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Medicare Advantage Plans in North Dakota


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If you’re weighing your Medicare coverage options as a new enrollee, or currently enrolled in Original Medicare but considering a switch, you may want to look into Medicare Advantage in North Dakota.

Although about 80% of enrollees in North Dakota choose Original Medicare, there are currently six different plans for Medicare Advantage in North Dakota according to the Centers for Medicare and Medicaid Services (CMS). Here’s what you should know about Medicare Advantage before you decide which plan is right for you.

What is Medicare Advantage in North Dakota?

Medicare Advantage is also known as Medicare Part C. It’s simply another way to get your Medicare Part A and Part B benefits. All Medicare Advantage plans must cover everything that Original Medicare covers—you don’t lose out on any important benefits by switching to Medicare Advantage in North Dakota.

But because these plans are offered by private insurance companies approved by Medicare, they are able to offer additional benefits not available under Original Medicare. For example, many plans include coverage for routine vision and dental care, and most include Medicare Part D coverage for prescription drugs. Some even offer discounts on over-the-counter medications and gym memberships through the Silver Sneakers program.

What are the benefits of Medicare Advantage in North Dakota?

Some people really appreciate the convenience of having all their Medicare benefits in one convenient plan; Medicare Advantage in North Dakota tends to operate more like employer group health insurance than Original Medicare does.

Unlike Original Medicare, there is a maximum out-of-pocket limit on Medicare Advantage in North Dakota. The limit is set by Medicare each year, but some plans may set theirs at an even lower level. You have the assurance you’ll never pay more than that amount for medical expenses, regardless of how much care you need.

Under Original Medicare, you pay separate deductibles for Part A and Part B. With Medicare Advantage plans in North Dakota, you may not have an annual deductible, or if you do, there’s generally just one for all your coverage.

You may also find it easier to plan for your out-of-pocket costs. Many Medicare Advantage plans use a copayment cost-sharing structure, where you pay a flat fee each time you get care. With Original Medicare, you pay 20% of allowable charges under Part B, and a daily coinsurance amount on hospital stays over 60 days.

Some Medicare Advantage plans may have premiums as low as $0 but you must continue to pay your Medicare Part B premium.

How do I enroll in Medicare Advantage in North Dakota?

It’s a good idea to get information about the plans and companies offering Medicare Advantage in North Dakota before your initial enrollment period, or the open enrollment period each year. That way, you can compare them, estimate your costs, and decide whether Medicare Advantage makes sense for you.

Once you decide on a plan, simply contact the insurance company and follow their steps to enroll. It’s a good idea to compare Medicare Advantage plans each year before open enrollment; you may find that switching plans saves you money.

What else should I know about Medicare Advantage in North Dakota?

Typically, Medicare Advantage in North Dakota is a managed care plan. This means that you may need to choose a primary care provider and get referrals for specialist care and certain tests and procedures. Under these plans, you may also need to get all your care (except in the case of emergencies) within the plan’s network.

Other types of managed care plans don’t require you to use a provider network, but they charge you more out-of-pocket if you go outside the plan’s network. If you have a long-term relationship with a particular doctor or other provider, and you’re considering a Medicare Advantage plan in North Dakota, it’s a good idea to make sure he or she participates with that plan.

If you travel a lot, or spend part of the year away from your primary residence, make sure you understand any restrictions on out-of-network care your plan may impose.

Medicare Advantage plans can’t be combined with a Medicare Supplement Insurance Plan.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The provider network may change at any time. You will receive notice when necessary.

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