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Advantage Plans

Medicare Advantage (Part C) Plans in North Dakota

North Dakota residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies.

Medicare Advantage plans are available from private companies that contract with the Centers for Medicare and Medicaid Services to provide Medicare benefits to enrollees.

Joining a Medicare Advantage plan requires careful thought. Medicare is working with private insurance companies to offer you ways to meet your personal health care needs through a variety of products, including Private Fee-For-Service (PFFS), Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) or Special Needs Plans (SNP). The plans must provide all benefits provided by Medicare and they may provide additional benefits. Members may pay a premium and plans may charge co-payments or coinsurances.

Here are some other general features of the Medicare Advantage Plans:

  • Claims go directly to the Medicare Advantage company and bypass Medicare
  • Medicare Advantage plans are NOT supplements
  • Members may pay the plan a monthly premium
  • Members must have Medicare Part A and B
  • Members must not have end stage renal disease
  • Members usually charge a co-payment or co-insurance for services rendered
  • Residents must live in the plan’s service area
  • Some Medicare Advantage plans offer prescription drug coverage
  • The plan may provide additional benefits than Medicare
  • The plan must provide all benefits that are provided by Medicare; however, they can reimburse each benefit at a different level

Key point: Make sure your physicians and hospital accept any Part C plan you’re considering. In most plans, enrollees may be limited in the providers they can receive services from without paying extra. Typically the plans have a “network” of providers that patients can use. Going outside the network may require permission or extra fees.