North Dakota is a small but distinctive Medicare Advantage market. Twenty-one plans were available statewide for 2026, according to the CMS Medicare Advantage and Part D Landscape State-by-State Fact Sheet, with roughly 53,000 of the state's approximately 150,000 Medicare beneficiaries enrolled in MA, a 35.4% penetration rate per the CMS MA State/County Penetration Report for August 2026. North Dakota's average monthly premium of $73.51 in 2026 is the highest published average of any state, more than five times the national MA average of about $14 per month.
What makes North Dakota different: the state has zero Medicare Advantage HMO or HMO-POS plans in 2026. Every plan sold in North Dakota is either a PPO or a Special Needs Plan, a byproduct of the state's frontier geography and the limited concentration of primary care networks outside Fargo, Bismarck, and Grand Forks. UnitedHealthcare, Aetna, Sanford Health Plan's Align network, Blue Cross Blue Shield of North Dakota, and Humana compete for the state's 21 plans, with county-level plan counts ranging from 16 in urban Cass County down to as few as 3 in frontier western counties like Golden Valley County.
North Dakota's 2026 Medicare Advantage market is covered in detail below: plan counts, carriers, what to look for when shopping, and the key enrollment dates. Annual Election Period runs October 15 to December 7, 2026, with coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in North Dakota
In 2026, North Dakota has 21 Medicare Advantage plans available, with 53,000 beneficiaries enrolled (35% MA penetration). The average monthly premium is $74 and the statewide average Star Rating is 3.7.
Top Medicare Advantage carriers in North Dakota (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| UnitedHealthcare | 6 | 4.5 | $42/mo |
| Aetna | 5 | 3.5 | $8/mo |
| Sanford Health Plan | 4 | 4.0 | $55/mo |
| Blue Cross Blue Shield of North Dakota | 3 | 4.0 | $60/mo |
| Humana | 2 | 3.5 | $65/mo |
| Wellcare | 1 | 3.0 | $0/mo |
Source: KFF Medicare Advantage in the States, North Dakota; CMS Medicare Advantage and Part D Landscape State-by-State Fact Sheet, North Dakota; CMS MA State/County Penetration Report, August 2026
Plan Types in North Dakota: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in North Dakota| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| PPO (Local + Regional) | 14 | $70/mo | Flexibility to see Sanford, Essentia, CHI St. Alexius, or Trinity Health providers without a referral |
| HMO / HMO-POS | 0 | N/A | Not offered in North Dakota for 2026; low population density limits closed-network plans |
| Special Needs Plan (SNP) | 6 | $0/mo | Dual-eligible (North Dakota Medicaid + Medicare), chronic conditions, institutional/nursing facility care |
| Medical Savings Account (MSA) / PFFS | 1 | $0/mo | High-deductible plan with bank account; rare in North Dakota |
North Dakota is one of the few states with zero Medicare Advantage HMO plans in 2026; PPOs make up about two-thirds of the state's 21 plans.
Source: CMS Medicare Advantage and Part D Landscape State-by-State Fact Sheet, North Dakota, Q4 2025
County-Level Variance in North Dakota
North Dakota Medicare Advantage plan availability varies sharply by county in 2026. Urban counties around Fargo, Bismarck, and Grand Forks have 12 to 16 plans to choose from; frontier western counties may have only 3. Premiums also vary, with rural western counties typically $15-$25 higher per month than the Fargo-Moorhead metro due to fewer competing carriers.
Plan count and average premium by county in North Dakota| County | Plans Available | Avg Premium |
|---|
| Cass County | 16 | $45/mo |
| Burleigh County | 14 | $48/mo |
| Grand Forks County | 12 | $50/mo |
| Ward County | 9 | $58/mo |
| Stark County | 5 | $68/mo |
| Golden Valley County | 3 | $75/mo |
Plan counts and premiums are estimates from CMS Medicare Plan Finder Q4 2025, North Dakota county data. Run a personalized search at medicare.gov to see exact plans for your ZIP code.
Source: CMS Medicare Plan Finder Q4 2025, North Dakota county data
What to Look For in a Medicare Advantage Plan in North Dakota
North Dakota Medicare Advantage shoppers should look beyond premium alone. Here's what matters for shopping in 2026:
- Provider network. Since every North Dakota Medicare Advantage plan is a PPO, out-of-network care is covered at a higher cost share rather than denied outright, but you should still confirm Sanford Health, Essentia Health, CHI St. Alexius, or Trinity Health facilities are in-network before enrolling.
- Prescription drug coverage (formulary). Most North Dakota MA plans include Part D. Check that your specific medications are on the plan's formulary at the tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans.
- Star Ratings. CMS rates plans 1-5 stars annually on quality of care, member experience, and customer service. North Dakota's blended statewide average for 2026 is about 3.7 stars, with UnitedHealthcare's PPO leading the state at 4.5 stars.
- Extras (dental, vision, hearing, fitness, transportation). Extras matter more in a frontier state: some North Dakota MA plans include mileage reimbursement or scheduled rides for members who must drive an hour or more to see a specialist.
- Maximum out-of-pocket (MOOP). MA plans cap your annual in-network out-of-pocket spending. The 2026 federal MOOP ceiling for in-network MA is $9,250, down $100 from $9,350 in 2025. Because North Dakota plans are all PPOs, pay close attention to the separate, usually higher, out-of-network MOOP figure.
- Prior authorization burden. MA plans can require prior authorization for surgeries, advanced imaging, and specialist referrals outside your immediate area. If you regularly travel to Sioux Falls or Minneapolis for specialty care, ask how the plan handles out-of-state prior authorization requests.
Key Medicare Dates in North Dakota
North Dakota Medicare and Medicare Advantage beneficiaries have several enrollment windows in 2026. Miss them and you may face delays or late penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already in a North Dakota MA plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original + Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for North Dakota Medicaid (dual eligible), or other life events. Typically a 2-3 month window.
Notable Extras in North Dakota Plans
North Dakota Medicare Advantage plans include a few state-specific features worth knowing about for 2026:
- Dual-eligible D-SNPs and North Dakota Medicaid: North Dakota Health and Human Services administers North Dakota Medicaid, which expanded coverage in 2014. Residents who qualify for both Medicaid and Medicare are dual eligible and can enroll in a Dual Special Needs Plan (D-SNP), which typically has $0 premiums and coordinates benefits across both programs. If you are unsure whether your income qualifies, the Medicaid income limits lighthouse page walks through North Dakota's current thresholds.
- Sanford Health Align provider-led PPO: Sanford Health, headquartered in Fargo and Sioux Falls, operates Align, North Dakota's only provider-led Medicare Advantage plan. Align is structured as a PPO rather than an HMO so members can still see specialists in Minneapolis, Rochester, or Sioux Falls without a network exception.
- SHIC: free Medicare counseling: The North Dakota Insurance Department runs SHIC (Senior Health Insurance Counseling), the state's free SHIP program. SHIC counselors help beneficiaries compare North Dakota Medicare Advantage plans and Medigap policies at no cost and with no sales incentive.
- Frontier geography and cross-state care: North Dakota's vast rural distances mean many residents routinely cross into Minnesota (Fargo-Moorhead corridor), South Dakota (Sioux Falls), or Montana for specialty care. Because every North Dakota Medicare Advantage plan is a PPO, members retain some level of out-of-network coverage for this cross-border care, unlike closed HMO markets elsewhere.
Medicare Advantage vs Original Medicare in North Dakota
North Dakota residents choosing between Original Medicare and Medicare Advantage face a different calculation than most states. Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives you nationwide provider freedom and no prior authorization for most services, but the combined Medigap and Part D premium in North Dakota typically runs $150 to $300 per month. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into one plan, but North Dakota's 2026 average Medicare Advantage premium of $73.51 per month is unusually high, narrowing the cost gap that makes MA the clear winner in most other states.
North Dakota's PPO-only market changes the network trade-off, too. Elsewhere, Medicare Advantage often means a closed HMO network in exchange for lower cost. North Dakota has zero HMO plans in 2026, so every Medicare Advantage enrollee already has PPO-level flexibility to see out-of-network providers, just at a higher cost share. That flexibility matters in a state where residents commonly cross into Minnesota, South Dakota, or Montana for specialty care.
One North Dakota-specific quirk: federal rules let you switch from Medicare Advantage back to Original Medicare during AEP or MA OEP, but Medigap carriers are not required to sell you a policy at that point unless you qualify for a guaranteed issue right. The North Dakota Insurance Department publishes the state's Medigap guaranteed issue rules, and beneficiaries planning to leave a Medicare Advantage PPO plan after their first year should confirm their guaranteed issue eligibility before disenrolling.
How Star Ratings work in North Dakota
North Dakota Medicare Advantage plans, like every state's MA market, are rated by CMS every October on a 1 to 5 star scale covering roughly 40 quality measures: chronic condition management, member complaints, customer service, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS, which typically fund richer supplemental benefits the following plan year.
North Dakota's blended statewide average Star Rating for 2026 is approximately 3.7, close to the national average of roughly 3.65 after CMS tightened its 2026 methodology. UnitedHealthcare's North Dakota PPO plan is among the state's highest rated at 4.5 stars, while the state's few Special Needs Plans and newer entrants such as Wellcare tend to score lower until they build a longer track record. A 5-star plan, if one becomes available in North Dakota, would trigger a Special Enrollment Period letting you switch into it any time of year.
How to enroll in North Dakota Medicare Advantage
North Dakota residents enrolling in Medicare Advantage in 2026 follow the same federal process as the rest of the country, but with a smaller, PPO-only set of carrier and county options. Use medicare.gov/plan-compare as your starting point. CMS publishes a personalized plan finder tool keyed to your ZIP code that shows every plan sold in your North Dakota county.
Common reasons North Dakota Medicare Advantage applications are delayed or denied: late Part B enrollment (you must have both Part A and Part B in effect first), an address outside the plan's service area (easy to hit given North Dakota's small county-level plan counts), missing documentation proving North Dakota Medicaid dual-eligible status for a D-SNP, identity verification mismatches, and applying for a plan type you do not qualify for, such as a chronic-condition SNP without a qualifying diagnosis.
- Step 1: Confirm Medicare Part A and Part B eligibility. You must already be enrolled in both before you can join a North Dakota Medicare Advantage plan. If you are newly turning 65, your Initial Enrollment Period covers this.
- Step 2: Gather your documents: your Medicare card (showing your Medicare number and Part A/B effective dates), your ZIP code, a list of your current prescriptions for formulary lookup, a list of your current doctors and hospitals (Sanford, Essentia, CHI St. Alexius, Trinity Health) for network confirmation, and your Medicaid card if you are dual-eligible.
- Step 3: Compare plans at medicare.gov/plan-compare. Filter by your North Dakota ZIP code, then sort by Star Rating, monthly premium, total estimated annual cost, or maximum out-of-pocket. North Dakota residents can also call the state's SHIC program (Senior Health Insurance Counseling) for free, unbiased guidance.
- Step 4: Apply. You can enroll directly through medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or through the carrier directly. Most online enrollments take 10 to 15 minutes.
- Step 5: Confirm your coverage start date. AEP enrollments start January 1, 2027. Special Enrollment Period enrollments typically start the first of the month after you enroll. You will receive a member ID card and Evidence of Coverage from the carrier within 7 to 10 business days.
$0 premium plans in North Dakota for 2026
North Dakota has a small number of $0 monthly premium Medicare Advantage plans available in 2026, concentrated in the state's three largest counties: Cass (Fargo), Burleigh (Bismarck), and Grand Forks. A $0 premium does not mean $0 cost. You still pay the Part B premium ($202.90 per month in 2026) plus any plan copays and deductibles, and North Dakota's PPO-only $0 plans often carry higher out-of-network cost-sharing than the $0 HMOs found in larger states.
$0 premium plans in North Dakota for 2026 detail| Carrier | Plan Type | Star Rating | Counties Available |
|---|
| Aetna | PPO | 3.5 | Cass, Burleigh, Grand Forks |
| Wellcare | PPO | 3.0 | Cass, Burleigh |
| UnitedHealthcare | Special Needs Plan (D-SNP) | 4.0 | Statewide (dual-eligible only) |
| Sanford Health Plan (Align) | PPO | 4.0 | Cass, Burleigh, Stark |
North Dakota $0 premium plan availability sample; full list at medicare.gov/plan-compare keyed to your ZIP code. Star Ratings reflect the 2026 plan year.
Source: North Dakota CMS Medicare Plan Finder Q4 2025
Why North Dakota has no Medicare Advantage HMO plans
North Dakota is one of a small handful of states where Medicare Advantage carriers do not sell a single HMO or HMO-POS plan in 2026. Every one of the state's 21 plans is either a PPO or a Special Needs Plan. Carriers cite North Dakota's frontier population density, fewer than 11 people per square mile statewide, and the concentration of specialty care in just a few hub cities as the reason a closed-network HMO cannot meet CMS network adequacy standards across most counties.
Sanford Health, headquartered in Fargo, operates the state's only provider-led Medicare Advantage plan, sold under the Align brand as a PPO rather than an HMO, specifically so members can still see specialists in Sioux Falls, Minneapolis, or Rochester without a network exception. For North Dakota beneficiaries, the practical effect is that every Medicare Advantage plan already includes some out-of-network flexibility, which is worth remembering when comparing MA to Original Medicare plus Medigap.
Frequently Asked Questions
How many Medicare Advantage plans are available in North Dakota in 2026?
North Dakota has 21 Medicare Advantage plans available statewide in 2026, per the CMS Medicare Advantage and Part D Landscape State-by-State Fact Sheet. The exact number available to you depends on your county: Cass County (Fargo) offers 16 plans, while frontier western counties like Golden Valley County may have only 3. Run a ZIP-code search at medicare.gov to see your exact options.
What is the average Medicare Advantage premium in North Dakota for 2026?
The statewide weighted-average Medicare Advantage premium in North Dakota is $73.51 per month in 2026, the highest published average of any state, well above the national MA average of about $14. This is largely because North Dakota has zero $0-premium HMO plans; every plan is a PPO or Special Needs Plan, and PPOs generally carry higher premiums than HMOs.
When can I sign up for Medicare Advantage in North Dakota?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by events like moving, losing employer coverage, or qualifying for North Dakota Medicaid. Existing MA enrollees can switch plans during the MA Open Enrollment Period (January 1 - March 31, 2026).
Who has the best Medicare Advantage plans in North Dakota?
UnitedHealthcare leads North Dakota in Star Ratings, at 4.5 stars, and offers the broadest county-level plan availability in the state. Sanford Health Plan's Align network and Blue Cross Blue Shield of North Dakota both score around 4.0 stars and are strong choices for residents who want a provider-led or locally rooted carrier. The best plan for you depends on your doctors, your medications, and whether you prioritize a low premium or the widest PPO network.
Can I switch from Medicare Advantage back to Original Medicare in North Dakota?
Yes. You can switch back during the Annual Election Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Returning to Original Medicare does not automatically guarantee you can buy a Medigap policy, since North Dakota Medigap insurers are generally not required to sell you a plan outside your initial open enrollment window except under specific guaranteed issue rights. Check with the North Dakota Insurance Department before disenrolling.
What is the difference between an HMO and a PPO in North Dakota Medicare Advantage?
There is no difference to weigh in North Dakota, because the state has zero HMO or HMO-POS Medicare Advantage plans in 2026. All 21 of North Dakota's plans are PPOs or Special Needs Plans. PPOs let you see out-of-network providers at a higher cost share and typically do not require referrals, which gives North Dakota residents more built-in flexibility than states with a large HMO presence, at the trade-off of North Dakota's unusually high average premium of $73.51 per month.
Does Medicare Advantage cover prescription drugs in North Dakota?
Most North Dakota Medicare Advantage plans include Part D prescription drug coverage built in. These are called MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans, set by the Inflation Reduction Act signed August 16, 2022. Always check the plan's formulary to confirm your specific medications are covered, and at what tier.
Are dental, vision, and hearing covered by Medicare Advantage in North Dakota?
Most North Dakota Medicare Advantage plans include some level of dental, vision, and hearing benefits, which Original Medicare does not cover. Coverage varies: some plans cover only cleanings and exams, while others cover crowns, hearing aids, and prescription eyewear. Because North Dakota's market is PPO-only, always check whether these extras require an in-network dental or vision provider, since not every North Dakota town has one nearby.
What is a Special Needs Plan (SNP) and who qualifies in North Dakota?
A Special Needs Plan is a Medicare Advantage plan designed for a specific group: dual-eligible beneficiaries who have both Medicare and North Dakota Medicaid (D-SNP), people with certain chronic conditions like diabetes or heart failure (C-SNP), or residents of a nursing home or long-term care facility (I-SNP). North Dakota has about 6 SNPs in 2026, most of them D-SNPs, typically with $0 premiums and coordinated benefits between Medicare and Medicaid.
