Medicare in North Dakota

Medicare is a federal program providing health insurance for individuals who are aged 65 years or older, and those who are living with certain disabilities. Medicare is divided into several different parts, each covering different aspects of medical care. Part A covers hospital stays, home health care, nursing homes and other types of long-term care. Part B covers outpatient care and preventative care services. Seniors who are enrolled in Original Medicare receive these elements of cover, and have the option to add Part D coverage for prescription drugs, as well as supplemental cover which offsets the cost of care elements not already included in Parts A and B.

In addition to these coverage options, some insurance companies offer Medicare Advantage, known as Part C. This provides most of the coverage of Original Medicare (with the exception of hospice stays), but can have additional coverage for benefits such as vision, dental or hearing care, as well as non-prescription medications. Seniors might also opt for supplemental insurance, known as Medigap, to help control out-of-pocket expenses.

In North Dakota, there are 143,566 seniors eligible for Medicare, and 22,703 who are registered for Medicare Advantage, compared to 139,473 people enrolled in the Original Medicare. The state spends almost $1.2 billion annually on Medicare Parts A and B, accounting for a very small portion of the $395 billion spent nationwide. Medicare Advantage is growing in North Dakota, with the number of enrollees increasing by almost 75% between 2022 and 2023. This growth may be due to the number of available plans increasing from 23 to 27 in the same time period, and the average monthly cost of coverage falling by 7.5%.

In this guide, we’ll explore the cost of Medicare in North Dakota, as well as other care options. We’ll also list some resources seniors may find helpful when planning their long-term care arrangements.

Options for Medicare Coverage in North Dakota

Original Medicare is a good choice for many older North Dakotans, but an increasing number of seniors are exploring options in Medicare Advantage and Medicare Supplement plans so they can find policies that better suit their needs for expanded services. In addition to regular Medicare administered by the federal government, Medicare Advantage and Medicare Supplement plans can be purchased from private health insurance companies, and plans vary depending on where those companies are located in various parts of the state. All MA plans are regulated by Medicare to ensure they offer adequate coverage for beneficiaries.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and has two parts. Part A is typically referred to as Hospital Insurance while Part B is Medical Insurance. It uses a nationwide provider network, simplifying the process for beneficiaries to access care anywhere in the U.S., but not abroad. Seniors pay for services as they receive them, and as of 2023, there’s an annual deductible of $1,600 for Part A and $226 for Part B in addition to the initial payment. Medicare then covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage (MA) is an alternative to Original Medicare, administered by private companies and regulated by the federal government. MA plans must contain Medicare Parts A and B, minus hospice care which is Part A exclusive. Most MA providers offer prescription drug coverage (Part D), and some plans include wellness programs or medical transportation.

The five MA plan types are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs) and Medicare Savings Accounts (MSAs). In North Dakota there are 27 different MA plan options, provided by Aetna Medicare, Humana, United Healthcare and Anthem.

Who Should Consider Medicare Advantage

Medicare Advantage can be a good choice for people who:

• Are comfortable with managed care
• Need additional benefits that are not covered by the Original Medicare
• Are generally healthy so may benefit from lower premiumsWant more control over out-of-pocket costs

The Top Medicare Advantage Plans in North Dakota

There is a wide range of highly rated Medicare Advantage plans to choose from in North Dakota. The following table lists the most popular providers in the state based on the total number of people enrolled. It also provides information about the types of available plans and the costs for beneficiaries as of August 2023 As each provider offers multiple plans, the costs are provided as a range rather than an average. For more information about Medicare Part C, seniors can visit this link to Medicare Advantage in North Dakota.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in North Dakota

Many seniors find they need assistance to navigate Medicare’s enrollment process and the public and private health care options available to them. North Dakota has a number of resources that offer guidance to Medicare-eligible residents. The following resources have one-on-one counseling and other services that can help beneficiaries enroll in Medicare, understand benefits and find the best Original Medicare, Medicare Advantage or Medigap plan for their needs.