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North Dakota Medicare Guide

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Explore your options

Compare options, including Medicare Advantage, Medicare Supplement, and prescription plans.

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Receive extended support to help you use your plan effectively, find doctors, and get savings.

This guide will help you understand the basics of Medicare in North Dakota, so you can make the best Medicare decisions for your specific health and financial needs. 


Feeling overwhelmed? You’re not alone. Get free, personalized advice from one of our licensed North Dakota Medicare Advisors. Schedule a free consultation or give us a call at (888) 604-0055 to get started.


Use this table of contents to jump to specific sections:


Snapshot of Medicare in North Dakota

There are 137,000 Medicare beneficiaries in North Dakota, making up 18% of North Dakota’s total population. While most people age into Medicare, about 10% are on Medicare because they have a disability. 11% of North Dakota’s Medicare beneficiaries also receive support from North Dakota Medicaid.


Medicare Advantage vs. Original Medicare in North Dakota

Medicare beneficiaries have options. One of those options is between staying on Original Medicare or switching to a Medicare Advantage plan. We’ll explain more about how each works later on in this guide, but it’s worth noting that 77% of North Dakota residents stay on Original Medicare and only 23% move to Medicare Advantage. 


North Dakota Medicare Advantage Plans

There are 25 Medicare Advantage (MA) plans available in North Dakota. The specific plans and pricing available to you will depend on the county you live in. For example, there are 23 Medicare Advantage plans available in Burleigh County, ND and 11 available in Benson County. 


Legally Medicare Advantage plans must provide at least the same coverage as Original Medicare. They’re a popular alternative to Original Medicare because most also provide Part D (prescription drug) coverage and added benefits, which may include:

  • Dental, vision, and hearing services

  • Flex spending cards

  • Meal delivery

  • Fitness perks

  • Transportation services


Many Medicare Advantage plans offer additional coverage and benefits at a low or zero-dollar premium—although Medicare Advantage enrollees still need to pay their Original Medicare premiums. If this sounds too good to be true, you should consider the downsides of Medicare Advantage. These plans come with:

  • Limited provider networks

  • Prior authorization requirements

  • High out-of-pocket costs 


Original Medicare doesn’t cover about 20% of costs for covered services and it doesn’t have an out-of-pocket maximum. This means that Original Medicare, alone, can leave you on the hook for thousands of dollars. This is why many Medicare recipients enroll in a Medicare Advantage plan that replaces Original Medicare or pair a Medicare Supplement plan with their Original Medicare coverage.


North Dakota Medicare Supplement Plans

There are ten Medicare Supplement (aka Medigap) plans available in North Dakota. Each of these plans is labeled by a letter A-N. While plan pricing may vary, each plan of the same letter is identical in coverage. For example, two Medigap Plan Gs cover the same services even if the premiums and insurance carriers are different. Each of these plan types helps to significantly reduce your out-of-pocket costs, covering things like your:

  • Part A deductible

  • Part B coinsurance

  • Part A coinsurance

  •  Skilled nursing facility coinsurance


Compared to Medicare Advantage plans, Medigap plans have some big benefits, like:

  • No networks - you can see any doctor who accepts Medicare nationwide

  • No prior authorization requirements for covered services

  • Lower out-of-pocket costs


Knowing when to enroll in a Medigap plan is important because outside of a guaranteed issue period, insurance companies can ask you questions about your health history and deny you Medigap coverage. Every Medicare beneficiary has a guaranteed issue period when they first enroll in Medicare: the Medigap Open Enrollment Period. This period lasts for six months after your Part B effective date and is a one-time opportunity to enroll in any Medigap plan from any insurance company with acceptance guaranteed. 


North Dakota Prescription Drug (Part D) Plans

Original Medicare does not include prescription drug coverage. Most Medicare Advantage enrollees receive prescription coverage from their plans. North Dakota Original Medicare beneficiaries can enroll in a stand-alone prescription drug plan. There are 24 North Dakota Part D plans ith an average monthly premium of $30.65.


If you aren’t taking prescriptions when you first enroll in Medicare, we recommend that you enroll in a low-cost drug plan. This will help you avoid the Medicare Part D penalty later!


If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed North Dakota Medicare Advisors or give us a call at (888) 604-0055. 


Get help paying for Medicare in North Dakota

There are three government programs that can help Medicare beneficiaries with low incomes pay for their health-related expenses. 


Medicaid

Medicaid is run by both the state and federal governments, but each state is responsible for day-to-day operations. Medicaid works with Medicare to provide access to care for low-income Americans. North Dakota’s Medicaid program is run by North Dakota Health & Human Services.


After 65, you’re eligible for North Dakota Medicaid if you meet the following criteria:

  • You’re a North Dakota resident

  • You’re a US citizen or an alien who’s lawfully admitted for permanent residence

  • You have less than $3,000 in countable assets (for individuals)

  • Your monthly income is less than $1,009 in 2023 (individuals)


North Dakota Medicaid also offers Medicare Savings Programs, which help Medicare beneficiaries pay for some or all of their Medicare expenses. North Dakota has three Medicare Savings Programs

  • The Qualified Medicare Beneficiaries (QMB) Program pays for recipients’ Part A & B premiums, deductibles, and coinsurance.

  • The Special Low-Income Medicare Beneficiaries (SLMB) Program pays for recipients’ Part B premiums.

  • The Qualifying Individuals (QI) Program pays for recipients’ Part B premiums. 


Eligibility requirements for Medicare Savings Programs are based on monthly incomes.If you’re an individual with a monthly income of less than $1,641 in 2023, then you may qualify! 


You can apply for North Dakota Medicaid programs here. Reach out to one of our licensed North Dakota Medicare Advisors to get help with your application.


Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.


You automatically qualify for Extra Help if you:

  • Receive full Medicaid coverage from North Dakota

  • North Dakota pays your Part B premium

  • Are eligible for Supplemental Security Income (SSI)


If you don’t automatically qualify for Extra Help, you may still be eligible. Talk to one of our licensed North Dakota Medicare Advisors to get free support with your application.


Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:


You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.


North Dakota Medicare Eligibility and Enrollment Steps

Medicare eligibility is the same across the US. You’re eligible for Medicare if you’re a US citizen who meets one of the following criteria:

  • You’re 65 or older

  • You have certain disabilities, like End-Stage Renal Disease or ALS


Three key steps for North Dakota Medicare enrollment:

  1. Enroll in Original Medicare (Part A & Part B)

  2. Choose your additional coverage

    • Medicare Supplement (Medigap)

    • Medicare Advantage (Part C)

    • Part D (drug coverage)

  3. Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.



Due to its multiple parts and supplemental options, Medicare can feel overwhelming, but it doesn’t have to! One of our North Dakota Medicare Advisors would be happy to answer any questions you have, help you understand and compare your options, and guide you through enrollment. Get started by scheduling your free consultation or calling us at: (888) 604-0055.