Noridian Medicare Review 2023

Pros Explained

• Near 100% provider participation: BCBSND contracts with 99.6% of doctors and 100% of hospitals across North Dakota.
• One of North Dakota’s leading health insurers: Founded in 1940, BCBSND dominates the North Dakota market, with 51% of the employer insurance market.

Cons Explained

• Limited Medicare Advantage options: BCBSND, through its NextBlue of North Dakota brand, offers just two PPO types; many Medicare Advantage carriers provide a more comprehensive range of plan types, including HMO plans which tend to be lower cost, and Special Needs Plans for members who qualify for both Medicaid and Medicare.
• Medicare Advantage plans not rated: The Centers for Medicare and Medicaid Services rates Medicare Advantage plans on a standard set of customer satisfaction and health plan quality measures. BCBSND plans are not rated and can’t be compared to others based on Star Ratings.

Available Plans

BCBSND offers numerous types of plans and coverages.

Medicare Advantage Plans

BCBSND offers two Medicare Advantage PPO plans under the name of NextBlue of North Dakota: 

• NextBlue Classic PPO: This is a $0 premium plan with extra benefits and national coverage for members who travel.
• NextBlue Premium PPO: This plan provides prescription drug coverage with extra benefits such as hearing, vision, and dental coverage.

Stand-Alone Prescription Drug Plans

Stand-alone Prescription Drug Plans (PDPs) help members pay for medicines that Medicare doesn’t cover. This is commonly referred to as “the coverage gap." These plans offer no other medical coverage or extra benefits. They're paired with Original Medicare Parts A and B and Medicare Supplement Insurance (Medigap) plans.

BCBSND members can get MedicareBlue Rx PDPs with two options: Standard and Premier. Standard plans are designed for members who mostly take generic drugs. Premier is better for those who take multiple medications, including brand names.

Both plans cover generic, brand name, and specialty drugs at a national network of pharmacies. Standard has lower premiums but it does have a deductible. Premier has higher premiums and no deductible, making it likely to be the better choice for people who take more prescriptions. Preferred pharmacies typically carry lower copayments and include chains such as Walmart, CVS, and Thrifty White Pharmacy. Members can get mail order prescriptions through CVS Caremark.

Medicare Supplement Insurance (Medigap) Plans

Medicare Supplement plans, also known as Medigap, offer standard benefits to supplement Original Medicare. These plans cover some of the costs that Original Medicare covers, but which costs and how much they cover tend to vary by plan type. These plan types are standard for all carriers. The only difference between carriers is how much the plans cost and whether the insurer offers any extra benefits or coverage.

BCBSND offers six Medicare Supplement Plan types, including A, G, C, F, L, and N. Plan A offers the least coverage and Plan F offers the most, but it’s only available to people who were eligible for Medicare before the end of 2019. All Medigap plan benefits are the same no matter the insurer, but costs and any additional benefits can vary. 

Extra Benefits

BCBSND Medicare Advantage plans offer extra benefits, including over-the-counter allowances, dental benefits, eye exams and vision benefits, hearing aids, and fitness benefits. The two PPO plans offer different levels of extra benefits.

Customer Service

Prospective members can call 800-241-2567 daily between 8 a.m. and 8 p.m. CST. 

NextBlue of North Dakota, BCBSND's Medicare Advantage plan, has different numbers. Prospective and current members can call 844-753-8038, 8 a.m. through 8 p.m. CT daily from Oct. 1 through March 31. This line is only available Monday through Friday between April 1 and Sept. 30.

Current members can send correspondence to the plan at P.O. Box 2600438, Plano, TX 75026. Nurse, pharmacy, and telehealth support is available for members 24 hours a day, seven days a week. 

Call 800-280-2583 to speak with an agent Monday through Friday between 8:30 a.m. and 4:30 p.m. CT for Medicare Supplement Insurance (Medigap) plans.

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) tracks complaints against insurers of all types, including health insurers. The index uses the company’s share of complaints divided by its share of premiums in the market. A score of less than 1.0 means the insurer received fewer than expected complaints. A score of greater than 1.0 means it received more than expected. A score of 2.0 would indicate that the company had twice as many complaints as expected.

BCBSND received no complaints across any insurance product line in 2018 and 2020. It received four complaints total in 2019 for a complaint index of 0.08. Of the four complaints, none was in the Medicare Supplement business line, and only one was in the individual accident and health category resulting in a complaint index of 0.03. The rest were in categories that would not include Medicare enrollees.

Third-Party Ratings

AM Best

AM Best, the credit rating agency that assesses insurance companies’ financial strength, has not rated BCBSND or Noridian Mutual Group.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage and Prescription Drug Plans on a five-star quality rating system. The Star Ratings reflect member satisfaction generally and how easy it is for members to access the care they need. BCBSND’s Medicare Advantage plans do not appear to be rated by CMS under the NextBlue of North Dakota name. 

Cost

The 2022 prices for BCBSND Medicare Advantage PPO plans include prices for NextBlue PPOs and MedicareBlue Rx.

NextBlue Classic PPO costs are as follows: 

• No monthly premiums 
• $250 in annual prescription deductibles
• $6,000 annual out-of-pocket maximum
• Other out-of-pocket costs include:
• $20 copayments on primary care visits
• $40 copayments on specialty visits
• Telehealth visits starting at $0 copayments
• Prescription drug copayments start at $2

NextBlue Premium PPO costs are as follows:

• $69 monthly premiums
• $200 in annual prescription deductibles
• $4,250 annual out-of-pocket maximum
• Other out-of-pocket costs include:
• $0 copayments on primary care visits
• $25 copayments on specialty visits
• Telehealth visits starting at $0 copayments
• Prescription drug copayments start at $0

BCBSND members who opt for a stand-alone prescription drug plan (PDP) can access MedicareBlue Rx. The 2022 costs for each of these plans include:

MedicareBlue Rx Standard PDP costs are as follows:

• Monthly premium: $66.40
• Annual deductible: $0 on Tier 1 and 2 drugs, $445 on Tiers 3, 4, and 5 drugs
• Copayments: Between $1 and $29 on Tiers 1 through 3 with preferred pricing and between $10 and $46 with standard pricing
• Coinsurance: Applies to Tiers 4 (31% with preferred and 36% with standard pricing) and 5 (25%)

MedicareBlue Rx Premier PDP costs are as follows:

• Monthly premium: $104.70
• Annual deductible: $0 on all drug tiers 
• Copayments: $0 on Tiers 1 and 2 with preferred pricing, or $15 on Tier 1 and $20 on Tier 2 with standard pricing
• Coinsurance: Applies to Tiers 3, 4, and 5 (between 17% and 45%, depending on the drug tier and whether there is preferred or standard pricing)

Costs for Medicare Supplement Insurance (Medigap) Plans vary depending on age, gender, and other factors, including tobacco use. Estimated premiums range from $82.60 to $166.30 per month, depending on plan type, for a 65-year-old, non-tobacco-using female.

Competition: Blue Cross Blue Shield of North Dakota vs. Humana

BCBSND is a market leader in North Dakota. It partners with 99.6% of doctors and 100% of hospitals in North Dakota. But it offers many fewer plan options and customer service channels compared to one of the largest national players, Humana. BCBSND may be the right choice for consumers who want a local leader instead of a national carrier.

Humana wins for its variety of plans and services. It operates Medicare Advantage in six North Dakota counties compared to BCBSND’s five. Quality is impossible to compare because BCBSND plans aren't rated, but BCBSND has exceedingly low and nearly non-existent complaints against it.

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Final Verdict

BCBSND has stood the test of time, operating in North Dakota since 1940. It has nearly universal provider participation across North Dakota, and it covers the basics for Medicare options. BCBSND won’t have what you want if you need more options, such as Medicare Advantage HMOs or Special Needs Plans. But BCBSND is a solid choice for a tried and true local plan with deep experience in Medicare operations.

Frequently Asked Questions (FAQs)

What does Noridian do for Medicare?

Noridian is a Medicare Administrative Contractor (MAC). As such, it provides customer service as well as provider management, medical review, and claims processing.

What jurisdiction is Noridian Medicare?

Noridian Healthcare Solutions Noridian is another affiliate of HealthyDakota Mutual Holdings and it has been a Medicare Administrative Contractor (MAC) for Jurisdictions E and F since 1966.

Jurisdiction E serves Part A and Part B Medicare providers California, Hawaii and Nevada, as well as Guam, American Samoa and the Northern Mariana Islands. Jurisdiction F covers Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.

Does Noridian Medicare accept paper claims?

Noridian indicates that electronic filings are mandatory, but the company does provide for some exceptions. These include small providers with fewer than ten full-time employees, home oxygen therapy claims, and providers that submit roster claims, among other circumstances. One of these other exceptions is for "usual circumstances."

How do you look up eligibility on Noridian Medicare?

Visit the Noridian Medicare Portal and go to the main menu. Click on the Eligibility tab and enter the required information, including your Medicare number, last name, and either your first name or date of birth. Your first and last name must match what appears on your Medicare card.

Methodology

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners complaint index and AM Best financial stability ratings. We also considered information from the companies on their programs and strategies.