Medicare in North Dakota

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 2025 in all 53 counties in North Dakota, but some counties in western North Dakota have just three plans available, while residents in Burleigh County can select from among 22 different Medicare Advantage plans.²

As of September 2024, about 35% of North Dakota Medicare beneficiaries were enrolled in Medicare Advantage.¹ Nationwide, the average was above 50% at that point.⁵

The other 65% of North Dakota Medicare beneficiaries were enrolled in Original Medicare as of September 2024.¹

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). People who are already enrolled in Medicare Advantage plans 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.

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.⁶

But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSup) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they only had Original Medicare alone.

According to an AHIP analysis, 52,858 people in North Dakota had Medigap coverage in 2022.⁷ That was about 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. Twenty-eight insurers offer Medigap plans in North Dakota in 2025.⁸

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 (or “no age” rating), which means premiums don’t vary based on age; some states require one of these approaches, but North Dakota does not.

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.

Almost one in ten Medicare beneficiaries in North Dakota are under age 65, which amounts to more than 13,000 people.¹ 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. (Legislation introduced in 2025 would address this issue.⁹)

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 late 2024, CHAND charges the following premiums for enrollees who are under age 65:

• About $237/month for the basic Medicare supplement
• About $478/month for the standard Medicare supplement
• These supplements are also available — at a lower price — 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.

(Note that the legislation introduced in North Dakota in 2025 to create some guaranteed-issue access to Medigap coverage for beneficiaries under age 65 would also direct the state to close CHAND.⁹)

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 Alaska, Iowa, New Mexico, South Carolina, Washington, and Wyoming.

Disabled Medicare beneficiaries have access to the normal 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, 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 $9,350 in 2025, plus the out-of-pocket cost of prescription drugs.¹⁰

Original Medicare does not provide coverage for outpatient prescription drugs.

Some beneficiaries have supplemental coverage from a current or former employer that includes 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. As of late 2024, nearly 55 million people, nationwide, had Part D coverage.⁵

Medicare beneficiaries can buy Part D plans on a stand-alone basis, or obtain Part D coverage integrated with a Medicare Advantage plan (not all Medicare Advantage plans include Part D benefits, but most do).

Medicare Part D enrollment is available when a person is first eligible for Medicare (or loses access to other creditable drug coverage later on), and plan changes can be made each year during the annual open enrollment period from October 15 to December 7, with coverage effective the following January.

There are 16 stand-alone Medicare Part D plans for sale in North Dakota in 2025, with premiums that start at $0/month.³

As of September 2024, 78,884 Medicare beneficiaries in North Dakota had stand-alone Medicare Part D plans, and another 36,790 had Medicare Advantage plans that included integrated Medicare Part D coverage.¹

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in North Dakota includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Need help with Medicare enrollment in North Dakota or California, or have questions about Medicare eligibility in North Dakota?

You can contact SHIC, the North Dakota State Health Insurance Counseling Program.

The state’s department of insurance website includes several informational pages that can help to guide you with your Medicare application in North Dakota:

• Medicare Advantage plans in North Dakota
• General info about Medicare Supplement plans (Medigap) and North Dakota Medicare Supplement FAQs
• Medicare Part D plans in North Dakota

The Medicare Rights Center website provides information geared to Medicare beneficiaries, caregivers, and professionals.