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Medicare in North Dakota

October 6, 2016

Medicare offers health insurance coverage to eligible individuals 65 or older and those with certain disabilities in North Dakota, as in all states. You might also have the option to sign up for a Medicare plan offered by a private, Medicare-approved insurance company through Medicare Advantage (Medicare Part C) and Medicare Part D (prescription drug coverage). Another option you might have is purchasing Medicare Supplement (Medigap) insurance.

Original Medicare for North Dakota beneficiaries

Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together form Original Medicare.

To be eligible for Original Medicare, you must be 65 or older and a U.S. citizen or legal permanent resident of five continuous years or more. People who are younger than 65 may be eligible for Medicare if they have certain health conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or if they’ve collected disability benefits for 24 continuous months or more from the Social Security Administration (SSA) or the Railroad Retirement Board.

You can sign up for Original Medicare during the seven-month Medicare Initial Enrollment Period, which begins three months before the month you turn 65, includes your birthday month and ends three months after your birthday month. You may also sign up for Medicare at a later date, during the annual General Enrollment Period, which runs from January 1 to March 31. However, if you miss your seven-month Initial Enrollment Period, you might have to pay a late-enrollment penalty in the form of a higher monthly Medicare premium.

Premium-free Medicare Part A is available to many North Dakota Medicare beneficiaries because they (or their spouses) have worked at least 10 years, contributing tax payments to Medicare and accruing Social Security benefits.  If you don’t have Social Security benefits, though, you may still be able to enroll in Medicare and pay a monthly premium.

Medicare Part A coverage includes the following services:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (non-custodial)
  • Hospice care
  • Home health services

Most North Dakota Medicare beneficiaries pay a Medicare Part B monthly premium. Under Medicare Part B, Medicare beneficiaries have coverage for medical services and supplies that include:

  • Physician services, including preventive care screenings
  • Radiology (X-ray) and Laboratory services
  • Outpatient services
  • Medicare-approved clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, or partial hospitalization)
  • Limited outpatient prescription drugs, such as medications administered by a doctor
  • Medicare-approved clinical research.

Medicare plan options in North Dakota

You may choose to receive your Medicare benefits in North Dakota from a Medicare Advantage plan, which is provided by private insurance companies approved by Medicare. A Medicare Advantage plan in North Dakota, as elsewhere in the United States, is required by the government to offer at least the same medical and hospital coverage as Original Medicare, Part A and Part B (except hospice care, which continues to be covered under Part A). Many Medicare Advantage plans also offer additional benefits not available under Original Medicare, like hearing, routine vision, or dental benefits. Medicare Advantage Prescription Drug plans, which combine health and prescription drug coverage into a single private plan are fairly common. You must have Medicare Part A and Part B to sign up for a Medicare Advantage or Medicare Advantage Prescription Drug plan. If you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you continue paying the Medicare Part B premium.

Medicare beneficiaries who want to stay enrolled in Original Medicare but also desire Part D prescription drug coverage have the option of signing up with a stand-alone Medicare Part D Prescription Drug Plan. A stand-alone Medicare Part D Prescription Drug Plan can work alongside your Original Medicare (Part A and Part B) benefits. Stand-alone Medicare Part D Prescription Drug Plans are offered by Medicare-approved insurance companies, and they are designed to help Medicare beneficiaries cover costs for prescription drugs. Costs for Medicare Part D Prescription Drug Plans in North Dakota vary, but they generally require payment of a monthly premium, annual deductible, and copayment or coinsurance. If you decide on this option, instead of getting your Medicare benefits through a Medicare Advantage Prescription Drug plan (described above), you may also be able to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Medicare beneficiaries in North Dakota may have access to various Medicare plans, depending on the county in which they live. Therefore, it’s a good idea to customize your search for plans based on your own coverage needs as well as your county of residence.

To learn more about your Medicare plan options in North Dakota you may refer to the resources listed below:

North Dakota resources for Medicare beneficiaries

Medicare.gov lists a number of resources designed to help Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

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