Thanks to greater plan options and expanding benefits, Medicare Part C enrollment has nearly doubled over the past decade. More commonly known as Medicare Advantage (MA), almost half of Medicare beneficiaries had an MA plan in 2022. This page explains Medicare Advantage plans in North Dakota, how the program works, and what to look for when comparing your options.
What Is Medicare Advantage in North Dakota?
Every North Dakota Medicare Advantage plan must provide the same coverage you have with Original Medicare. This includes:
- Medicare Part A: Pays for covered inpatient services that you'd receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B: Covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more
Prescription drug coverage is provided by Medicare Part D, not Original Medicare.
Medicare Advantage plans are not limited to the benefits provided by Parts A and B. In fact, over 90 percent of them offer additional coverage. The most common items are:
- Fitness programs
- Prescription drug coverage
- Routine vision services
- Routine dental care
Even if you join an Advantage plan, you're still responsible for paying the Medicare Part B premium.
North Dakota Medicare Advantage Plans with Prescription Drug Coverage
North Dakota's Medicare Advantage Prescription Drug plans (MA-PD) combine the benefits of Medicare Parts A, B, and D into a single plan.
To avoid the Medicare Part D late enrollment penalty, you must have creditable prescription drug coverage. (Creditable means a plan that is comparable to Medicare.) If your preferred Advantage plan doesn't cover prescriptions AND you don't have creditable coverage elsewhere, you need to join a standalone Medicare Part D plan.
Who Is Eligible for Medicare Advantage in North Dakota?
Once you sign up for Medicare Parts A and B, you can join a Medicare Advantage plan in North Dakota.
American citizens and permanent legal residents qualify for Medicare when they turn 65. Enrollment in Parts A and B is only automatic if you started collecting Social Security benefits at least 4 months before turning 65. Everyone else needs to apply for Medicare.
You can qualify for Medicare before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically during month 25.
When Can You Sign Up for a Medicare Advantage Plan in North Dakota?
You may first join a Medicare Advantage during your Initial Enrollment Period (IEP). It starts 3 months before your Medicare eligibility month and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits is in June, your IEP runs from March 1 through September 30.
The General Enrollment Period runs from January 1 until March 31 and is for anyone who did not sign up for Medicare Part A and/or Part B during their IEP. Once General Enrollment ends, you have from April 1 to June 30 to join an Advantage plan.
Current beneficiaries may sign up for a Part C plan during the Medicare Annual Enrollment Period (AEP) that occurs every year from October 15 until December 7.
If you're already in an MA plan, you may change to a different one during the Medicare Advantage Open Enrollment Period from January 1 to March 31. You may also move back to Original Medicare. If you to lose your prescription drug coverage making that change, you can also join a standalone Medicare Part D plan during Open Enrollment.
You may be eligible for a Special Enrollment Period (SEP) if you experience certain life changes. There are dozens of ways to qualify. Find the full list on Medicare.gov.
Types of Medicare Advantages Plans in North Dakota
There are four common types of Medicare Advantage plans in North Dakota.
Health maintenance organizations are the most common, accounting for over half of all MA plans. HMO plans help control costs with provider networks and will not cover non-emergency care received from an out-of-network provider. If you join an HMO, you'll need to choose a primary care doctor and get a referral to visit a specialist.
Preferred provider organizations (PPO) also use provider networks. However, members can get out-of-network services for a higher copay. They also don't have to choose a primary doctor or get a referral to see a specialist.
Private fee-for-service (PFFS) plans determine what the plan and its members will pay for covered services. Most use a provider network but are like PPOs in that they allow members to receive out-of-network care for a higher price. They also don't require enrollees to have a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people in one of the following populations:
- Those who have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
- People who live in an institution, such as a nursing home, or require at-home care
- Those who are dual eligible, meaning they qualify for both Medicare and Medicaid
Plan benefits are tailored to meet the specialized needs of the population served by the SNP.
How to Choose a Medicare Advantage Plan in North Dakota
To get the best Medicare Advantage plan for your unique situation, consider the following:
- Costs: May include an annual deductible, monthly premium, and copays or coinsurance.
- Coverage: Benefits vary, so look closely at coverage to understand what that monthly premium gets you. Don't forget to review the drug formulary of an MA-PD plan.
- Network: Any entity that provides healthcare services – doctors, labs, hospitals, etc. – may be included in the provider network.
- Ratings: Each fall, Medicare publishes its Advantage plan ratings to help beneficiaries prepare for Annual Enrollment.
Our Find a Plan tool makes comparing Medicare Advantage plans in North Dakota easy. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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