Medicare in North Dakota runs on federal rules, but the state adds free SHIC counseling through the Insurance Department and its own process for applying to the Medicare Savings Programs. This guide covers every part of Medicare for North Dakota residents in 2026: what it costs, what plans exist, and how to get help paying.
In This Guide
- Key Takeaways
- Original Medicare: Parts A and B
- Medicare Advantage in North Dakota (Part C)
- Medicare Part D: Prescription Drugs
- Medigap in North Dakota
- Help Paying for Medicare in North Dakota
- Medicare Enrollment Periods
- Free Medicare Help: North Dakota SHIC
- Frequently Asked Questions
About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or North Dakota SHIC at 1-888-575-6611.
Original Medicare: Parts A and B
Original Medicare is run directly by the federal government and has two parts. The mechanics and costs are identical in North Dakota and every other state.
Part A (Hospital Insurance)
Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave the hospital or SNF. Get readmitted after that and the deductible applies again.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.
Medicare Advantage in North Dakota (Part C)
Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.
North Dakota residents in the Fargo, Bismarck, and Grand Forks areas generally see the widest choice of plans. Rural counties across much of the state tend to have fewer options, and some areas may have very limited Medicare Advantage availability. Plan options, networks, and prices change every year and differ by county, so compare what's available at your address before you decide.
How These Plans Work
- You keep paying your Part B premium ($202.90) on top of any plan premium. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.
- Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll.
- Plans usually require prior authorization for certain services, which Original Medicare generally does not.
- Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap.
Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. A North Dakota SHIC counselor can help you read the results for free.
Medicare Part D: Prescription Drugs
Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.
The Inflation Reduction Act eliminated the old coverage gap, so that higher-cost middle stage is gone. Part D now moves through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. The average standalone Part D premium for 2026 is about $46.50 a month, though actual plan premiums vary widely. Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in North Dakota
Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.
North Dakota offers the federally standardized plans, labeled A through N, including high-deductible Plan F and Plan G, regulated under state insurance law. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.
Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health. Outside it, North Dakota insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.
North Dakota does not have a state law extending guaranteed-issue Medigap rights to under-65 beneficiaries on Medicare through disability, so access to Medigap before 65 depends on what individual insurers are willing to offer.
Medigap or Medicare Advantage?
You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.
Help Paying for Medicare in North Dakota
If you're on a fixed income, two programs can cut your Medicare costs sharply.
Medicare Savings Programs
North Dakota administers its Medicare Savings Programs through ND HHS Medicaid. The state uses the standard federal income tiers and resource limits, not higher state-set ones.
| Program | Federal name | Individual | Couple | What it pays |
|---|---|---|---|---|
| QMB | Qualified Medicare Beneficiary | Up to about $1,350 | Up to about $1,824 | Part A and B premiums, deductibles, coinsurance |
| SLMB | Specified Low-Income Medicare Beneficiary | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Qualifying Individual | Up to about $1,816 | Up to about $2,455 | Part B premium |
QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. The income figures are tied to the Federal Poverty Level and update each April. You apply through ND HHS, and SHIC counselors (1-888-575-6611) can walk you through the application. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.
Extra Help for Part D
Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.
- Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically
Apply through Social Security at ssa.gov/benefits/medicare/prescriptionhelp.html or call 1-800-772-1213.
Medicare Enrollment Periods
Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in North Dakota as everywhere else.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes you make during Annual Open Enrollment take effect the following January 1. If you're already getting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security.
Free Medicare Help: North Dakota SHIC
You don't have to figure this out alone, and you don't have to pay a broker. North Dakota runs the State Health Insurance Counseling program, known as SHIC. It's the state's version of the federal State Health Insurance Assistance Program (SHIP), housed inside the North Dakota Insurance Department. Counselors are trained, give free and unbiased help, and don't sell insurance.
A North Dakota SHIC counselor can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans side by side
- Apply for Medicare Savings Programs and Extra Help
- Sort out claims, denials, and appeals
Call 1-888-575-6611 or email ndshic@nd.gov. You can also find local counseling resources through insurance.nd.gov/consumers/medicare.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the 2026 average is about $46.50), and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you pick and the care you use.
Plan availability varies by county. Fargo, Bismarck, and Grand Forks residents generally have the widest choice, while many rural areas of the state have few or no Medicare Advantage plans. Use the Medicare Plan Finder or call SHIC at 1-888-575-6611 to see exactly what's available at your address.
North Dakota's Medicare Savings Programs (QMB, SLMB, QI) are administered through ND HHS Medicaid using standard federal income tiers. QMB pays your Part A and B premiums plus all cost-sharing; SLMB and QI pay the Part B premium. You apply through ND HHS, and enrolling automatically qualifies you for Extra Help with Part D.
The North Dakota Insurance Department runs SHIC (State Health Insurance Counseling), the state's free, one-on-one Medicare counseling program. Call 1-888-575-6611 or email ndshic@nd.gov to reach a trained counselor who doesn't sell insurance.
Learn More
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Enrollment Periods
Find personalized help with Medicare in North Dakota at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.