Medicare is a government-sponsored health insurance plan available in North Dakota to people ages 65 and older or those with certain health conditions or disabilities.
From original Medicare to drug coverage and Advantage plans in North Dakota, Medicare has a range of plans and coverage options to suit your budget and your healthcare needs.
When considering your options for Medicare plans in North Dakota, you’ll first have to decide on the level of coverage you need.
Parts A and B
Original Medicare plans in North Dakota provide government-funded health insurance for hospital and medical care. Original Medicare can be divided into Part A (hospital insurance) and Part B (medical insurance).
Original Medicare coverage includes:
- inpatient and outpatient hospital care
- an annual physical exam
- lab tests
- limited, part-time home healthcare
- very limited, short-term skilled nursing facility care
- ambulance services
- mental health care
Most people are automatically enrolled in Part A when they turn 65 years old.
Medicare Advantage (Part C) plans in North Dakota are offered by private insurance carriers, and they provide more extensive healthcare coverage than original Medicare.
Advantage plan coverage includes:
- everything original Medicare covers
- drug coverage for a specific list of medications
- optional coverage for other services such as dental, hearing, or vision
Prescription drug coverage is offered by private health insurance carriers as Part D plans. You can add a Part D plan to your original Medicare North Dakota plan for help covering the cost of your medications.
Each plan has a unique list of covered medications, known as a formulary. So, when comparing Part D plans, check the list against the prescriptions you’re taking to make sure they’re included.
Medicare supplement (Medigap) plans in North Dakota are offered by private insurance carriers, and they cover out-of-pocket costs like copays and coinsurance that original Medicare plans don’t.
You may not purchase both Part C and Medigap. You must be enrolled in original Medicare and may choose either Part C or Medigap.
Medicare Advantage plans in North Dakota are all provided by private insurance carriers. Each carrier offers unique insurance plans with different coverage options and premium rates.
Providers and plans vary by county, so when searching for Medicare Advantage plans in North Dakota, make sure you’re looking only at the ones available in your ZIP code and county.
The carriers listed below offer Medicare-approved Part C plans to residents of North Dakota:
You need to meet only a couple of eligibility criteria for Medicare plans in North Dakota:
- you must be 65 years old or over
- you must be a U.S. citizen or a permanent resident of the United States
Are you under age 65? You may still be eligible for Medicare if:
You’ll have several opportunities to enroll in Medicare or change your coverage. It’s important to note the dates so you don’t miss the chance to make any changes you need.
Initial enrollment (7 months around your 65th birthday)
Your first opportunity to enroll in Medicare plans in North Dakota is a 7-month window around your 65th birthday. You can begin the enrollment process 3 months before your birthday. It continues during your birth month and for 3 months after your birthday.
This initial enrollment period may be started automatically by the Social Security Administration, but you’ll still need to decide if you want to enroll in a drug plan or Advantage plan.
General enrollment (January 1 to March 31) and annual enrollment (October 15 to December 7)
After you’ve enrolled in Medicare, you’ll have two opportunities per year to reevaluate your current coverage, make changes to your plans, switch to an Advantage plan, or leave an Advantage plan and return to original Medicare North Dakota.
During the general enrollment period from January 1 to March 31 and the open enrollment period from October 15 to December 7, you can make changes to your coverage. Note that Medicare Advantage open enrollment also occurs from January 1 to March 31.
Have you recently moved to a new county or left your job? You can make changes to your current coverage or enroll in Medicare plans in North Dakota during a special enrollment period. Some situations that will result in a special enrollment period include:
- moving out of range of your current coverage
- moving into a long-term care facility
- joining a Program of All-inclusive Care for the Elderly (PACE) plan
- losing employer-sponsored healthcare coverage
- enrolling in employer-sponsored healthcare coverage
With so many coverage options — and both government and private plans to choose from — it’ll take some time to weigh your options, compare plans, and find one that balances your healthcare needs and your current budget. Here are some steps you can follow:
- Start your search by using your ZIP code when looking for prescription drug plans or Medicare Advantage plans in North Dakota. This way, you won’t waste your time reading the fine print for plans that aren’t even offered in your county.
- Next, call your doctor’s office. Most physicians will accept original Medicare coverage but work with only a handful of private insurance providers. Find out which carriers they accept.
- Third, make a complete list of all your prescription and over-the-counter medications. If you’re considering a Part C (Medicare Advantage) or Part D plan, check this list against the list of medications covered by each plan.
- By now, you should have a short list of plans to choose from. Find out what plan members thought of each plan by checking its star rating. In the star rating system, members rate their plan on a scale of 1 to 5, depending on how satisfied they were in the past year. This system ranks plans based on plan responsiveness, member complaints, and customer service, among other categories. Aim to choose a plan with a 4-star rating or higher, if possible.
If you’d like to access additional resources about Medicare plans in North Dakota, you can contact your local state organizations at any time. These are some to keep in mind:
- The State Health Insurance Counseling (SHIC) program. The SHIC program will give you free counseling about Medicare or other health insurance coverage. You can call SHIC at 888-575-6611.
- Department of Adults and Aging Services. Contact Adults and Aging Services (855-462-5465) to find out more about assisted living, home care, and long-term care.
- North Dakota Senior Medicare Patrol. The Medicare Patrol detects and prevents Medicare fraud and abuse through outreach, education, and counseling. You can reach the Medicare Patrol at 800-233-1737.
If you’re approaching 65 years old or you’re about to retire, compare Medicare plans in North Dakota to find the one that will best meet your healthcare and budget needs. Remember to:
- Decide on the level of healthcare coverage you’d like to have. You can choose from among original Medicare, an added Part D drug plan, or Medicare Advantage plans in North Dakota for more comprehensive coverage.
- Narrow down your search using the steps above and decide on your top plans.
- Contact Medicare, the plan carrier, or your local SHIC counselor for advice on plans or to begin the enrollment process if you’ve decided on a plan.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.
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