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Medicare Advantage in North Dakota

Last Updated on

October 6, 2016

Medicare Advantage (Medicare Part C) gives Medicare beneficiaries living in North Dakota the option to receive their health benefits through a private insurance plan contracted with Medicare rather than through Original Medicare, Part A and Part B. Beyond providing the benefits of Original Medicare Part A and Part B, your coverage from a Medicare Advantage plan in North Dakota generally depends on the health plan you select and on the zip code in which you live.

How Medicare Advantage works in North Dakota

If you’re seeking more extensive coverage than what’s provided under Original Medicare, Part A (hospital insurance) and Part B (medical insurance), you may want to enroll in a Medicare Advantage plan in North Dakota. Medicare Advantage plans in North Dakota, as in the rest of the United States, are required by the government to offer at least the same medical and hospitalization benefits as Original Medicare (with the exception of hospice care, which remains covered by Medicare Part A); many Medicare Advantage plans offer more coverage and additional benefits, like routine vision, hearing, dental, and some also provide prescription drug coverage.

To sign up for a Medicare Advantage plan in North Dakota, you must be enrolled in Original Medicare, Part A and Part B. You can enroll in Original Medicare in North Dakota during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. If you receive disability benefits, you may be automatically enrolled in Medicare in the 25th month of disability benefits. You may also qualify for Medicare before 65 if you have certain medical conditions such as amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).

If you miss your seven-month Initial Enrollment Period, you may be liable for a late-enrollment penalty, in the form of higher premiums. You may still sign up for Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late-enrollment penalty.

You may also switch Medicare Advantage plans in North Dakota during the Annual Election Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. Another time you may switch Medicare Advantage plans in North Dakota is during Special Election Periods, which may occur if you experience a certain major life event. These major life events include, but are not limited to, moving to a new address where your existing plan is not available or losing your current employer-sponsored group health coverage. Special Election Periods in North Dakota vary depending on the particular health plan you choose and on the reason you are losing your present coverage.

If you decide to switch from a Medicare Advantage plan back to Original Medicare, Part A and Part B, you can make the change during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year, in North Dakota and the rest of the United States.

Types of Medicare Advantage plans in North Dakota

There are various types of Medicare Advantage plans in North Dakota. Some, if not all types, may be available where you live. The more prevalent types of Medicare Advantage plans are briefly described below.  As you will see many of these types design their benefits around using a network of health-care providers who participate in the plan.

  • A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that may require you to use doctors, health-care providers, and hospitals included in your plan’s network to receive benefits for covered services. A Medicare Advantage HMO plan usually will not pay for services you receive from a health-care provider who does not participate in the plan’s network unless you needed emergency care or received pre-approval from the plan to receive treatment outside the network. You may have to get a referral from your primary doctor to receive coverage for certain health services. An HMO Point-of-Service plan, on the other hand, is a more flexible option, allowing you to go out of network for some health services and receive benefits, but generally you pay higher out-of-pocket costs for these covered services than you would pay if you received the services from providers in the plan’s network.
  • If you prefer a Medicare Advantage plan with more flexibility, you may be able to choose a Preferred Provider Organization (PPO)* In a Medicare Advantage PPO plan, you may choose doctors, health-care providers, and hospitals in or outside of your plan’s network. Your out-of-pocket costs are typically lower when you receive covered services from providers in the plan’s network.
  • You may be able to select a Private Fee-for-Service (PFFS) plan, which is a type of Medicare Advantage plan that may include a partial or full network of participating providers. It is important to check with the provider to see if he or she accepts the plan because not all providers accept it.
  • Another option may be Medicare Advantage Medical Savings Account (MSA) plan, which combines a high deductible with a savings account that you can use to pay for your health care expenses.
  • If you have specific health conditions, you may want to consider a Medicare Advantage Special Needs Plan (SNP). There are Medicare SNPs for people with certain chronic diseases, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid. A Medicare SNP can offer coverage tailored to these situations.
  • And if you’re seeking both health and prescription drug coverage, you may want to choose a Medicare Advantage Prescription Drug (MAPD) plan, which combines into a single plan health and prescription drug coverage (also available as a stand-alone Medicare Part D Prescription Drug Plan if you have a Medicare Advantage plan without prescription drug coverage or Original Medicare).

If you decide to enroll in Medicare Advantage in North Dakota, you have to remain enrolled in Original Medicare, and continue paying your Medicare Part B premium, in order to retain your health insurance coverage.

Always keep in mind that even if you sign up for a Medicare Advantage plan in North Dakota, you must remain enrolled in Original Medicare and continue paying your Medicare Part B premium to retain your health coverage.

Comparing Medicare Advantage plans available in North Dakota

As a Medicare beneficiary in North Dakota, you may find it useful to compare the various Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary. You may find that some Medicare Advantage plans in North Dakota offer premiums as low as $0; but always remember that you have to keep paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, to retain your Medicare insurance coverage.

Some Medicare Advantage plans may offer benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage through a Medicare Advantage Prescription Drug plan. With so many health insurance options available, you can understand why it may be a good idea to compare each Medicare Advantage plan in North Dakota to determine which Medicare Advantage plan provides the coverage and cost that fits your needs.

To start comparing Medicare Advantage plans in North Dakota today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.

For more information about Medicare in North Dakota, see the following pages:

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.