Medicare Plans in North Dakota

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.

Coverage and Benefits

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
  • Offered 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

Senior citizens 65 and older who apply for Medicare have some wiggle room to customize the benefits they get. For example, you can choose not to except (and therefore not pay for) Medicare Part B benefits if you so wish. If you have a more affordable coverage option, this could make financial sense. But you could also be limiting yourself and leaving yourself open to expensive health care costs. Medicare Part A, on the other hand, is not optional – if you accept Medicare benefits, you have to pay for Part A.

If you choose a Medicare Part C plan, you won’t technically be paying for Medicare Part A and B; you will, however, be paying for a private insurance policy which provides the exact same benefits. You may even choose to purchase more coverage depending on your medical needs. But you cannot accept less coverage. If you decide to stick with Original Medicare but also want Part D prescription drug coverage, then opting out of Medicare Part B is no longer an option. Medicare Part A, Medicare Part B, and Medicare Part D are a package deal.

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 North Dakota Medicare Plans

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.

Senior citizens 65 and older who apply for Medicare have some wiggle room to customize the benefits they get. For example, you can choose not to except (and therefore not pay for) Medicare Part B benefits if you so wish. If you have a more affordable coverage option, this could make financial sense. But you could also be limiting yourself and leaving yourself open to expensive health care costs. Medicare Part A, on the other hand, is not optional – if you accept Medicare benefits, you have to pay for Part A.

If you choose a Medicare Part C plan, you won’t technically be paying for Medicare Part A and B; you will, however, be paying for a private insurance policy which provides the exact same benefits. You may even choose to purchase more coverage depending on your medical needs. But you cannot accept less coverage. If you decide to stick with Original Medicare but also want Part D prescription drug coverage, then opting out of Medicare Part B is no longer an option. Medicare Part A, Medicare Part B, and Medicare Part D are a package deal.

In order to find the best supplemental insurance policy, you need to sit down and take an honest inventory of your current and potential future medical needs. Then, you have to look at what each insurance policy has to offer. Whichever one coincides best with your current and future needs is the supplement you should purchase. Unfortunately, this is much easier said than done.

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.

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.

Specific Differences in Medigap and Medicare Advantage

There are two main contenders when it comes to insurance policies which cover the gaps in Original Medicare: Medicare Part C – also known as Medicare Advantage – and a Medicare Supplement, also known as Medigap. Although they strive to accomplish similar goals, they’re very different from one another.

One popular choice is a Medicare Advantage policy. This is a rather large and bulky option. It completely replaces your Original Medicare with a nearly identical private health insurance policy. It also gives you the option to add many different and extra types of coverage ranging from gap coverage to prescription drugs, dental insurance and more. But with it come all the hassles of dealing with a private insurance company. Despite this, some seniors choose this option anyway because it can be more affordable under certain circumstances.

Then there’s Medigap. There are 10 different Medigap policies in total and they are standardized across the country. Choosing a Medigap Plan F, for example, means you’ll get the exact same benefits in North Dakota as you would in North Carolina or New York. You can only choose one plan because the plans are designed to start with a basic amount of coverage and scale up to provide additional benefits. Purchasing more than one plan would be redundant. These plans are smaller in scope and specifically target medical benefits which are not provided in Original Medicare due to those gaps in coverage we discussed earlier.

There are advantages and disadvantages to each plan. For example, Medicare Part C (Medicare Advantage) has a broader scope and gives seniors the option to add additional coverages which can all be bundled under one insurance plan. Medigap policies, on the other hand, would require you to purchase things like dental or prescription drug coverage separately. However, having a Medigap policy is easier to use and the coverage is accepted buy more doctors and hospitals than Medicare Advantage is. Figuring out which plan you should purchase is all about performing a cost/benefit analysis and deciding which policy best fits your lifestyle.

Even if you are very aware of your healthcare needs and are well-informed about these supplement insurance plans, it can still be difficult to make a decision. That’s why we’re here to help you. If you call us today, we can even assist you in finding a quote on an affordable policy from a trustworthy provider near you. Please don’t hesitate to reach out and contact us if you need assistance.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? Your Medicare Advantage provider estimates your annual healthcare costs based on local statistical data; then they send a bill to the government for your monthly premium. The government pays either all or a portion of it. What the government doesn’t pay for you will. Your Medigap insurance provider will quote you a monthly premium up front. If you decide that their quote is fair and affordable for the coverage you are purchasing, then you agree to pay that premium every month in exchange for the benefits offered.
Will I still have to pay for Part B? Yes Yes
What will it cost me? It can be difficult to estimate the costs of a Medicare Advantage plan. The government may not pay for all of your premium. You may have coinsurance and co-pays attached to your plan; and if, for whatever reason, you can’t visit an in-network doctor or hospital, things can start to get very expensive. For very comprehensive plans, all it will cost you is your monthly premium – to a certain degree, coinsurance, co-pays, or Parts A & B premiums can be covered by your Medicare Supplement policy. Less comprehensive plans may not offer this option.
What will the plan cover? Legally, Medicare Advantage plans must offer duplicate benefits which are identical to Medicare Parts A & B. Beyond that, you can add more coverage if you wish, but it is not required. Medigap supplements specifically target the gaps in Medicare Part A coverage. The more comprehensive your plan, the more gaps in Medicare Part B coverage you can cover; increasingly comprehensive policies will cover more gaps than others.
Is it easy to budget my health care expenses? It can be, but only if you are in exceptionally good health and don’t require frequent medical care. Otherwise budgeting can get difficult. If you get a comprehensive Medigap plan which covers things like coinsurance and co-pays, it becomes extremely easy to budget with a Medigap insurance policy.
Is my plan guaranteed? Or can it be cancelled? Because Medicare Advantage is provided by a private institution, you are just as vulnerable to coverage cancellation as you would be with normal health insurance. There are much stronger guarantees associated with Medigap; in fact, you can only lose your coverage if you stop paying your premiums or if the company becomes financially insolvent.
Do I have to clear a pre-approval or pre-certification process? Because Medicare Advantage is a private insurance plan, you will be subjected to the same pre-approval and pre-certification that regular health insurance requires – and you can be just as easily rejected. As long as the federal government approves you for Medicare, you will be automatically approved for a Medigap insurance plan.
Am I limited to specific doctors or hospitals? Yes, Medicare Advantage plans do you restrict your network of approved doctors and hospitals; on the upside, however, this can make your policy highly affordable depending on where you live. It is highly unlikely that you won’t be able to visit the doctor or hospital you want to since Medigap insurance is as universally accepted as Medicare is.
What type of plan is best for me? Being in good health, living in an area with many health care options, and needing additional coverage like vision or dental can make a Medicare Advantage plan seem more attractive. If you need more medical care than the average senior, if you live in an area where your doctor and hospital choices are limited, and if you don’t require extra types of coverage but are worried about the gaps in Original Medicare, then it’s a good idea to look into a Medigap insurance 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.

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