Medicare in North Dakota
- Start out on your journey to Medicare enrollment today by reading this guide. It covers Medicare in North Dakota, including who can enroll and when they must do it.
What North Dakota Medicare Plans Are Available?
As you approach retirement age — or if you're already there — you might be wondering about health coverage for your future. The majority of older adults are covered by Medicare plans, but it's a bit more complex than many realize. Find out more about North Dakota Medicare plans below and then read on for information about who is eligible and how you can enroll.
Original Medicare: Parts A & B
The original Medicare benefit from the federal government is broken down into two parts called Medicare A and Medicare B. Medicare A provides inpatient coverage, which means it kicks in to pay for covered medical expenses when you're in the hospital, some nursing homes or other overnight in some surgery centers.
Medicare Part B is medical coverage that helps you pay for outpatient treatments, such as being seen for a wellness check at your GP, managed for cardiovascular disease by a cardiologist, seeking urgent care in an ER (if you're not admitted) or getting tests done at a medical lab or imaging center. Medicare Part B also helps pay for medically necessary equipment and supplies such as orthotics, mobility devices or even diabetic testing supplies.
Medicare Part A often doesn't come with a premium, but you will pay a monthly premium for Part B. The amount you pay depends on your income. Part B also comes with a small deductible that you have to cover every year before Medicare begins to pay for services covered under that part of the plan. Part B also has a 20% copay, which means if you go to the doctor and there are $100 in allowed charges, you would typically be responsible for $20 of it.
Medicare Advantage: Part C
Medicare Advantage plans are known as Medicare Part C. This isn't a third option you can add to the other two; it's a separate option that replaces your Parts A and B coverage.
Medicare Advantage plans are funded by the federal government but are administered by private insurance companies. The government requires these plans to provide at least the same level of coverage as you get under Part A and Part B together. But many plans include additional benefits, which is one reason people may choose them. Some of these extra benefits often include dental, hearing, vision, prescription drug coverage and more.
Part C plans typically come with a monthly premium, deductibles and coinsurance amounts. When considering whether you want to stick with Original Medicare or go with a Part C plan, think about the total costs versus what coverage you will have and whether it will work well for you. You may also need to see what doctors and hospitals take your Medicare Advantage plan because these are HMO and PPO plans, which means they often come with approved provider networks.
Medicare Prescription Drug Coverage: Part D
Medicare Part D is a prescription drug benefit. You have to purchase it separately from your other plans, but it can help significantly reduce the cost of prescription medications for those who manage chronic disorders or regularly fill prescriptions. Some Part C plans include prescription drug benefits already, so check the option you choose before you select a separate Part D plan.
Medicare Supplemental Insurance: Medigap
Medigap is a supplemental form of insurance that stands in the gap between what Medicare pays and the total amount owed. For example, if you owe 20% after Part B Medicare payments, that can add up to a significant amount over the year. A supplemental insurance plan often pays those copays and any deductibles. You can purchase a Medicare supplemental insurance plan, typically for a fairly low monthly premium. If you qualify for state Medicaid coverage, it can act as an insurance secondary to Medicare in some cases.
In North Dakota, 133,422 people are covered by some type of Medicare plan. The bulk of adults covered by Medicare in the state opted for Original Medicare — 108,401 had this type of coverage in 2020. Just over 25,000 people in the state had a Medicare Advantage plan.
Who Is Eligible for North Dakota Medicare?
Most people are eligible for Medicare coverage once they turn 65. Some people are eligible for coverage prior to that time if they have a disability that keeps them from working or working a certain amount.
If you have worked and paid into the Social Security program — or are eligible because your spouse has — you may be automatically enrolled in Medicare around 3-4 months before you turn 65. The coverage, however, doesn't start until the first of the month during which you turn 65. If you turn 65 on the first of the month, your coverage may start the previous month. Automatic enrollment does require that you're actively getting benefits through Social Security at least 4 months before you turn 65.
For those who aren't automatically enrolled, an initial enrollment period (IEP) begins four months prior to their 65th birthday. It lasts for three months after that time. You can make elections and decide which Medicare plan you want to enroll in.
If you miss this enrollment period or decide you want to change your coverage to a different type of plan, you do have enrollment options later. Open enrollment runs from October 15 through December 7 every year, and you can also opt out of or switch your Medicare Advantage plan between January 1 and March 31 every year.
It's important to note that if you don't enroll in Medicare at the age of 65, you may end up paying a higher premium for coverage at a later date.
How Do I Enroll in Medicare in North Dakota?
You can apply for Medicare online with the Social Security Administration. You can also call the SSA visit a local Social Security office to apply.
Contact Information for North Dakota Medicare, Medicaid and Insurance Help
- Find out more about North Dakota Medicaid and if you qualify. Medicaid can act as a secondary insurance to Medicare, potentially reducing how much you have to pay personally for medical expenses.
- The North Dakota State Health Insurance Counseling Program can provide some answers and help for those seeking insurance coverage. You can browse its website online or call 866-575-6611 for more information.
- Find out more about Prescription Connection for North Dakota, which can help you find free or discount programs for prescription drugs.
North Dakota Rx Card is another option for those looking to reduce the cost of prescription drug coverage.