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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

At a glance: Medicare health insurance in North Dakota

Medicare enrollment in North Dakota

128,898 people in North Dakota were covered by Medicare as of December 2018. That’s about 17 percent of the state’s population, versus a little more than 18 percent of the total US population enrolled in Medicare.

Most Americans become eligible for Medicare when they turn 65. But nationwide, there are nearly 10 million people under the age of 65 who are covered by Medicare, accounting for about 16 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 in North Dakota, just 12 percent of Medicare beneficiaries were under age 65 as of 2016.

In Alabama, Kentucky, and Mississippi, 23 percent of Medicare beneficiaries are disabled and under age 65. At the other end of the spectrum, just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Medicare Advantage in North Dakota

Medicare beneficiaries can choose to get their coverage through private Medicare Advantage plans, or directly from the federal government via Original Medicare. There are pros and cons to either option, and the right solution depends on each enrollee’s circumstances and preferences.

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 2019 in all 53 counties in North Dakota, but some counties have just one plan available, while others have as many as 18 plan options.

Just 18 percent of North Dakota Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2017; nationwide, the average was 33 percent at that point. As of December 2018, total private Medicare enrollment in North Dakota (not counting people with private supplemental coverage like Part D and Medigap) stood at 23,323 people, which was still about 18 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. North Dakota’s remaining 105,575 Medicare beneficiaries had Original Medicare as of late 2018.

The popularity of Medicare Advantage varies from one state to another. In Minnesota, 56 percent of the state’s Medicare population is enrolled in 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). Starting in 2019, people who are already enrolled in Medicare Advantage 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 2016, according to an AHIP analysis, there were 48,010 people in North Dakota with Medigap coverage. That’s nearly 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 48 insurers that offer Medigap plans in North Dakota as of 2019.

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, 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 — offers Medigap Plan A and high-deductible Plan F with issue-age rating, and there are 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 2019, 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. 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.

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 2019, CHAND charges $176.50/month for the basic Medicare supplement, and $356.50/month for the standard Medicare supplement (these supplements are also available 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 noraml 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. 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, plus the out-of-pocket cost of prescription drugs.

Medicare Part D in North Dakota

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 stane-alone basis, or obtain Part D coverage integrated with a Medicare Advantage plan (not all Advantage plans include Part D benefits, but most do). Both options are available for purchase (or plan changes) during the annual election period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.

There are 28 stand-alone Part D plans for sale in North Dakota in 2019, with premiums that range from about $15 to $94/month.

85,219 North Dakota Medicare beneficiaries had stand-alone Part D plans as of late 2018, and another 6,247 had Medicare Advantage plans that included integrated Part D coverage. Together, that’s nearly 71 percent of the state’s Medicare beneficiaries with Part D coverage.

Medicare spending in North Dakota

Original Medicare’s average per-beneficiary spending in North Dakota was about 11 percent lower than the national average in 2016, at $8,673 (nationwide, the average was $9,533). 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 $11,399, and lowest in Hawaii, at just $6,441.

You can read more about Medicare in North Dakota in our state Medicare guide. You can also contact SHIC, the North Dakota State Health Insurance Counseling Program, with questions related to Medicare coverage in North Dakota.


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.