.9
Extra Benefits
Hearing
Hearing exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation Not covered
Hearing aids - prescription Not covered
Hearing aids - over the counter Not covered
Preventive dental
Oral exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Cleaning In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Dental x-rays In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services In-network: 25%-50% coinsurance
Out-of-network: 25%-50% coinsurance
Out-of-network: 25%-50% coinsurance
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Periodontics In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Prosthodontics, removable In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Maxillofacial prosthetics Not covered
Implant services In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Oral and maxillofacial surgery In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Orthodontics Not covered
Adjunctive general services Not covered
Vision
Routine eye exam In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Contact lenses In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Eyeglass frames (only) In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Eyeglass lenses (only) In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Upgrades In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
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