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Medicare in North Dakota

Medicare in North Dakota offers options for health insurance

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Rachael Zimlich, RN, BSN.

Key Takeaways

  • Medicare in North Dakota is not free, but there are options for each income level and programs that can help offset your share of costs.

  • Medicare Parts A and BOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). cover basic hospital care and outpatient preventive services.

  • Medicare members enrolled in Part A and Part B can enroll in a Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan that may offer expanded coverage like vision, dental and hearing, and Part D.

  • Original Medicare beneficiaries in North Dakota can add Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. prescription drug coverage to Parts A and B.

  • Medicare has specific enrollment periods when you can sign up, drop, or change your plan.

 

As a bread basket state, many people in North Dakota have taken part in supporting the nation’s health by growing food crops and other goods. There comes a time when that support is paid back.

There are several Medicare plans available to residents of North Dakota regardless of their health or income. GoHealth agents licensed in North Dakota can help you choose the right plan for your needs and budget.

What are the Requirements for Medicare Coverage?

Medicare in North Dakota is available to U.S. residents ages 65 and older. If you are under 65 and qualify for Social Security disability, you may be eligible.

Medicare is a federal public insurance program, so eligibility rules are the same in every state. For North Dakota, like other states, anyone who is 65 or older is eligible for Original Medicare. Medicare in North Dakota includes hospital (Part A) and outpatient medical care (Part B).

You may also qualify for Medicare before age 65 if you have one of the following conditions:

  • You have been qualified for disability by the Social Security Administration or the Railroad Retirement Board for at least 24 months.
  • You receive dialysis for kidney disease or have received a kidney transplant.

There are several types of Medicare plans, and the options can be confusing. A licensed insurance agent in your state can help you navigate your coverage options, the costs involved, and how and when to sign up. Different enrollment periods and rules depend on whether you choose to sign up for Original Medicare or a Medicare Advantage plan.

Who qualifies for Medicaid in North Dakota?

Medicaid is another public health insurance program that is state-specific. People in low-income groups or with special healthcare needs may qualify for coverage under both Medicare and Medicaid. Generally, people who meet the following conditions qualify for Medicaid in North Dakota:

  • Citizens of the United States and residents of North Dakota
  • Limited income or assets
  • Children with disabilities
  • Children in foster care
  • Children with subsidized adoptions
  • Pregnant women
  • Individuals with breast or cervical cancer
  • Disabled workers
  • Blindness
  • Various physical or mental disabilities

Is Medicare Required When You Turn 65?

Medicare isn’t mandatory when you turn 65 if you choose to continue an employer or private insurance plan. However, if you don’t have health insurance at 65 and neglect to enroll in Part B, you will have to pay a late penalty if you enroll in Part B later. The same is true if you neglect to enroll in Part D when you turn 65.

  • For Part B, the penalty adds 10% of your premium cost for each year you delay or decline coverage. This penalty will be added to your premium cost each year for the duration of your enrollment.
  • Late enrollment for Part D will add a charge that is 1% of the national base beneficiary premium—which is $33.06 in 2021—multiplied by the number of months that you declined enrollment. This penalty will apply for the duration of your coverage.

Some people are automatically enrolled in Original Medicare when they reach age 65 or receive disability benefits for 24 months. You should receive a notice from Medicare if you are automatically enrolled or eligible to sign up. You can sign up on your own or use a licensed insurance agent to help.

Can I use Medicare in a different state?

The most simple answer is, yes. If you have Original Medicare, you can receive care in other states and even other countries, although you might have to pay a higher share of the costs. [1] Medicare Advantage plans may have restrictions on care in other states, but medically necessary or emergency care coverage is required. The difference with private Medicare Advantage plans is that your plan may dictate where you should receive care, and charge you a higher share of the cost if you go outside a designated network.

How Do You Get Medicare If You are Under 65?

If you are under age 65, you may still qualify for healthcare benefits through the Medicare program. For this to happen, you will have to meet certain criteria.

  • You have been approved to receive Social Security Disability benefits for at least 24 months.
  • You have been approved to receive Railroad Retirement Board benefits for at least 24 months
  • You have been diagnosed with end-stage renal disease and have had a kidney transplant or receive hemodialysis treatments.
  • You have Amyotrophic Lateral Sclerosis (ALS)

What Are the Different Medicare Plans Available?

There are several types of Medicare plans, and each covers a different aspect of your healthcare.

  • Medicare Part A. This plan is open to anyone who is over age 65 or who meets specific criteria. Medicare Part A generally covers any care you receive in a hospital setting.
  • Medicare Part B. This plan has the same eligibility requirements as Part A but covers outpatient care like visits with your primary care provider or a specialist. Together, Medicare parts A and B make up what is often called Original Medicare.
  • Medicare Part C. These are Medicare Advantage plans. These are private insurance products that replace Medicare parts A and B. Medicare Advantage plans combine hospital and outpatient coverage, plus additional services that aren’t usually covered under Original Medicare depending on the plan you choose. Sometimes, these plans will include things like dental care or prescription drug coverage.
  • Medicare Part D. This is Medicare’s prescription drug plan. It is not mandatory, but if you don’t sign up when you are first eligible, you will pay penalties that can increase the cost of your plan. If you choose not to enroll in a Medicare Part D plan on its own or through a Medicare Advantage plan, you must pay the entire cost of your prescription medications on your own.

Medicare Supplement Plans. Medicare Supplement Plans, or Medigap coverage, is another private insurance option that can help you cover your share of your Medicare costs. These plans help you pay for things like copayments, coinsurances, and deductibles. You can only use these plans with Original Medicare.

Is Medicare Free at 65?

Some parts of Medicare might not cost you, but it depends on how long you worked and paid into the Medicare system through your taxes.

Medicare Part A does not have a monthly premium for most people. This applies to anyone (or spouse) who has paid Medicare taxes for at least 10 years. You will, however, have to pay a deductible and coinsurance with Part A coverage.

Medicare Part B  has a monthly premium. Based on your income or combined income for couples, the premium could be higher than the standard Part B premium. Part B has an annual deductible and coinsurance.

Medicare Part C plans vary in cost based on the insurance carrier and the plan you choose. Everyone eligible for Medicare can select one of these plans, but you must enroll in Part A and Part B first.

Medicare Part D prescription plans also vary in cost depending on the plan and insurer you choose. There are 28 prescription drug plans in North Dakota that can be purchased on their own as an add-on to Original Medicare or bundled with the cost of a Medicare Advantage plan. If you have trouble paying for your medications, some programs can help. Eighteen percent of people with Medicare Part D plans qualify for Extra Help, a supplemental program that offers subsidies to low-income people.

Medicare supplement (Medigap) plans vary widely by the insurance company. You can compare Medicare supplement plans on Medicare’s website or with the help of a licensed insurance agent.

What is the Best Prescription Plan for Medicare?

There is no “best” prescription plan under Medicare Part D, but prescription drug plans can meet various needs and budgets. When choosing a Medicare Part D plan, a licensed GoHealth insurance agent can help you sort through options and find the best plan for both your current and future needs.

Which States Have the Best Medicare Advantage Plans?

Medicare Advantage plans vary by the insurance company, state, and sometimes even zip code. A Medicare Advantage plan in one area may not be available where you live, or you may have to travel far to see healthcare providers covered under the plan. The best Medicare Advantage plan is one that fits both your needs and your budget.

Medicare helps make the selection process a little bit easier, though, by assigning a star rating to plans based on surveys of members, doctors, and insurance companies. These surveys poll members on both quality and performance. A five-star rating is the highest designation given to a plan. If you compare plans on Medicare’s website, you can use the star rating.

Medicare in North Dakota by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 120,993 people are enrolled in Medicare in North Dakota. The total number of beneficiaries enrolled in Medicare Advantage in North Dakota is 24,716. The previous year, 24,373 enrolled in Medicare Advantage. Medicare Advantage participation in North Dakota went from 20.65% to 20.35% year over year. If you’d like to dive deeper into how Medicare in North Dakota breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of North Dakota
120,993
Beneficiaries with Part A & Part B
24,617
Medicare Advantage Beneficiaries
20.35%
Medicare Advantage Participation Rate
53.82%
% Female
46.18%
% Male
0.91
Average HCC Score
$9,042.74
Actual Per Capita Costs
14.53%
% Eligible for Medicaid
28.55%
% of Beneficiaries with an Emergency Department Visit
16.27%
Hospital Readmission Rate
93.26%
% Non-Hispanic White
0.50%
% African American
0.67%
% Hispanic
5.57%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

North Dakota Medicare Resources & Contacts

Beneficiaries spend an average of $9,042.74 each year on Medicare in North Dakota. To be sure you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which North Dakota-based resources, like these, may be able to help:

North Dakota Insurance Department

(701) 328-2440
(800) 247-0560
TTY: (800) 366-6888

http://www.nd.gov/ndins/

What should I know about the North Dakota Insurance Department?

If you have questions about insurance you bought for yourself and/or your family, contact NDID.

North Dakota Medicaid Program

(701) 328-2321
(800) 755-2604

http://www.nd.gov/dhs/services/medicalserv/medicaid/

What should I know about North Dakota Medicaid?

If you have a hard time affording health coverage or you’d like more information about eligibility or current Medicaid benefits, contact ND Medicaid.

Senior Health Insurance Counseling (SHIC)

(888) 576-6611
(701) 328-2440
Local: 211

http://nd.gov/ndins/shic

What should I know about SHIC?

If you are on Medicare and have a question, or if you have a disability or end stage renal disease and want to enroll or find out if you are eligible for Medicare, contact SHIC.

North Dakota Department of Veterans Affairs

701-239-7165
866-634-8387

http://www.nd.gov/veterans/

What should I know about the North Dakota Department of Veterans Affairs?

What should I know about the North Dakota Department of Insurance? If you are a veteran and have a question or concern about veterans’ health care benefits, contact NDVA

Nationwide Resources

Speak with an insurance agent that is licensed in North Dakota about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in ND, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

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