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Medicare in North Dakota


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Overview of Medicare in North Dakota

Whether you’re newly eligible for Medicare or you’ve been enrolled in the program for a while, you may be wondering about your different coverage options in North Dakota. In 2018,  126,602 people in North Dakota received Medicare coverage, according to the Centers for Medicare & Medicaid Services (CMS). As a Medicare beneficiary residing in North Dakota, you may be able to choose from a variety of types of plans for your Medicare coverage, as described below.

Original Medicare is the government-sponsored health insurance program for eligible American citizens and legal permanent residents who have lived in the country for at least five continuous years. While many people are eligible for Medicare if they are 65 or older, younger beneficiaries may be eligible for Medicare before 65 through disability or having certain conditions, such as Lou Gehrig’s disease or end-stage renal disease.

Original Medicare works the same way In North Dakota, as it does in the rest of the country. The federal program is made up of two parts: Medicare Part A and Part B.

  • Medicare Part A is hospital insurance and covers inpatient hospital, skilled nursing facility, some home health visits, and hospice care.
  • Medicare Part B is medical insurance helps pay for physician services, outpatient care, durable medical equipment, some home health care, and preventive medical services.

Original Medicare doesn’t cover everything. For example, Original Medicare does not pay for most prescription drugs; you’ll be covered for medications you get during a covered inpatient hospital or skilled nursing facility stay, as well as certain medications you get in an outpatient setting (like a doctor’s office). However, for the most part, you’ll need to enroll in a separate Medicare Prescription Drug Plan for prescription drug coverage.

Original Medicare also doesn’t cover the following:

  • Long-term care (also known as custodial care)
  • Routine vision services
  • Routine dental services
  • Hearing
  • Dentures
  • Acupuncture
  • Health coverage when you’re traveling outside of the country

If you’re a North Dakota beneficiary enrolled in Original Medicare, you have the option to enroll in a Medicare Part D Prescription Drug Plan (PDP) for help with your prescription drug costs. As mentioned, these plans work alongside your Original Medicare coverage and provide stand-alone prescription drug benefits (Medicare Part D). Medicare Prescription Drug Plans are offered through Medicare-approved private insurance companies that do business in North Dakota. Also, in some cases, you can enroll in a stand-alone Medicare Prescription Drug Plan to work alongside a Medicare Advantage plan if the Medicare Advantage plan does not provide Medicare Part D prescription benefits. Keep in mind that in most cases, however, you’ll need to get your Medicare Part D coverage through a Medicare Advantage plan that includes this benefit.

Medigap (Medicare Supplement) insurance plans are also offered by private insurance companies and might help you pay your out-of-pocket costs for services covered under Original Medicare.

Instead of getting your Original Medicare coverage directly through the government program, you may be eligible to enroll in a Medicare Advantage plan in North Dakota instead. Medicare Advantage plans provide an alternative way to get the same Medicare Part A and Part B benefits as Original Medicare. Also known as Medicare Part C, these plans are offered by private insurance companies that contract with CMS.

Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, with the exception of hospice care, which is paid by Medicare Part A. Many Medicare Advantage plans also include extra benefits such as routine dental and vision care. One benefit of these plans is that many Medicare Advantage plans also include prescription drug coverage, giving you the convenience of having all of your Medicare benefits covered through a single plan; these are called Medicare Advantage Prescription Drug (MA-PD) plans.

One important difference between Original Medicare and Medicare Part C is that Medicare Advantage plans are required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Part A and Part B. Every Medicare Advantage plan has a yearly out-of-pocket spending limit; once you reach this limit (which varies by plan), the Medicare Advantage plan will pay for 100% of covered medical costs for the remainder of the year. This means that if you have a medical emergency and require a lot of ongoing treatment, you’ll have peace of mind knowing that there’s a yearly cap on your health-care spending. Original Medicare doesn’t have a maximum out-of-pocket spending limit.

North Dakota beneficiaries, as in the rest of the country, are eligible for Medicare Part C if they:

  • Have Medicare Part A and Part B.
  • Live in the service area of a Medicare Advantage plan.
  • Do not have end-stage renal disease (with some exceptions).

Keep in mind that if you enroll in a Medicare Advantage plan, you’ll need to keep paying your Medicare Part B premium, in addition to any premium directly to your plan. Some service areas may offer Medicare Advantage plans with premiums as low as $0; if you enroll in a Medicare Advantage plan with a $0 premium, keep in mind that you may still have other costs, including deductibles, copayments, or coinsurance. In addition, you’ll need to keep paying the Medicare Part B premium, even if you don’t have a premium for your Medicare Part C coverage.

Would you like to start researching Medicare plan options available in your area? It’s easy to do so: Just enter your zip code into the eHealth plan finder tool on this page to get started. If you like, you can also provide your current list of prescription drugs to narrow you search.

Medicare resources in North Dakota

North Dakota Adults and Aging Services – The Adults and Aging Services is located under the umbrella of the North Dakota Department of Human Services. Residents in search of information about Medicare plans in North Dakota will find this office provides assistance through two specific programs:

  • Quality Health Associates (QHA) of North Dakota, formerly North Dakota Health Care Review Inc.QHA offers information to North Dakota Medicare beneficiaries about the providers who accept Medicare patients in the state. The purpose of this program is to promote quality care to North Dakota seniors through education and assistance with their Medicare questions.
  • Senior Medicare Patrol – The primary goal of SMP is to prevent fraud, waste, and abuse by raising awareness of potential risks through education and counseling. The SMP program uses highly trained volunteers to counsel North Dakota Medicare beneficiaries on how to protect themselves from fraud and report errors on their claims forms.

North Dakota Insurance Department – The Insurance Department oversees the State Health Insurance Counseling Program (SHIC). This program offers free assistance and education about Medicare plans to eligible beneficiaries. Assistance is also available for filing Medicare claims and appeals. Information from this office is available through their website or through one-on-one counseling services. The department staffs trained counselors and volunteers to help North Dakota Medicare beneficiaries better understand their coverage.

North Dakota Department of Human Services – The Department of Human Services is the go-to office for North Dakota Medicare beneficiaries who are having trouble affording their premiums and deductibles for their health-care coverage. This department oversees the state’s Medicaid program, which also provides assistance to eligible beneficiaries in need. Some individuals may qualify for dual eligibility in both Medicare and Medicaid; eligibility is dependent on income level. Additional information is available on this website regarding Medicaid fraud, waste, and abuse and contact information for federal offices for Medicare and Medicaid assistance.

Medicare statistical trends in North Dakota

In 2018 –

  • Approximately 19% (or 23,825 individuals) of Medicare beneficiaries were enrolled in Medicare Advantage plans and other Health plans. 102,777 individuals were enrolled in Original Medicare Part A and/or Part B.
  • 90,508 Medicare beneficiaries in North Dakota enrolled in Part D prescription drug coverage either from a stand-alone Medicare Prescription Drug Plan (PDP) or from a Medicare Advantage plan that included prescription drug coverage in its benefits (Medicare Advantage Prescription Drug Plan).

Some noteworthy points regarding Medicare and North Dakota in 2018 include:

  • 6 Medicare Advantage plans are available in the state.
  • 23 Medicare Prescription Drug Plans are available in the state.
  • 79% of people with Medicare Part D have access to a plan with a lower premium than what they paid in 2017.
  • 20% of people with Medicare Part D are eligible to receive Extra Help (also called the Low-Income Subsidy, or LIS).
  • $20.40 is the lowest monthly premium for a Medicare Prescription Drug Plan. (Premiums may be lower for individuals who qualify for Extra Help or higher for individuals who pay a late-enrollment penalty.)

Statistical data from the Centers for Medicare & Medicaid Services, “Medicare Enrollment Dashboard ” as of July 28, 2015; and “2018 MA Part D Landscape State-by-State Fact Sheet”

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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