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Medicare Part D in North Dakota

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If you’re shopping for Medicare Part D in North Dakota, you may have various options. According to the Centers for Medicare and Medicaid Services (CMS), there are 23 stand-alone Medicare Part D Prescription Drug Plans available in North Dakota. There are also 6 different Medicare Advantage plans in North Dakota which could include prescription drug coverage. The vast majority of beneficiaries choose stand-alone Medicare Part D in North Dakota to complement Original Medicare.

Here’s what you should know about Medicare Part D coverage for prescription drugs if you’re shopping for a plan in North Dakota.

What is Medicare Part D in North Dakota?

Medicare Part D is the Medicare program that helps pay for prescription medications. Although it’s considered voluntary coverage, you may be charged a penalty on your Medicare Part D premiums if you go without creditable drug coverage for more than 63 consecutive days after your initial enrollment period.

Medicare Part D in North Dakota is offered by private insurance companies approved by Medicare to offer this type of coverage. Although there is a minimum level of coverage all plans must provide, each company has some leeway in how they structure their plans. Plans can set their own premiums, deductibles, copayments, and coinsurance amounts, although plan deductibles cannot exceed the cap set by Medicare each year. They can also decide what drugs to cover, as long as they include at least two in each prescription drug class set out by Medicare.

Most plans cover many different generic and brand-name medications to treat conditions common to Medicare enrollees. In addition, Medicare Part D  prescription drug plans in North Dakota is required by law to cover virtually all medications in six drug classes including antidepressants, antipsychotics, HIV/AIDS drugs, anti-cancer medications, seizure medications, and immunosuppressants. All plans must also cover commercially available vaccines not covered by Medicare Part B.

Why would I need Medicare Part D in North Dakota?

Most people in North Dakota choose Original Medicare (Part A and Part B) for their Medicare coverage, which doesn’t pay for most prescription medications you take at home. Without Part D prescription drug coverage, you’re exposed to potentially significant out-of-pocket costs for medication. Even if you have a Medicare Supplement (Medigap) plan, you are on the hook for your prescription medication expenses, since Medicare Supplement doesn’t cover those costs.

The good news is that Medicare Part D prescription drug plans in North Dakota can be affordable; the lowest monthly premium in 2018 was under $21 according to CMS. If you meet income requirements, you may even qualify for the Extra Help program to help offset your costs. About 20% of all North Dakotans qualify for these subsidies reports CMS.

How do I enroll in Medicare Part D in North Dakota?

Your Part D initial enrollment period corresponds with your regular Medicare initial enrollment period, which is the seven-month period before, during, and after your 65th birthday. You can also enroll during the annual Open Enrollment period, which runs from October 15 to December 7 each year.

The eHealth plan finder tool can help you find a plan that covers the prescription drugs you are currently taking. Do keep in mind you can only enroll in one Medicare Part D Prescription Drug Plan at a time. If you have a Medicare Advantage plan with Part D coverage for prescription drugs and you enroll in a stand-alone Part D plan, you’ll be unenrolled from your Medicare Advantage plan and returned to Original Medicare.

What else should I know about Medicare Part D in North Dakota?

Some plans use a provider network; depending on the plan rules, you may only be allowed to fill your prescriptions at pharmacies within the plan’s network, or you may pay less out-of-pocket when you use network providers.

If you take prescription drugs on a daily basis, it’s a good idea to check the formulary of each plan you are interested in to be sure they are covered. The formulary is the list of covered medications, which may change at any time, but you will receive notice when necessary. You should also pay attention to any special rules your plan may require. For instance, some require prior authorization to fill certain medications. Others may limit the amount of medication you can get at one time.

Your plan may also use a tiered formulary structure. In a tiered formulary, you pay a lower copayment or coinsurance amount for generic medications and a higher amount for more expensive brand-name medications.

The formulary, 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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