Medicare in North Dakota
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, hearing, and Part D.
- Original Medicare beneficiaries in North Dakota can add Part DMedicare 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.
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.
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, residents who meet one of the following conditions may qualify for Medicaid in 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
What Medicare coverage is right for my specific situation?
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 multiplied by the number of months that you declined enrollment. This penalty will apply for the duration of your coverage.
Can I Use Medicare in a Different State?
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. 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. 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).
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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: 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: Covers outpatient care like visits with your primary care provider or a specialist. Together, Parts A and B make up what is often called Original Medicare.
- Medicare Part C: These are Medicare Advantage plans. These private insurance products substitute for Parts A and B and usually include additional services that aren’t covered under Original Medicare depending on the plan you choose. These may include coverage for dental care and 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. 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 Insurance: Also known as Medigap coverage, Medicare Supplement Insurance is another private insurance option that can help cover your share of your Medicare costs. These plans help you pay for things like copayments, coinsurance 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 benefit 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 prescription drug plans in North Dakota that can be purchased on their own as an add-on to Original Medicare or are bundled within a Medicare Advantage plan.
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 GoHealth licensed insurance agent.
What Is the Best Prescription Plan for Medicare?
Medicare Part D prescription drug plans 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 plan that fits your current and future needs.
Ready for a new Medicare Advantage plan?
Which States Have the Best Medicare Advantage Plans?
Medicare Advantage plans vary by the insurance company, state, and 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. You can use the star rating to compare plans on Medicare’s website.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 127,180 people are enrolled in Medicare Part A and B in North Dakota. The total number of beneficiaries enrolled in Medicare Advantage increased from 25,622 to 28,582 year over year. Medicare Advantage participation in North Dakota went from 20.68% to 22.47% 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.
127,180 Beneficiaries with Part A & Part B
28,582 Medicare Advantage Beneficiaries
22.47% Medicare Advantage Participation Rate
53.43% Female
46.57% Male
92.95% Non-Hispanic White
0.55% African American
0.76% Hispanic
5.74% Other/Unknown
14.02% Eligible for Medicaid
0.9 Average HCC Score
$9,322.50 Actual Per Capita Costs
16.34% Hospital Readmission Rate
25.65% % of Beneficiaries with an Emergency Department Visit
25,622 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
20.68% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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 Insurance Department
(800) 247-0560
TTY: (800) 366-6888
https://www.insurance.nd.gov/
What should I know about the North Dakota Insurance Department?
If you have questions about insurance you bought for yourself or your family, contact NDID.
North Dakota Medicaid Program
(800) 755-2604
https://www.hhs.nd.gov/healthcare/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)
(701) 328-2440
Local: 211
https://www.insurance.nd.gov/consumers/medicare
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
866-634-8387
https://www.veterans.nd.gov/
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 a GoHealth insurance agent that is licensed in North Dakota about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration 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
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Travel outside the U.S. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.