Last Updated on
October 6, 2016
Medicare beneficiaries in North Dakota who need coverage for their prescription drugs may want to consider enrolling in a Medicare Part D Prescription Drug Plan. Each Medicare Part D Prescription Drug Plan in North Dakota has a different cost, depending on your location and zip code, but most require you to pay a monthly premium, annual deductible, and copayment or coinsurance.
If you’re a Medicare beneficiary in North Dakota, you may be receiving health coverage through Original Medicare, Part A (hospital insurance) and Part B (medical insurance) or a Medicare Advantage (Medicare Part C) plan without drug coverage. If you also need prescription drug coverage, you should consider Medicare Part D. Medicare Part D is designed to help Medicare beneficiaries get coverage for their prescription drug expenses because the cost of prescriptions taken outside of the hospital will not be covered by Medicare Part A or Medicare Part B.
You can receive Part D coverage from private insurance companies contracted with Medicare to offer prescription drug coverage to Medicare beneficiaries in North Dakota. To enroll, you must have Original Medicare Part A and Part B and live within the North Dakota service area of the Medicare Part D Prescription Drug Plan you are choosing.
Each Medicare Part D Prescription Drug Plan in North Dakota has a formulary, which is a list of covered prescription drugs. The formulary may change at any time. If enrolled, you will receive notice from your plan when necessary. Typically a Medicare Part D Prescription Drug Plan groups the medications in its formulary into coverage categories called “tiers.” Each tier has a designated out-of-pocket cost (e.g., copayment or coinsurance amount) for the medications within the tier. The highest tier contains the higher-cost drugs, while the lowest tier includes the least expensive medications. If your doctor or health-care provider determines that a drug in a higher tier is medically necessary for your treatment instead of a similar drug in a lower tier, you or your doctor can ask your plan for a tiering exception, allowing you to benefit from a lower copayment for a higher tier medication.
Most Medicare Part D Prescription Drug Plans in North Dakota allow you to choose between brand-name drugs and generic drugs. The Food and Drug Administration (FDA) describes generic drugs as having the same active ingredients as brand-name drugs, at the same strength, dosage, and with the same method of administration. The FDA requires generics to be tested as having the same results as brand-name drugs. The primary difference is that generic drugs frequently cost less than the brand-name versions, translating into cost savings for Medicare beneficiaries. If a certain generic drug is unavailable, your Prescription Drug Plan may allow you to substitute with similar generic drugs used to treat your health condition to save you the expense of the brand-name drug. Be sure to discuss all prescription drug options with your doctor or health-care provider.
When you enroll in a Medicare Part D Prescription Drug Plan in North Dakota, you have to remain enrolled in Medicare and continue to pay any Part A premium (if you’re not entitled to premium-free Medicare Part A coverage) and/or Part B premium to retain your insurance coverage. You may have to pay a premium to your Medicare Prescription Drug Plan in exchange for its prescription drug benefits as well.
A good time to enroll in a Medicare Part D Prescription Drug Plan is during your seven-month Medicare Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. Or, if you’re enrolled in Medicare due to a disability, you can sign-up for a Part D Prescription Drug Plan in North Dakota from three months before until three months after your 25th month of disability.
Another time you may enroll in a Part D Prescription Drug Plan available where you live in North Dakota is during the Annual Election Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 each year. You can also switch Medicare Part D Prescription Drug Plans during the same period.
If you enrolled in a Medicare Advantage plan and change your mind, you can disenroll from Medicare Advantage during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year. If you disenroll from a Medicare Advantage plan during this period and return to Original Medicare, Part A and Part B, you can add a stand-alone Medicare Part D Prescription Drug Plan through February 14 as well.
Keep in mind that if you go without creditable drug coverage (that is, prescription drug coverage that is at least as good as Medicare Part D) for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty for as long as you have Medicare Part D coverage. The penalty is calculated using 1% of the national base beneficiary premium and the number of full months you were eligible for Medicare Part D but didn’t sign up. This amount is then added to your Medicare Part D monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
You are likely to have choices in your selection of a Medicare plan that provides prescription drug coverage in North Dakota. Depending upon where you live and what other choices you’ve made about your Medicare coverage, one of these two types is likely to be a good fit. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may select to work in conjunction with Original Medicare, Part A and/or Part B, to help cover costs for prescription drugs. A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into a single plan, offering at least the same coverage as Original Medicare, and sometimes additional benefits, like routine vision, hearing, and dental, all for a single premium.
Medicare plans offering prescription coverage have different costs. Premiums, deductibles, copayments, and coinsurance are likely to vary. Also formularies, the lists of covered prescription drugs, may vary. So it’s important to check to see if your medications are on the plan’s formulary and, if so, on which tier.
If you are currently enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, it’s a good idea to review your coverage each year to be aware of any changes in benefits. Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans in North Dakota are allowed to change their premiums, copayments, deductibles, and formularies each year. You will receive notice of these changes in the Annual Notice of Changes and Evidence of Coverage the plan mails you in the fall before the new benefits are effective the following January 1st. You may want to compare plans every year during the Annual Election Period to make sure you are choosing the coverage that best meets your needs. To assist you in this research, you may enter your zip code in the eHealth Plan Finder located on this page.
Access the following resources to get useful information about Medicare in North Dakota: