Medicare in North Dakota serves about 145,000 beneficiaries, with 28% enrolled in Medicare Advantage and the remainder on Original Medicare + Medigap. Average Medigap Plan G premium for a new 65-year-old enrollee: $128/mo. Stand-alone Part D plans average $41/mo.
Medicare Beneficiaries
145,000
Age 65+ and disabled
MA Enrollment
28%
% on Medicare Advantage
Avg Medigap Plan G
$128/mo
New enrollee, age 65
| Topic | Detail | Notes |
|---|---|---|
| Medicare Advantage plans available | 12+ | Varies by county; check medicare.gov plan finder |
| Top MA carriers | Sanford Health Plan, UnitedHealthcare, Medica | Networks differ by county |
| Stand-alone Part D | $41/mo | Required if you have Original Medicare + Medigap |
| Annual guaranteed-issue Medigap switching | No (one-time 6-month window at 65) | No state annual GI rights; Sanford Health is the dominant integrated health system in the Dakotas and operates a strong local MA plan. |
Medigap premiums vary by carrier, age, and ZIP code. The 2026 Part B premium is $202.90/month and Part B deductible is $283. Part D out-of-pocket cap is $2,100 in 2026.
North Dakota has one of the lowest Medicare Advantage enrollment rates in the country at roughly 28%, reflecting the state's rural character and the challenge of building provider networks across a sparsely populated Great Plains state. Sanford Health, headquartered in Fargo and Sioux Falls (SD), is the dominant health system in the state and operates its own Medicare Advantage plan — Sanford Health Plan — which leverages its integrated delivery model to offer competitive coverage in the Red River Valley and Bismarck markets. Fargo-Moorhead (spanning North Dakota and Minnesota) is the largest Medicare market in the state. CHI St. Alexius Health serves the Bismarck market.
North Dakota beneficiaries outside the Fargo, Bismarck, and Grand Forks metro areas often rely on Critical Access Hospitals (CAHs) and find Original Medicare with Medigap more practical for accessing specialist care at regional centers. Medigap Plan G averages about $128/month — affordable but reflecting lower healthcare cost baseline in rural Plains states. Oil and gas wealth in western ND's Bakken region has created higher-income communities where IRMAA may be relevant for some retirees. North Dakota has no birthday rule or annual Medigap switching protections. The state's extremely low cost of living helps offset the healthcare cost burden for most Medicare beneficiaries.
In North Dakota, traditional Medicare combined with a Medigap supplement (typically Plan G or N) plus a stand-alone Part D plan provides nationwide access with predictable costs. Plan G covers everything except the $283 Part B deductible.
Medicare Advantage (Part C) plans bundle Medicare Parts A, B, and usually D into one private plan, often with $0 premium beyond Part B. Trade-offs include network restrictions and prior authorization. 28% of North Dakota beneficiaries currently choose MA.
No state annual GI rights; Sanford Health is the dominant integrated health system in the Dakotas and operates a strong local MA plan.
💡 North Dakota Pro Tip
North Dakota has one of the smallest Medicare Advantage markets in the country, with typically 12 to 20 plans available in the Fargo and Bismarck areas. Sanford Health Plan is the dominant local option. Rural western North Dakota counties (Williston, Minot) generally have fewer than 10 MA plan choices, which is a key reason Original Medicare remains the majority coverage type.
The average Medigap Plan G premium for a 65-year-old in North Dakota is approximately $128 per month. Sanford Health Plan, Medica, and Mutual of Omaha are among the carriers offering Medigap options in the state. The limited number of carriers means comparing quotes from all available options is especially important.
North Dakota does not have a birthday rule or annual guaranteed-issue protections for Medigap. Outside your 6-month initial open enrollment at 65 or qualifying federal events, insurers can apply medical underwriting. Given the very limited MA plan alternatives available in rural ND, maintaining Medigap coverage is particularly prudent.
Beneficiary counts and MA enrollment percentages from CMS state-level Medicare data; premium averages from 2026 carrier rate filings for North Dakota. Verify current plan costs at medicare.gov before enrolling.
Jennifer Walsh
Editorial Lead, Health & Medicare
This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.
Reviewed May 2026
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