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Medicare in North Dakota

North Dakota is one of several states that have maintained pre-ACA high-risk pools to provide Medicare supplemental coverage for people unable to obtain private plans

Key takeaways

Medicare enrollment in North Dakota

137,961 people were covered by Medicare in North Dakota as of November 2021, amounting to about 18% of the state’s population with Medicare coverage.

Most Americans become eligible for Medicare when they turn 65. But nationwide, there are more than 8 million people under the age of 65 who are covered by Medicare, accounting for almost 13% of all Medicare beneficiaries. This is because Medicare eligibility is also triggered once a person has been receiving disability benefits for 24 months, or has kidney failure or ALS. But only about 10% of Medicare beneficiaries in North Dakota are under age 65.

Medicare options

Medicare beneficiaries have choices when it comes to how they access Medicare coverage. The first choice is between Medicare Advantage, where coverage is provided through private Medicare Advantage plans, or Original Medicare, where medical care is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.

Original Medicare includes Medicare Parts A and B. Medicare Part A (also called hospital insurance) helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center. Medicare Part B (also called medical insurance) helps pay for outpatient care like a doctor visit  and preventive healthcare service, such as most vaccinations).

Medicare Advantage includes all of the basic coverage of Medicare Parts A and B, and these plans generally include additional benefits — such as prescription drug and dental coverage — for a single monthly premium.

Medicare Advantage in North Dakota

Medicare Advantage plans are offered by private insurers, so plan availability varies from one area to another. There are Medicare Advantage plans for sale in 2022 in all 53 counties in North Dakota, but some counties in western North Dakota have just two plans available, while residents in Burleigh County can select from among 34 different Medicare Advantage plans.

Or call 855-577-4410 (TTY 771) to speak to a licensed insurance agent.
(Mon-Fri 8am-9pm, Sat 10am-7pm ET)

As of late 2021, about 23% of North Dakota Medicare beneficiaries were enrolled in private plans (not counting people with Original Medicare plus private supplemental coverage like Part D and Medigap). Nationwide, the average was almost 44% at that point.

In most parts of the country, all or nearly all Medicare beneficiaries with private coverage are enrolled in Medicare Advantage. But as of 2019, the majority of private plan enrollees in North Dakota were covered under Medicare cost plans, which are a type of private Medicare coverage.

The other 77% of North Dakota Medicare beneficiaries are enrolled in Original Medicare.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). People who are already enrolled in Medicare Advantage plans also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in North Dakota

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they only had Original Medicare on its own.

As of 2019, according to an AHIP analysis, there were 55,343 people in North Dakota with Medigap coverage. That was about half of the state’s Original Medicare beneficiaries (Medigap coverage cannot be used with Medicare Advantage plans).

Medigap plans are sold by private insurers, but they’re standardized under federal rules and regulated by state laws and insurance commissioners. There were 55 insurers that offered Medigap plans in North Dakota as of 2021. (That link is for all of the insurers that offer Medigap Plan A. That’s a comprehensive list, as all Medigap insurers are required to offer Plan A; The North Dakota Insurance Department has links to the lists of companies that offer each of the other standardized Medigap plans.)

North Dakota allows Medigap insurers to pick their own rating approach, so nearly all of the plans for sale in the state use attained-age rating, which means that an enrollee’s premiums will increase as they get older, regardless of how old they were when they first enrolled. The other two approaches to Medigap premiums are issue-age rating, in which premiums are based on the age the person was when they enrolled, and community rating (or “no age” rating), which means premiums don’t vary based on age; some states require one of these approaches, but North Dakota does not. As of 2019, only one insurer — Bankers Fidelity Life Insurance — offered Medigap Plan A and high-deductible Plan F with issue-age rating, and there were no insurers in North Dakota offering community-rated Medigap plans.

Federal rules require Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s open enrollment period, which begins when the person is at least 65 years old and enrolled in Medicare Part B (and Part A; you have to be enrolled in both to obtain Medigap). But federal rules do not guarantee access to Medigap plans for people under age 65.

About one in ten Medicare beneficiaries in North Dakota are under age 65, which amounts to more than 14,000 people. But although the majority of the states have enacted rules to ensure access to Medigap plans for disabled enrollees under age 65, North Dakota has not. As of 2022, according to Medicare’s plan finder tool, United American Insurance Company is the only insurer in North Dakota that voluntarily offers Medigap plans to disabled enrollees who are under age 65, and it only offers them Plan B and high-deductible Plan F (note that under federal rules, Plan F and high-deductible Plan F can only be purchased by someone who was already eligible for Medicare prior to 2020; newly-eligible beneficiaries cannot buy those plans). The insurer also charges significantly higher premiums for these plans than the average rates that Medigap insurers charge people who are enrolling in Medicare due to age when they turn 65.

Although North Dakota does not require Medigap insurers to offer guaranteed-issue coverage to Medicare beneficiaries who are under age 65, the state has maintained its pre-ACA high-risk health insurance pool (CHAND, the Comprehensive Health Association of North Dakota) and Medicare beneficiaries who are unable to qualify for a Medigap plan can enroll in CHAND’s Medicare supplemental coverage, with a basic supplement and standard supplement option available. As of 2022, CHAND charges $183.40/month for the basic Medicare supplement, and $370.10/month for the standard Medicare supplement (these supplements are also available — at a lower price — for people over age 65 who want to purchase a Medigap plan after their initial enrollment window has closed, and are unable to do so because of their medical history).

Several other states have maintained their high-risk pools and use them to offer supplemental coverage to Medicare beneficiaries who are unable to obtain private Medigap plans. They include AlaskaIowaNebraskaNew MexicoSouth Carolina, Washington, and Wyoming.

Disabled Medicare beneficiaries have access to the normal Medigap open enrollment period when they turn 65. At that point, they have access to any of the available Medigap plans, at the standard age-65 rates.

Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare, and the premiums are not higher for those under 65. But Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $7,550, plus the out-of-pocket cost of prescription drugs.

North Dakota Medicare Part D

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries nationwide have supplemental coverage either through an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare Part D, created under the Medicare Modernization Act of 2003, provides drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Medicare beneficiaries can buy Part D plans on a stand-alone basis, or obtain Part D coverage integrated with a Medicare Advantage plan (not all Medicare Advantage plans include Part D benefits, but most do).

Medicare Part D enrollment is available when a person is first eligible for Medicare (or loses access to other creditable drug coverage later on), and plan changes can be made each year during the annual open enrollment period from October 15 to December 7, with coverage effective the following January.

There are 22 stand-alone Medicare Part D plans for sale in North Dakota in 2022, with premiums that range from about $7 to $116/month.

As of late 2021, 90,679 Medicare beneficiaries in North Dakota had stand-alone Medicare Part D plans, and another 10,367 had Medicare Advantage plans that included integrated Medicare Part D coverage. Together, that’s more than 73% of the state’s Medicare beneficiaries with Part D coverage.

How does Medicaid provide financial assistance to Medicare beneficiaries in North Dakota?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in North Dakota includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Medicare in North Dakota: Resources

Need help with Medicare enrollment in North Dakota or California, or have questions about Medicare eligibility in North Dakota?

You can contact SHIC, the North Dakota State Health Insurance Counseling Program.

The state’s department of insurance website includes several informational pages that can help to guide you with your Medicare application in North Dakota:

The Medicare Rights Center website provides information geared to Medicare beneficiaries, caregivers, and professionals.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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