Medicare in North Dakota: Plans and Coverage (2026)

Medicare in North Dakota runs on federal rules, but the state adds free SHIP 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.1,2

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 SHIP
• 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, so check the current figures at medicare.gov before you budget. To reach a person, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays (TTY 1-877-486-2048), or call North Dakota SHIP at 1-888-575-6611.5,1

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.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. 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. Original Medicare doesn't cover routine dental, vision, or hearing.3,6

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program 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.7

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.6

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. CMS also notes that some plans may help pay all or part of your Part B premium itself.3,6
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.6
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.6
• 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 of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.6

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 SHIP 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.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).8
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

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 $34.50 a month, though actual plan premiums vary widely.3 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.4 People who qualify for Extra Help often pay much less, sometimes nothing.

For a deeper look at how the redesigned Part D benefit works, see our guide to Medicare Part D drug coverage.

Medigap in North Dakota

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They pair with Original Medicare, not with Medicare Advantage: a Medigap policy can't pay an Advantage plan's copayments, coinsurance, deductibles, or premiums.6

North Dakota offers the federally standardized plans, labeled A-D, F, G, and K-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.9,10,3

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.9 Outside it, North Dakota insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.

Federal law does not require insurers to sell Medigap to people under 65, so under-65 access varies from state to state and comes down to what individual North Dakota insurers choose to offer. If you're on Medicare through disability, ask a SHIP counselor what's actually available before you assume you're shut out.11,1 And mark the calendar for 65: because you are already entitled to Part B, your Medigap Open Enrollment Period begins on the date you attain age 65, and during those six months an insurer may not deny you a policy or price it against you because of your health.12

Medigap or Medicare Advantage?

Pairing them doesn't work, and while you're in an Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. That isn't permanent: if this is your first Advantage plan, a federal trial right lets you return to Original Medicare within 12 months and buy a Medigap policy.6 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 the North Dakota Department of Health and Human Services (ND HHS) Medicaid program, with applications taken at county social services offices. The state uses the standard federal income tiers and resource limits, not more generous state-set ones.2

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.13 For all three programs the resource limit, effective the January 2026 benefit month, is $9,950 for one person and $14,910 for a couple (up from $9,660 and $14,470 in 2025), plus an additional $1,500 in designated burial funds allowed on top of each. That ceiling applies to the total value of your non-excluded assets, so excluded assets do not count against it, and North Dakota's policy manual notes the amount changes annually.2 Each income figure above already includes the $20 monthly general income exclusion, so what North Dakota measures is your income after that subtraction, not your gross pay. The income figures are tied to the Federal Poverty Level and update annually. These are the federal standards, not a hard cutoff to screen yourself against: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so a North Dakotan above these figures should apply rather than rule themselves out. QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next year.13 You apply through ND HHS at your county social services office, and SHIP counselors (1-888-575-6611) can walk you through the application. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D; QDWI, the fourth savings program, does not.13

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.14 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, in the 48 contiguous states and DC (Alaska and Hawaii run higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses14
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically13

Apply through Social Security at ssa.gov/medicare/part-d-extra-help or call 1-800-772-1213 (TTY 1-800-325-0778).14,15

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.16

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.16 If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first; miss that window and you wait for the General Enrollment Period (January 1 to March 31) and may owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17

Free Medicare Help: North Dakota SHIP

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 Assistance Program, or SHIP, out of the North Dakota Insurance Department. It's the state's arm of the national SHIP network, and you may still see it called State Health Insurance Counseling, or SHIC, on older documents. Counselors are trained, give free and unbiased help, and don't sell insurance.1

A North Dakota SHIP 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.1

Key North Dakota Medicare Contacts

Learn More

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.