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Medicare Plans in North Dakota – Coverage and Benefits

It’s safe to say that most senior citizens over the age of 65, especially in North Dakota, are well aware of the Medicare health insurance program offered by the federal government. With Traditional Medicare – another way of referring to Medicare Parts A and B – you can get most of your health care needs covered, from hospital stays to doctor visits and more. But there are some things which Medicare will not cover, no matter how badly you need that type of care. And you might be left footing the bill if you aren’t careful.

For the most part, Medicare is designed to be affordable for retired citizens who are living on a fixed income. There are required premiums and deductibles for recipients of Part B, and you can figure out your own personal costs for Part B on this web page. Additionally, Part A could end up costing you more in deductibles and fees if you have a lackluster employment history. Anything shorter than ten years (or 40 quarters) will, unfortunately, land you in the category with others who have to pay for access to Part A.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

A Variety of Medicare Plans in North Dakota

A small yet significant number of senior citizens are currently enjoying Medicare benefits in North Dakota – 110,827 to be exact. Of those, 37% either do not have supplemental coverage, or have an alternative means of supplementing their benefits (possibly through an employer benefit program). By far, most North Dakota seniors prefer the peace of mind that a Medigap supplement insurance policy gives, which explains why 49% of beneficiaries (54,716 seniors) have one. An additional 14% prefer their Medicare Advantage policy.

Are you a qualified senior looking to supplement your current Medicare benefits? If not, enrolling in Medicare is easy – just click that link.

Purchasing Supplemental Coverage in North Dakota

Although supplemental coverage isn’t mandatory, it’s certainly worth thinking about. Unfortunately, present Medicare benefits don’t cover every single form of treatment. And the few things that aren’t covered, should you require them in a medical emergency, can end up costing you a lot of money:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

For any senior citizen who wants to protect themselves and their finances from these potentially disastrous gaps, there is hope. The two most popular supplemental coverage plans, Medigap and Medicare Advantage, are available to anyone over the age of 65 who is currently receiving Medicare benefits. We’ll examine them more closely below.

Medigap – Medicare Supplement Insurance

Medigap policies are small, affordable forms of supplemental coverage designed with Traditional Medicare coverage gaps in mind. They give you the exact amount of coverage you need to protect yourself from surprise medical bills at a fairly low additional cost. Plans A-D, F, G, and K-N are now available (plans E, H, I, and J were phased out in 2010). The only variables that change based on your specific location are prices and providers – each plan offers the same benefits regardless of what state you’re in.

[chart category=”supplement” name=”planTypes” state=”ND” zipcode=”58103″]

What Medicare Advantage Means for You

Medicare Advantage is actually more of an alternative to Traditional Medicare than a supplement or any other form of additional coverage. There are a couple of important factors to consider before you decide to deviate from Traditional Medicare in favor of an Advantage policy. For one, their medical networks are usually much more restricted than others, and it is not unheard of for seniors to be required to switch doctors in order to stay in-network. Additionally, you will be handing over the management of your Medicare benefits to a private company, which may operate differently than the US government.

Legally, however, your benefits are protected. The private health insurance company who underwrites the policy cannot offer you less than what Traditional Medicare does. Some of them even offer more, such as prescription drug coverage, in order to sweeten the deal for customers. Some seniors also believe that the simplicity of having one single policy is superior to any other form of supplement coverage, despite the inherent risks associated with Advantage policies.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are health care provider networks through which Medicare Advantage plans provide their services.

[chart category=”advantage” name=”topHMOPlans” zipcode=”58103″ state=”ND”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”58103″ state=”ND”]

Specific Differences in Medigap and Medicare Advantage

This easy-to-read table helps compare and contrast Medigap and Medicare more effectively:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional North Dakota Resources and Information

Please make use of the directory we have included on this page. It will help you get in touch with knowledgeable Medicare experts in your area who will be more than happy to help you with any additional questions you may have.

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

Compare Medigap Plans Online


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