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When you become eligible for Medicare, you have two primary options for coverage. You could get Original Medicare, which includes Medicare Part A for hospital insurance and Part B for medical insurance. Or you could opt for a Medicare Advantage Plan.
Medicare Advantage Plans (also called Medicare Part C) are an all-in-one alternative to Original Medicare that provide the same coverage as Parts A and B. Plans also frequently include other benefits Original Medicare won’t cover, like prescription drug coverage, hearing, dental, and vision.
This article contains everything you need to know about Medicare Advantage Plans in North Dakota.
Compare ratings of insurance companies offering Medicare Advantage Plans in North Dakota:
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 27 Medicare Advantage Plans available in North Dakota, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are 27 Medicare Advantage Plans available in North Dakota for 2023, including:
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In North Dakota, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which North Dakota Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|North Dakota Committee on Aging||(701) 328-2810||The North Dakota Committee on Aging focuses on issues and services impacting older adults in the state. It also advises the North Dakota Department of Human Services.|
|North Dakota Financial and Health Care Coverage Resources||(701) 328-2372||The North Dakota Health Department can connect you with a list of financial and health care coverage resources, including booklets that explain Special Health Care Coverage, North Dakota Medicaid Expansion, and others.|
|North Dakota Insurance Department||(701) 328-2440||They help consumers by answering their questions, investigating their complaints, and helping them to understand their insurance.|
|Legal Services of North Dakota||(866) 621-9886||Legal help for low-income North Dakota residents seeking assistance with civil legal needs.|
|North Dakota Medicare Premium Assistance Program||(701) 328-2310||The state’s Medicare Assistance offer a few cost-sharing programs based on your income that can help with paying for Medicare Part B premiums and other Medicare expenses.|
|North Dakota Senior Medicare Patrol (SMP)||(701) 858-3580||The Senior Medicare Patrol (or SMP) helps Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse.|
|North Dakota Medicaid||(701) 328-7068||North Dakota Medicaid is public health insurance for qualifying residents.|
|Resource||Contact||How they help|
|211 North Dakota FirstLink||211||2-1-1 North Dakota FirstLink can connect you to critical resources (such as shelter availability childcare, or rent payment assistance) simply by dialing a three-digit number.|
|North Dakota Aging Services Division in Bismarck||(855) 462-5465||The North Dakota Aging Services Division is an Area Agency on Aging (AAA) that provides a range of assistance and services for aging adults in the state, including guidance with Medicare.|
|AARP North Dakota||(800) OUR-AARP||AARP North Dakota provides aging resources including information about Medicare and related programs.|
|North Dakota Aging & Disability Resource Link (ADRL)||(855) 462-5465||The ADRL is a clearinghouse of aging and health resources for older adults in North Dakota.|
|North Dakota Senior Service Providers||ndseniorservices.com/contacts||This organization is made up of 30 non-profit agencies that offer services to older adults throughout North Dakota.|
|Resource||Phone||How they help|
|CMS Medicare Managed Care Appeals & Grievances||1-800-MEDICARE||Offers information and guidance on Medicare and its connected programs.|
|CMS Medicare Managed Care Eligibility and Enrollment||1-800-633-4227||This resource contains information for current and future contracting Medicare Advantage (MA) organizations, other health plans, and other parties interested in the operational and regulatory aspects of Medicare health plan enrollment and disenrollment.|
|CMS Medicare Prescription Drug Eligibility and Enrollment||1-800-424-4301||This page contains enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment.|
|Medicare.gov||1-800-MEDICARE||The main government website for signing up for (or making changes to) Medicare coverage.|