Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare is a federal health care program that serves U.S. residents over the age of 65 as well as some younger residents with special health conditions. Original Medicare includes Part A (hospitalization costs) and Part B (general care, from doctor’s office visits to other health-related costs).
Medicare Advantage (MA), also known as Medicare Part C, combines all of the benefits covered by Original Medicare (Part A and Part B) into one single plan that may also include health care coverage not included in Original Medicare. The main difference between Original Medicare and Medicare Advantage is that while Original Medicare is provided by the federal government, private health insurance companies offer Medicare Advantage plans. MA plans may include prescription drug coverage (Part D), which is not covered under Original Medicare, and may also cover services like vision and dental care and more.
Thanks to their added coverage benefits and potential cost savings, Medicare Advantage plans are growing in popularity and currently account for 42% of all Medicare enrollees nationwide. In North Dakota, 21% of the state’s more than 130,000 Medicare beneficiaries were enrolled in Medicare Advantage plans in 2021. While this is half of the national average, Medicare Advantage enrollment in North Dakota has tripled since 2008. Plan availability varies from county to county, with some counties having only one or two plans for their residents.
Medicare Advantage plans set their own rules and policies for things like plan eligibility, physician networks, out-of-pocket costs and referral requirements. Seniors in North Dakota should pay close attention to the specifics of each plan before making a decision. This guide provides information about North Dakota’s Medicare Advantage plans, including what they cover, how much they cost, and how eligible residents can sign up for coverage.
The Top 7 Medicare Advantage Plans in North Dakota
Medicare-eligible North Dakota residents include seniors 65 and older and younger residents with special medical conditions. They can pick from a range of top-rated Medicare Advantage plans. The table below lists the top 10 most popular plans in North Dakota, ranked by total enrollment numbers. Many providers offer more than one Medicare Advantage plan, so cost data is displayed as a range instead of an average figure.
Both existing Medicare beneficiaries and new enrollees can use the data in this table to learn more about exactly which plan providers and which individual plans are available in the state of North Dakota. All data is accurate as of April 2022, and the most up-to-date information can be found at Medicare.gov.
NextBlue of North Dakota
Sanford Health Plan
Blue Cross and Blue Shield
How Medicare Advantage Plans Work in North Dakota
There are a few important things to understand about how Medicare Advantage plans work in North Dakota. There are six types of Medicare Advantage plans. The most popular four types are Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-For-Services (PFFS) plans, and Special Needs Plans (SNP). Insurance companies typically offer more than one plan type, giving North Dakota’s seniors the ability to find the right one for their specific needs.
Each plan type has its own policies and rules when it comes to eligibility, primary physician requirements, prescription drug coverage and more. The graphic below compares the four main types of Medicare Advantage plans.
What Medicare Advantage Plans Cover in North Dakota
Medicare Advantage plans are required to cover all of the services provided under Original Medicare Parts A and B, with the exception of hospice care which remains covered under Original Medicare. Covered services include hospital stays and skilled nursing care as well as preventative screenings, lab tests and durable medical equipment (DME) like wheelchairs and walkers.
Along with all Original Medicare services, Medicare Advantage plans generally include extra benefits like vision and dental care, hearing aids and prescription drugs. The table below contains a breakdown of what types of services are covered under Original Medicare versus Medicare Advantage.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in North Dakota
To be eligible for Medicare Advantage in North Dakota, residents must first be enrolled in Original Medicare. They also must live within a plan’s service area and must be a citizen or lawful immigrant. Certain plan types have additional eligibility requirements. For example, Special Needs Plans (SPNs) are only available to people with certain qualifying chronic health conditions.
North Dakota residents can only enroll in a Medicare Advantage plan during pre-defined enrollment periods. During the Annual Election Period (AEP), anyone can sign up for a new Medicare Advantage plan or change coverage. During the Open Enrollment Period, only previous enrollees can switch to a different plan. Outside of these periods, current enrollees cannot change coverage or sign up for new plans, except in very few special circumstances. Therefore, North Dakota’s seniors need to keep the start and end dates of the following enrollment periods in mind.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in North Dakota
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The North Dakota Insurance Department regulates the private insurance companies that are allowed to offer Part C coverage in the state. Seniors can access online information about each part of Original Medicare, requirements for seniors’ Medicare Advantage plans and an overview of Part D prescription drug coverage. The department also administers the State Health Insurance Counseling (SHIC) program, which provides invaluable advice to seniors about what kind of coverage they are eligible for, how to sign up and how to appeal a denial of claim. Trained counselors working for SHIC are fully independent and not affiliated with any private insurance company to ensure conflict-free advice seniors can rely on.
To learn about Medicare and Medicare Advantage options in the State of North Dakota, visit the North Dakota Insurance Department’s website, where educational articles are available to the public. To speak to a SHIC counselor, call 1-888-575-6611 or submit an email inquiry to [email protected]. The department may also be reached by mail at its main office in Bismarck.
North Dakota Medicaid is a health insurance program that offers basic coverage for eligible adults with low income and limited assets throughout the state. In addition to the Medicaid program’s ability to supplement Original Medicare, most seniors’ coverage includes a prescription drug benefit that can help close the coverage gap between co-payments and the annual spend down requirements. Medicaid workers can also answer questions for seniors about plan compatibility with various Medicare Advantage and supplemental programs.
To contact the North Dakota Medicaid program, seniors can visit the Medical Services Division online here. Interested applicants, or seniors with general inquiries about health coverage options in North Dakota, can also call the division directly at 1800-755-2604 or 701-328-2321. The Medical Services Division may be reached by mail through the North Dakota Department of Human Services in Bismarck.
The North Dakota Department of Veterans Affairs is a statewide agency that helps honorably discharged veterans find and obtain benefits they may be eligible for. Veterans who need help researching or signing up for Medicare Advantage can contact the department for advice and referrals to professional senior care planners. The department also provides information and links to supplemental plans senior veterans can apply to lower their Original Medicare and Medicare Advantage premiums. Veterans with special needs can contact one of the state’s Veterans Service Officers (VSOs) who provide in-person advice and assistance for senior veterans in all areas of North Dakota. In addition to helping eligible veterans in North Dakota obtain federal and state veterans’ benefits, VSOs are also available to receive and process inquiries and applications for health care and case worker assistance.
Contact the North Dakota Department of Veterans Affairs by phone at 1-866-634-8387. Inquiries to the department may be made online, or by email through the online contact form. Mail to the department should be sent to the NDVA’s main office in Fargo. To contact a local VSO, find a local office online via the searchable state map. Inquiries about finding a VSO may also be directed through the state Department of Veterans Affairs main telephone number.
The federal Indian Health Services (IHS) office operates 15 hospitals and several smaller clinics in the Great Plains division, which serves over 130,000 Native Americans in the region. Based in Aberdeen, South Dakota, this office works with tribal elders across its service area, including 17 Native American nations in North Dakota. Counselors working with the office, and with individual tribes, help eligible seniors sign up for Medicare and Medicare Advantage plans, locate Part D benefits and other prescription assistance and apply for Medicaid supplemental coverage for gaps in existing health services.
Seniors of all backgrounds may contact the Indian Health Services office for the Northern Great Plains by calling 605-226-7581. The office can also be reached by mail at its Aberdeen location, which is listed on the program’s website. Online inquiries can be made through the office’s contact form.
Human Service zones are county-level offices of the North Dakota Department of Human Services that can help seniors and low-income residents learn about and sign up for means-tested programs they may be eligible for. Additionally, workers at each county office are available to help seniors sign up for Medicare, Medicare Advantage, Medicare supplements, Medicaid cost-sharing assistance and Part D Extra Help options to lower their out-of-pocket and prescription drug costs. Most Human Service offices also offer educational materials and personal counseling about benefits seniors may be entitled to receive, and workers can provide seniors with some help planning for long-term care services.
Human Services county office locations and contact information may be viewed in a searchable online map of the state here. The North Dakota Department of Human Services may be reached by calling 1-800-472-2622 or by mail at its Bismarck main office, which is listed on the department’s website.