Noridian Medicare Review

A long history of Medicare operations in North Dakota

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Noridian Mutual

Noridian Mutual

Our Take

Until 2019, Noridian Mutual Insurance Company was the parent company for Blue Cross Blue Shield of North Dakota (BCBSND), the largest health insurer in North Dakota. In 2019, Noridian Mutual Insurance Company became a nonprofit entity called HealthyDakota Mutual Holdings. BCBSND has a long history offering health insurance in North Dakota, though its Medicare Advantage plans are newer. 

The holding company also owns Noridian Healthcare Solutions, which has been a Medicare Administrative Contractor (MAC) for the Centers for Medicare and Medicaid Services (CMS) since 1966. In that capacity, they provide customer service, provider management, medical review, and claims processing for Medicare.

  • Pros & Cons
  • Key Takeaways
  • Company Overview
Pros & Cons
Pros
  • Near 100% provider participation

  • One of North Dakota’s leading health insurers

Cons
  • Limited Medicare Advantage options

  • Medicare Advantage plans too new to be rated

Key Takeaways
  • Leading North Dakota health insurer 
  • Vast provider network coverage
  • Two Medicare Advantage options, both PPOs
  • Prescription drug plans available through MedicareBlue Rx
  • Medicare Supplement Insurance plans available for six Medigap plan types
Company Overview

Blue Cross Blue Shield of North Dakota (BCBSND) was founded in 1940 and is one of North Dakota’s largest health insurers, with 51% of the large employer insurance market in 2018.

From 1998 to 2019, BCBSND’s parent company was Noridian Mutual Insurance Company, which became HealthyDakota Mutual Holdings, a nonprofit holding company. Another affiliate of HealthyDakota Mutual Holdings, Noridian Healthcare Solutions (Noridian), has been a Medicare Administrative Contractor (MAC) since the inception of Medicare. Based in Fargo, North Dakota, Noridian contracts with the Centers for Medicare and Medicaid Services (CMS) to provide customer service, provider management, claims processing, and medical review. 

Geographical Restrictions

BCBSND offered Medicare Advantage plans under the NextBlue of North Dakota name in five counties (Burleigh, Cass, Morton, Richland, and Stutsman).

Noridian’s administrative contracts cover a much wider geography. CMS contracts with Noridian to process Medicare Part A and B claims for Medicare in California, Nevada, Hawaii, American Samoa, Guam, and Northern Mariana Islands. Noridian’s contract, worth $525 million, was re-awarded in 2020, serves nearly 120,000 physicians and 440 hospitals. The contract covers 10% of Medicare Part A and B claims. Noridian also provides durable medical equipment (DME) administration in Jurisdictions A and D, which include 29 states, Washington, D.C., and several U.S. territories.

  • Year Founded 1940
  • Kinds of Plans Medicare Advantage PPO plans, stand-alone prescription drug plans, and Medicare Supplement Insurance (Medigap) plans
  • Number of Plans 3
  • Payment Options Per contract terms
  • Customer Service Telephone, online
  • Phone Number Prospective Members: 800-280-2583; Current Members: 844-363-8457
  • Official Website www.bcbsnd.com/members/medicare

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 offer a wider 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 too new to be rated: The Centers for Medicare and Medicaid Services rates Medicare Advantage plans on a common set of customer satisfaction and health plan quality measures. BCBSND plans, though, are too new to be rated and can’t be compared to others based on Star Ratings.
Note

Blue Cross Blue Shield of North Dakota will have access to most if not all the doctors and hospitals in North Dakota. 

Available Plans

Medicare Advantage Plans

Under the name NextBlue of North Dakota, BCBSND offers two Medicare Advantage PPO plans

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

Blue Cross Blue Shield of North Dakota goes by the name NextBlue of North Dakota for its Medicare Advantage plans.

Stand-Alone Prescription Drug Plans

Stand-Alone Prescription Drug Plans (PDP) help members pay for medicines that Medicare doesn’t cover (“the coverage gap”). They offer no other medical coverage or extra benefits, and are 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, whereas Premier is better for people who take multiple drugs including brand-names. Though both plans cover generic, brand-name, and specialty drugs at a national network of pharmacies, Standard has lower premiums but 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 varies by plan type. These plan types are standard for all carriers; the only difference between carriers is how much these 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, though 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:

   NextBlue Classic PPO  NextBlue Premium PPO
Over-the-Counter Allowance $30 per quarter $60 per quarter
Dental Two free cleanings per year plus $500 in coverage Two free cleanings per year plus $1,000 in coverage
Vision One free eye exam plus $100 allowance One free eye exam plus $200 allowance
Hearing Aids $1,000 per year per ear $1,250 per year per ear
Other None Personal Emergency Response System

Customer Service

Prospective members should 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: 844-753-8038, 8 a.m. through 8 p.m. CST, daily from October 1 through March 31, and Monday through Friday only between April 1 and September 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. 

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

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 they received more than expected. For example, a score of 2.0 conveys that the company had twice as many complaints as expected.

BCBSND received no complaints across any insurance product line in 2017 and 2018. In 2019, BCBSND received four complaints total, for a complaint index of 0.09. Of the four complaints, none was in the Medicare Supplement business line and only one was in the individual accident and health category (for 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. Under the NextBlue of North Dakota name, BCBSND’s Medicare Advantage plans are too new to be rated by CMS. 

Though BCBSND has been in business since 1940, its Medicare Advantage plans are deemed too new to be rated. This doesn't mean these plans aren’t high quality, it just means you can’t compare them to other plans that are rated. 

Cost

The 2021 prices for BCBSND Medicare Advantage PPO plans include prices for NextBlue PPOs and MedicareBlue Rx. 

NextBlue Classic PPO costs are: 

  • No monthly premiums 
  • $250 in annual prescription deductibles
  • $6,000 annual out-of-pocket maximums
  • 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:

  • $69 monthly premiums
  • $200 in annual prescription deductibles
  • $4,250 annual out-of-pocket maximums
  • 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 2021 costs for each plan include:

MedicareBlue Rx Standard PDP costs are:

  • 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:

  • 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. For a 65-year-old, non-tobacco-using female, estimated premiums range from $82.60 to $163.30 per month, depending on plan type. 

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

BCBSND is a market leader in North Dakota and partners with 99.6% of doctors and 100% of hospitals in North Dakota. Compared to one of the largest national players, Humana, who also offers options in North Dakota, BCBSND offers many fewer plan options and customer service channels. 

BCBSND may be the right choice for consumers who want a local leader instead of a national carrier; Humana wins for variety of plans and the range of services. Humana operates Medicare Advantage in six North Dakota counties, compared to BCBSND’s five. Quality is impossible to compare because BCBSND plans are not rated; however, BCBSND has exceedingly low (near non-existent) complaints against it.

    Noridian (Blue Cross Blue Shield of North Dakota)   Humana
Number of States Available 1 50
Medicare Plans 3 7
Customer Service Options Telephone, online Telephone, online, in person, chat (for members)
AM Best Rating Not rated A- (Excellent)
Average CMS Star Rating N/A 3.63
Verdict

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

How We Reviewed Medicare Providers

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.

Article Sources

Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy .
  1. CMS. “What is a MAC.” Accessed January 17, 2021.

  2. Kaiser Family Foundation. “Market Share and Enrollment of Largest Three Insurers – Large Group Market.” Accessed January 17, 2021.

  3. Becker’s Payer Issues. “The largest commercial insurers in each state.” Accessed January 17, 2021.

  4. Medicare.gov. “What's Medicare Supplement Insurance (Medigap)?” Accessed January 17, 2021. 

  5. National Association of Insurance Commissioners. “BCBS of ND National Complaint Index Report.” Accessed January 17, 2021.

  6. AM Best. “Blue Cross Blue Shield of North Dakota.” Accessed January 17, 2021.

  7. Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed January 17, 2021.

  8. Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed January 17, 2021.