- About 134,000 residents are enrolled in Medicare in North Dakota; only 11 percent are under age 65 and eligible due to a disability.
- One in five North Dakota Medicare beneficiaries are enrolled in Medicare Advantage plans, versus about 40% nationwide.
- There are Medicare Advantage plans available throughout North Dakota, with plan availability ranging from just one plan in several counties, to 22 plans in Burleigh County.
- In North Dakota, 50 insurers offer Medigap plans, and half the state’s Original Medicare beneficiaries have Medigap plans.
- North Dakota does not require Medigap insurers to offer plans to people under 65, and only two insurers do so, voluntarily. But North Dakota’s pre-ACA high-risk pool is still operational, and offers two Medicare supplement plans for people who aren’t able to qualify for private plans.
- There are 29 stand-alone Medicare Part D prescription plans available in North Dakota in 2020, with premiums ranging from about $13 to $89 per month. More than 72 percent of North Dakota’s Medicare beneficiaries have Part D coverage, either under stand-alone plans or as part of their Medicare Advantage coverage.
- Per-enrollee spending for Original Medicare in North Dakota is about 13 percent lower than the national average.
Medicare enrollment in North Dakota
134,197 people were covered by Medicare in North Dakota as of July 2020, amounting to a little more than 17 percent of the state’s population with Medicare coverage.
For most Americans, filing for Medicare benefits goes hand in hand with turning 65. But nationwide, there are nearly 10 million people under the age of 65 who are covered by Medicare, accounting for about 15 percent 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 11 percent of Medicare enrollment in North Dakota consisted of beneficiaries under age 65 as of 2017.
In Alabama, Arkansas, Kentucky, and Mississippi, 22 percent of Medicare beneficiaries are under age 65. At the other end of the spectrum, just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.
Medicare beneficiaries can chose among several options to access Medicare coverage. The first choice is between Medicare Advantage plans, where coverage is through private Medicare Advantage plans or Original Medicare, where coverage 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 2020 in all 53 counties in North Dakota, but some counties have just one plan available, residents in Burleigh County can select from among 22 different Medicare Advantage plans.
Just 18 percent of North Dakota Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018; nationwide, the average was 34 percent at that point. As of mid-2020, total private Medicare enrollment in North Dakota (not counting people with private supplemental coverage like Part D and Medigap) stood at 26,689 people, which was about 20 percent of the state’s Medicare population. Most of those enrollees had Medicare Advantage plans, but there are also some people in North Dakota who have Medicare Cost plans, which are a type of private Medicare coverage. As of mid-2020, the remaining 107,508 beneficiaries of Medicare in North Dakota had Original Medicare.
The popularity of Medicare Advantage enrollment varies from one state to another. In Minnesota, nearly half of the state’s Medicare population is enrolled in Medicare Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (and those are via employer-sponsored coverage, as there are no Medicare Advantage plans available for individuals to purchase in Alaska).
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 2018, according to an AHIP analysis, there were 53,831 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 are 50 insurers that offer Medigap plans in North Dakota as of 2020. (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 base 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.
Twelve percent of Medicare beneficiaries in North Dakota were under age 65 as of 2017, which amounts to more than 15,000 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 2020, there are just two insurers in North Dakota that voluntarily offer Medigap plans to disabled enrollees who are under age 65: United American Insurance Company offers Plan B and high-deductible Plan F to enrollees under 65, and Blue Cross Blue Shield of North Dakota (Noridian) offers 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). Both companies charge 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. As of 2019, the same two insurers had also offered the same Medigap plans for Medicare beneficiaries under the age of 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 2020, CHAND charges $177.80/month for the basic Medicare supplement, and $359/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 Alaska, Iowa, Nebraska, New Mexico, South 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, as long as they don’t have kidney failure (note that as of 2021, Medicare beneficiaries with kidney failure will no longer be barred from enrolling in Medicare Advantage plans). Medicare Advantage plans are otherwise available to anyone who is eligible for 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 $6,700 per year for in-network care (increasing to $7,550 as of 2021), 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 29 stand-alone Medicare Part D plans for sale in North Dakota in 2020, with premiums that range from about $13 to $89/month.
As of mid-2020, 88,936 Medicare beneficiaries in North Dakota had stand-alone Medicare Part D plans, and another 8,211 had Medicare Advantage plans that included integrated Medicare Part D coverage. Together, that’s more than 72 percent of the state’s Medicare beneficiaries with Part D coverage.
Medicare spending in North Dakota
Average per-beneficiary spending for Medicare in North Dakota was 13 percent lower than the national average in 2018, at $8,825 (nationwide, the average was $10,096). The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage.
Average per-beneficiary Original Medicare spending was lower in North Dakota than it was in most states; only 15 states had lower average spending. Average per-beneficiary Original Medicare spending was highest in Louisiana, at $11,932, and lowest in Hawaii, at just $6,971.
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:
- Medicare Advantage plans in North Dakota
- General info about Medicare Supplement plans (Medigap) and North Dakota Medicare Supplement FAQs
- Medicare Part D plans 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.