Are you getting ready to sign up for Original Medicare and wondering if it offers enough coverage for you? Original Medicare, or Medicare Part A (hospital insurance) and Part B (outpatient insurance), doesn’t cover prescription drugs. There’s also no limit on your annual out-of-pocket costs.
Medicare Advantage (MA) plans could be a better option for coverage. Known as Medicare Part C, MA plans give you the same basic coverage as Original Medicare. Most Part C plans include coverage for prescription drugs and have an annual limit on out-of-pocket costs.
What You Need to Know
Your Medicare Advantage plan is provided by a private insurance company, but has the same basic coverage as Original Medicare.
Many plans include coverage for prescription drugs, dental services, and vision care.
There are several annual enrollment periods for MA plans in North Dakota.
What Types of Medicare Advantage Plans Are Available?
Most plans use a provider network of doctors and medical facilities to keep the cost of services down. The types of MA plans in North Dakota include:
- Health Maintenance Organization (HMO): Except in certain emergencies, you’ll need to visit an in-network doctor for care or pay more out-of-pocket for services. You’ll also have to designate a primary care physician (PCP) for regular care and referrals to specialists.
- Preferred Provider Organization (PPO): You don’t have to choose a PCP, but you’ll save money by going to an in-network doctor for care. You’ll likely pay more out-of-pocket if you go to an out-of-network doctor.1
- Special Needs Plans (SNP): These plans are available if you have certain health conditions.
- Chronic Condition SNP (C-SNP): You’re eligible for these plans if you’re diagnosed with a chronic condition like cancer or cardiovascular disease.
- Institutional SNP (I-SNP): You qualify for these plans if you live in a nursing home or other institution, or require in-home nursing care.
- Dual-Eligible SNP (D-SNP): You can join these plans if you’re eligible for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): You don’t need to choose a PCP, but your plan provider determines how much to pay doctors for services. The plan also chooses how much you’ll pay out-of-pocket.2
- Medicare Medical Savings Accounts (MSA): These plans use high-deductible insurance with an MSA to pay for out-of-pocket expenses.
In Network Saves
You’ll save money with most Medicare Advantage plans by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
With Original Medicare, you’d need to purchase a separate Medicare Part D plan to get prescription drug benefits. Most Medicare Advantage plans in North Dakota include coverage for prescription drugs.
Be sure the MA plan you’re considering covers your prescriptions by checking the drug formulary, or list of covered medications, before signing up.
How Do You Choose Medicare Advantage Plans?
You’ll need to compare the costs and benefits of each MA plan in North Dakota. Those costs include:
- Premiums: This is your monthly cost for your plan, along with the Medicare Part B premium ($148.50 for most people in 2021). You could also consider a zero-premium plan, but other costs, like your deductible or coinsurance, might be higher.
- Other Costs
- Deductible: The amount you have to cover out-of-pocket for services each year before your plan starts paying.
- Coinsurance: This is your portion of the cost of a service, usually as a percentage of the total cost.
- Copay: The fixed price for a specific service.
- Out-of-Pocket Maximum: Your annual limit on out-of-pocket expenses, except for premiums.
- Plan Benefits
- Vision: Coverage for frames and eye exams.
- Dental: Covers services like teeth cleaning and checkups.
- Telehealth: Provides coverage for remote health services like phone consultations or video office visits.
- Additional Perks: Many Medicare Advantage plans in North Dakota provide benefits like gym reimbursement or fitness classes.
Where You Lives Matters
How much you pay per month depends on where you live in North Dakota and the type of plan you choose.
When and How to Enroll in Medicare Advantage?
You can’t join an MA plan until you’ve enrolled in Original Medicare. You can first sign up during your Initial Enrollment Period, or Open Enrollment Period (OEP). This period starts three months before you turn 65 and ends three months after you turn 65.
You can still enroll in Original Medicare if you miss your Initial Enrollment Period. The annual General Enrollment Period runs from January 1 to March 31. You may have late penalties added to your Medicare premiums if you wait and enroll outside of your OEP.
You can sign up for Original Medicare online, at a local Social Security office or over the phone. After you’ve signed up for Original Medicare, you can join an MA plan.
There are several enrollment periods for Medicare Advantage plans in North Dakota:
- Initial Enrollment Period: You can sign up for an MA plan at the same time you enroll in Original Medicare.
- Medicare Annual Election Period (or Open Enrollment Period): You can pick an MA plan during open enrollment from October 15 to December 7 each year.
- Medicare Advantage Open Enrollment Period: You can switch back to Original Medicare or change MA plans from January 1 to March 31 annually.
- Special Enrollment Period: You might be eligible for a special enrollment period if you meet certain criteria, such as:
- You no longer live in your plan’s service area.
- You get coverage from an employer or union health plan.
- You’re losing your coverage, including becoming ineligible for Medicaid.
- Your plan is leaving the Medicare program or is being terminated.
- You need an SNP after being diagnosed with a health condition.
Who Has Signed Up for Medicare Advantage in North Dakota?
The penetration rate of Medicare Advantage plans in North Dakota shows how many people have signed up for MA plans compared to the number of eligible Medicare beneficiaries. In North Dakota, the penetration rate is 19%, or about 26,000 of people eligible for Medicare.
How Much Do Medicare Advantage Plans Cost in North Dakota?
Factors like your location play a big part in the cost of a Medicare Advantage plan. The average cost for Medicare Advantage plans in North Dakota is $50.62 in 2021.3
In Bismarck and Fargo, you could pay a monthly premium between $0 and $250.60.4 Your premium isn’t your only out-of-pocket cost, so be sure to consider costs like deductibles or copays as well.
What If You Want to Change Your Medicare Advantage Plan?
You can change your MA plan during any of the open enrollment periods each year. Simply sign up for a new plan. Your old coverage is canceled automatically when your new plan starts.
What Are Alternatives to Medicare Advantage?
Medicare Advantage isn’t your only option for coverage. Other options include:
- Program of All-Inclusive Care for the Elderly (PACE): This program provides healthcare and in-home services for seniors who meet eligibility requirements.5
- Original Medicare: You can keep Medicare Part A and B if that offers enough coverage for you.
- Medicare Supplement: Known as Medigap, these private insurance policies offer additional coverage to Original Medicare.
- Medicare Supplement with Part D: Medigap policies don’t include prescription drug plans, so you’ll need a separate Part D plan for coverage.
- Medicare Cost Plan: These plans are only offered in certain counties in North Dakota. Original Medicare covers your care when you go outside of your plan’s network.6
What Are Medicare Resources in North Dakota?
- State Health Insurance Counseling (SHIC): This program provides free help on choosing your Medicare and other health insurance coverage.7
- North Dakota Insurance Department: This state office provides information for consumers, including Medicare beneficiaries.8
- North Dakota Medicaid: This program provides health coverage to low-income seniors and those with disabilities who meet eligibility requirements.9
Compare your healthcare options before you’re eligible for Medicare. If Medicare Advantage is right for you, make sure you know which plan you want when it’s time to sign up.