If you’re a Medicare beneficiary in North Dakota, you have access to a variety of Medicare Advantage plans (Medicare Part C) that combine hospital, medical, and often prescription drug coverage into one convenient plan.
Let’s explore the options available, including plan types, top providers, and enrollment processes for beneficiaries in North Dakota.
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North Dakota Medicare Advantage Plans Overview
According to the Centers for Medicare and Medicaid Services (CMS), North Dakota offers a robust selection of Medicare Advantage plans, with coverage options available statewide. Here’s a summary of what’s offered:
- Total Companies Offering Plans: 10
- Total Plans Available: 54
Medicare Advantage Plan Type Breakdown:
- Cost Plans: 42.3%
- MA-PD (Medicare Advantage with Prescription Drug coverage): 34.6%
- MA (Medicare Advantage without Prescription Drug coverage): 11.6%
- SNP (Special Needs Plans): 10.0%
- PDP (Prescription Drug Plans): 1.4%
Top Insurance Companies Offering Medicare Advantage Plans in North Dakota:
- BCBS MN, MT, NE, ND, WY, Wellmark IA and SD
- Blue Cross Blue Shield of Michigan Mutual Insurance Co.
- CVS Health Corporation
- HealthPartners, Inc.
- UnitedHealth Group, Inc.
- Humana Inc.
These companies provide a range of HMO, PPO, and Special Needs Plans (SNP) tailored to the needs of North Dakota’s Medicare beneficiaries.
Types of Medicare Advantage Plans in North Dakota
Beneficiaries in North Dakota can choose from multiple plan types to fit their healthcare and financial needs:
- Health Maintenance Organization (HMO):
- Requires you to stay within a network of healthcare providers.
- Referrals are needed for specialists.
- Offers lower monthly premiums and copayments.
- Preferred Provider Organization (PPO):
- Allows out-of-network visits at a higher cost.
- Referrals are not required, offering more flexibility.
- Special Needs Plans (SNP):
- Tailored for individuals with chronic conditions, Medicaid eligibility, or those residing in nursing facilities.
- Cost Plans:
- Available in specific counties, offering a hybrid option between Medicare Advantage and Original Medicare.
- HMO-POS (Point-of-Service):
- Combines HMO and PPO features for more flexibility in accessing care.
Which Medicare Advantage Plan in North Dakota Is Best for You?
The best Medicare Advantage plan depends on your specific healthcare needs. Consider these factors:
- Prescription Drug Coverage: Ensure the plan covers your medications through its formulary.
- Network Providers: Confirm that your preferred doctors and specialists are in-network with your health insurance plan.
- Cost Structure: Compare monthly premiums, deductibles, and out-of-pocket maximums.
North Dakota Medicare Advantage Out-of-Pocket Maximums for 2025
Medicare Advantage plans in North Dakota include annual out-of-pocket maximums, protecting beneficiaries from excessive healthcare expenses. Here’s how plans are distributed in the state:
- $0-$2,300: 4.5%
- $2,301-$3,300: 18.0%
- $3,301-$4,400: 22.0%
- $4,401-$6,000: 25.5%
- $6,701-$8,700: 16.0%
- $8,701-$9,350: 14.0%
Lower MOOP values are often associated with HMO plans, which may require referrals and restrict out-of-network care.
Enrolling in a Medicare Advantage Plan in North Dakota
There are several ways to enroll in a Medicare Advantage plan in North Dakota:
- Independent Insurance Agents:
- Agents can compare multiple plans from different companies to find the best fit for your needs.
- Company-Specific Agents:
- Focus on plans from one insurance provider.
- Direct Enrollment:
- Visit medicare.gov or call Medicare’s TTY service for personalized assistance.
Don’t Miss the Annual Enrollment Period (AEP)
The Annual Enrollment Period is your opportunity to review and switch plans if necessary. During this time, you can enroll in a new Medicare Advantage plan, switch from Original Medicare, or adjust your prescription drug coverage.
Medicare Advantage Plans by County in North Dakota.
These are broken up into 3 categories which are gold, silver and platinum and represent the counties with the highest and lowest number of available Medicare Advantage plans to choose from.
Gold Tier (10 or more plans available):
- Burleigh County: 37 plans
- Cass County: 37 plans
- Grand Forks County: 37 plans
- Morton County: 37 plans
- Stutsman County: 37 plans
Silver Tier (5 to 9 plans available):
- Barnes County: 9 plans
- Benson County: 9 plans
- Bottineau County: 9 plans
- Dickey County: 9 plans
- Eddy County: 9 plans
- Foster County: 9 plans
- Griggs County: 9 plans
- LaMoure County: 9 plans
- McHenry County: 9 plans
- McIntosh County: 9 plans
- McKenzie County: 9 plans
- McLean County: 9 plans
- Nelson County: 9 plans
- Pembina County: 9 plans
- Ramsey County: 9 plans
- Ransom County: 9 plans
- Richland County: 9 plans
- Rolette County: 9 plans
- Sargent County: 9 plans
- Steele County: 9 plans
- Traill County: 9 plans
- Walsh County: 9 plans
- Ward County: 9 plans
- Wells County: 9 plans
- Williams County: 9 plans
Bronze Tier (1 to 4 plans available):
- Adams County: 5 plans
- Billings County: 5 plans
- Bowman County: 5 plans
- Burke County: 5 plans
- Cavalier County: 5 plans
- Divide County: 5 plans
- Dunn County: 5 plans
- Emmons County: 5 plans
- Golden Valley County: 5 plans
- Grant County: 5 plans
- Hettinger County: 5 plans
- Kidder County: 5 plans
- Logan County: 5 plans
- Mercer County: 5 plans
- Mountrail County: 5 plans
- Oliver County: 5 plans
- Pierce County: 5 plans
- Renville County: 5 plans
- Sheridan County: 5 plans
- Sioux County: 5 plans
- Slope County: 5 plans
- Stark County: 5 plans
- Towner County: 5 plans
Common Questions About Medicare Advantage Plans in North Dakota
- What Are the Copayments?
- Copayments vary depending on the service, such as primary care visits, specialist appointments, and prescription drugs.
- What About Deductibles?
- Many plans include deductibles, but others may cover Medicare Part A and Part B deductibles or have a separate drug deductible.
Important Medicare Terms
- Medicare Beneficiary: An individual eligible for Medicare, including Part A and Part B.
- Medicare Advantage Plans (Part C): Health insurance plans offered by private companies approved by Medicare that combine hospital, medical, and often drug coverage into one plan.
- Prescription Drug Plans (Part D): Standalone plans for prescription drug coverage.
- Medicare Supplement Plans (Medigap): Help cover out-of-pocket costs like coinsurance, copayments, and deductibles.
- Medicaid Services: Available for low-income beneficiaries who qualify for additional assistance.
Would you like to speak to an agent about Medicare solutions available in North Dakota?