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Medicare in North Dakota

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Are you approaching eligibility for Medicare in North Dakota? It’s good to know your options before you make a decision about which plan is right for you. In most cases, you can get your Medicare coverage in one of two ways:

  • Original Medicare (Part A and Part B)
  • Medicare Advantage (also called Medicare Part C)

You may also enroll in optional coverage including:

  • Medicare Part D Prescription Drug Coverage
  • Medicare Supplement

Here’s a look at options for Medicare in North Dakota and how to get the coverage you need.

What is Original Medicare in North Dakota?

Original Medicare in North Dakota is comprised of two parts. Part A is sometimes referred to hospital insurance; it may pay for your care when you are an inpatient in a hospital or skilled nursing facility. Part B is your medical insurance and it generally covers your doctor visits and other outpatient tests and procedures. In 2018, over 102,000 people were enrolled in Original Medicare in North Dakota according to the Centers for Medicare and Medicaid Services (CMS).

Most people qualify for premium free Part A, but there are other costs you should be aware of. You’ll pay a Part A deductible when you are admitted to the hospital or skilled nursing home, and there is a daily coinsurance amount for stays over 60 days. There is no cap on your out-of-pocket expenses under Part A.

There is a monthly premium for Part B, which is the same for everyone, unless you fall into a high income bracket. Under Part B, you pay an annual deductible, and you’re generally responsible for 20% of the allowable charges for most medical care you receive. Again, there is no cap on your out-of-pocket expenses under Part B.

By a wide margin, most people enrolled in Medicare (80% of Medicare beneficiaries) choose Original Medicare in North Dakota according to CMS.

What is Medicare Advantage in North Dakota?

Medicare Advantage is an alternate way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare. While all Medicare Advantage plans must cover the same services as Original Medicare (except for hospice care, which is still covered under Part A), they can choose to offer additional benefits. Some plans cover routine vision, dental, and hearing services, which are generally excluded from Original Medicare in North Dakota. In 2018, over 23,000 people were enrolled in Medicare Advantage in North Dakota, according to CMS.

Most Medicare Advantage plans in North Dakota include Part D coverage for prescription drugs. If you like the convenience of getting all your Medicare benefits in one plan, you may prefer Medicare Advantage in North Dakota.

In addition to your Medicare Part B premium, you may also pay an additional monthly premium for your Medicare Advantage plan. You may or may not have an annual deductible. All Medicare Advantage plans in North Dakota have a maximum out-of-pocket limit set by Medicare each year, although some plans set lower out-of-pocket caps.

You may have set copayment amounts for healthcare services, or you may pay a percentage of allowable charges. It’s important to check the cost-sharing arrangement with each plan you are considering so you understand what you’ll pay out-of-pocket for your care.

Most Medicare Advantage plans in North Dakota use provider networks. You may be required to get all your non-emergency care from network providers, or you may pay less out-of-pocket when you choose providers within the plan’s network. If you have a preferred doctor or pharmacy, be sure to check if your provider participates with any plans you are considering.

What is Medicare Part D in North Dakota?

Medicare Part D is the prescription drug insurance program. All Part D plans are provided by private insurance companies approved by Medicare, so specific benefits and costs will vary from plan to plan. There is, however, a minimum level of coverage that all approved plans must meet under Medicare rules.

Although it’s considered optional coverage, you will pay a penalty with your monthly premium if you go without creditable prescription drug coverage for 63 or more consecutive days after your initial enrollment period for Medicare in North Dakota. You can get Medicare Part D through a Medicare Advantage plan (as explained above) or a stand-alone Medicare Part D plan that goes alongside Original Medicare.

Over 90% of people with Medicare Part D in North Dakota have stand-alone Medicare Part D prescription drug coverage according to the Centers for Medicare and Medicaid Services (CMS).

What is Medicare Supplement in North Dakota?

Medicare Supplement Insurance Plans, also called Medigap, are policies that cover some or all of your out-of-pocket costs under Original Medicare, depending on the plan you choose. These costs include coinsurance, copayments, and deductibles. If you want Medicare Supplement, you may pay a separate monthly premium to your plan provider.

Keep in mind that Medigap does not cover out-of-pocket costs associated with prescription drugs. You can only enroll in Medicare Supplement if you have Original Medicare in North Dakota; if you choose Medicare Advantage, you can’t enroll in a Medigap plan.

If you think you want Medigap, you should enroll when you’re first eligible. During that initial enrollment period, you can’t be turned down and you can’t be charged a higher premium for your plan. If you wait, you may be subject to medical underwriting, and your plan can choose not to accept you.

The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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.

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