Medicare 2026: What they mean for North Dakotans

2026 Medicare Changes: What They Mean for North Dakotans

Medicare changes at the national level often ripple differently in each state, depending on local insurers, provider networks, and state-level Medicaid policies. For North Dakota, 2026 will bring both opportunities and adjustments. Here's a guide to what residents should watch and prepare for.

1. Local Medicare Advantage Plan Restructuring in ND

One of the most concrete state-level updates is from NextBlue of North Dakota, a local insurer offering Medicare Advantage plans:

• NextBlue is introducing two new plans for 2026: Discover PPO and Summit PPO.
• Their existing Freedom PPO plan will be renewed for 2026.
• Their current Classic PPO and Premium PPO plans will be discontinued as of December 31, 2025.
• All 2026 NextBlue plans will offer extra benefits beyond Original Medicare, such as a “flex card” that can be used for dental, eyewear, and hearing items.

So, if you're in North Dakota and currently on a NextBlue Advantage plan, you’ll want to review the plan changes and see whether the new or renewed ones better meet your needs.

Also, North Dakota’s Medicare Advantage market is still active; the state’s Insurance Department offers information on Advantage plans contracting with CMS.

2. Dual-Eligible & SNP Plans

In North Dakota, there is at least one Dual Complete PPO D-SNP (Dual Eligible Special Needs Plan) for 2026. This kind of plan is tailored to people who qualify both for Medicare and Medicaid.

For beneficiaries who are dual-eligible, changes in how D-SNPs are regulated nationally (eligibility, benefits) could mean you’ll want to double-check whether your plan will stay the same, or whether changes to coverage or premiums will occur.

3. Medicaid Expansion & Eligibility Shifts

While Medicare is for 65+ (or certain disabilities), changes in Medicaid can affect those who are dual-eligible, or those on the cusp of qualifying for assistance.

• North Dakota is expanding Medicaid eligibility starting in 2026, meaning more individuals will be eligible for coverage through Medicaid.
• The state explicitly notes that “some people’s Medicaid eligibility will change” starting in 2026, and encourages residents to check the “Stay Enrolled” page for updates.
• Additionally, new Medicaid work requirements may come into effect by the end of 2026. However, exemptions and details are not fully finalized.
• It is estimated state officials expect only about 5% of North Dakota Medicaid recipients to be impacted by these eligibility changes.

These transitions could affect dual-eligible individuals (Medicare + Medicaid), especially if Medicaid eligibility changes or coverage alters what cost-sharing or premiums they pay.

4. National Medicare Changes Still Matter (Especially in ND)

Many of the national changes for 2026 will affect North Dakotans in similar ways to the rest of the country. Below is a quick refresher with implications for this state.

ChangeWhat It Means for ND BeneficiariesHigher cost thresholds for Part D / out-of-pocket cap increasesThe out-of-pocket cap for prescription drugs under Part D rises to $2,100 in 2026.Part B / Part A / deductible increasesPremiums, deductibles, and co-insurance under Parts A and B will likely go up (as is typical). Beneficiaries should check their plans carefully. (National guidance)Full implementation of updated risk adjustment model for MAIn 2026, CMS plans to apply 100% of the 2024 CMS-HCC risk adjustment model in Medicare Advantage payments. This may shift how plans price and structure benefits in North Dakota.Notices, timelines, and plan comparisons• “2026 Medicare & You” handbook will be mailed to all beneficiaries. 
• Starting October 1, 2025, you can shop and compare plans on Medicare.gov. 
• Plan notices informing enrollees of changes must be sent in advance. 
• Open Enrollment (Annual Election Period) runs from October 15 to December 7, 2025.

Because of these national shifts, a North Dakota beneficiary comparing MA plans in 2026 must keep an eye on both the local plan changes (like NextBlue) and how national policy influences pricing and benefits.

5. What North Dakotans Should Do Now

To be prepared for 2026 changes in North Dakota, here are practical steps you or your audience can take:

1. Review your current plan notice: The “Annual Notice of Change” (if on Advantage or Part D) will show what changes are coming for 2026.
2. Compare new vs old plans: Especially for NextBlue enrollees, check how the new Discover and Summit PPO plans compare to your current one (benefits, premiums, provider networks).
3. Check Dual / SNP eligibility: If you're dual-eligible, verify whether your D-SNP plan is continuing, or how coverage might shift.
4. Stay informed on Medicaid eligibility: If you or someone you assist straddles the line between Medicare and Medicaid, check eligibility changes on the ND Medicaid “Stay Enrolled” page.
5. Watch your mail & Medicare.gov next fall: Be on the lookout for the “Medicare & You” handbook, plan change notices, and the plan comparison tool going live October 1, 2025.
6. Ask providers about prior authorization: In states where pilot prior authorization is required under Original Medicare, ask whether the services you anticipate might need approval in advance (especially for specialty procedures).
7. Consider plan stability in rural areas: Because rural areas often have fewer providers or insurers, be especially careful about changes to networks or plan exits.

We are here to help, please contact us at 701-757-1613 to set up an appointment to see what plan is best for you.