NextBlue of North Dakota

Name

NextBlue of North Dakota

Legal name

NextBlue of North Dakota Insurance Company

Website

https://nextbluend.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

51–100 employees

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

MA PPO Plans (Local/Regional PPO) (HLAEACAB)

akta.pro secondary industries

MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), MA Prescription Drug Plans (MA-PD) (HLAEACAF), Medicare Dental & Vision (MA Embedded & Supplemental) (FSAIAHAJ)

Keywords

• Medicare Advantage plans
• PPO health insurance
• Medicare supplemental benefits
• Prescription drug coverage
• Retiree health benefits

Headquarters

HQ city

Fargo

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicare Advantage Plan Premiums: The company generates revenue through Medicare Advantage plan premiums paid by members, including monthly premiums for Medicare Advantage PPO plans (Discover PPO at $59/month, Summit PPO at $149/month, Freedom PPO at $0 premium), as well as Part D prescription drug coverage premiums included in MAPD plans.
2. Government Medicare Contract Reimbursements: As a Medicare Advantage plan with a Medicare contract, NextBlue receives capitated payments from the Centers for Medicare & Medicaid Services (CMS) for providing coverage to enrolled Medicare beneficiaries. The company also participates in the Medicare Star Ratings system for quality-based payments.
3. Employer Group MAPD EGWP Premiums: Revenue from employer group solutions providing Medicare Advantage with Prescription Drug Employer Group Waiver Plans (MAPD EGWP) for Medicare-eligible retirees, with premiums funded through group arrangements.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

NextBlue of North Dakota is a private Medicare Advantage PPO health insurance carrier that sells three individual Medicare Advantage plans (Discover PPO, Summit PPO, Freedom PPO) to Medicare-eligible North Dakota residents statewide, combining Medicare Parts A and B with optional Part D prescription drug coverage, supplemental dental/vision/hearing Flex Card allowances, telehealth, PERS, fitness and OTC benefits. The company also offers a Medicare Advantage with Prescription Drug Employer Group Waiver Plan (MAPD EGWP) for employers funding retiree health benefits.

Product overview

NextBlue of North Dakota is a Medicare Advantage PPO plan provider offering three distinct 2026 plan tiers: Discover PPO (affordable with Part D coverage), Summit PPO (premium with lowest out-of-pocket costs), and Freedom PPO (medical-only for those with existing drug coverage). The plans are built on a unified platform providing hospital and medical care, with supplemental benefits delivered through a Flex Card system for dental, vision, and hearing. Additional value-added services include Virtual Care (Teladoc Health telehealth), Live Healthy Blue Rewards, Over-the-Counter drug benefits, Personal Emergency Response Systems, and a 24-hour nurse line. All plans leverage the Blue Cross Blue Shield national network for in-network care access throughout North Dakota and nationwide.

Differentiator

Problem solved

Functional benefit

Brands

• Discover PPO: Affordable Medicare Advantage plan with medical, prescription drug, telehealth and extra benefits, with $59 premium, $200 medical deductible, and $500 Supplemental Benefits Flex card.
• Summit PPO
• Freedom PPO

Products and services

• NextBlue Discover PPO Affordable Medicare Advantage PPO plan combining Medicare Parts A and B with Part D prescription drug coverage, telehealth, and supplemental benefits (including a $500 Flex Card for dental, eyewear, and hearing). Designed for Medicare-eligible North Dakota residents seeking all-in-one coverage beyond Original Medicare.
• NextBlue Summit PPO Premium Medicare Advantage PPO plan offering the lowest out-of-pocket costs and highest supplemental benefit allowance ($650 Flex Card) for dental, vision, and hearing, plus a Personal Emergency Response System (PERS) device. Includes Part D prescription drug coverage and is targeted at Medicare-eligible North Dakota residents wanting maximum benefits and lower cost-sharing.
• NextBlue Freedom PPO $0 premium Medicare Advantage PPO medical-only plan (no Part D coverage) designed for North Dakota beneficiaries who already have creditable drug coverage through the VA or TRICARE. Includes a Flex Card for dental/eyewear/hearing, $100 annual fitness allowance, $50 quarterly OTC allowance, and a Personal Emergency Response System.
• MAPD EGWP Employer Group Retiree Solution Medicare Advantage with Prescription Drug Employer Group Waiver Plan (MAPD EGWP) sold directly to North Dakota employers to fund retiree health benefits for their Medicare-eligible former employees, providing comprehensive medical and Part D prescription drug coverage with group-level pricing.

Quantifiable outcome

• Available in all 53 North Dakota counties including rural and underserved areas
• +2 more outcomes

Named customers3 records

Segments5 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

Feature3 records

Partnerships

Eleven partnerships are on record, tiered core and standard.

• Blue Cross Blue Shield of North Dakota (BCBSND)coreStrategic or Co-development PartnerNextBlue of North Dakota is an affiliate of Blue Cross Blue Shield of North Dakota, created in partnership with BCBSND. BCBSND is an independent licensee of the Blue Cross Blue Shield Association serving residents and businesses in North Dakota for over 80 years. NextBlue leverages the trusted Blue brand and provides access to the national Blue Cross Blue Shield network.
• Teladoc HealthcoreTechnology or IntegrationTeladoc Health provides virtual care services for NextBlue members, offering 24/7 access to board-certified doctors and mental health providers via smartphone, tablet, or computer. Members can access Teladoc through the mobile app or through their Blue Cross member account. Average wait time is 10 minutes or less.
• Arkos HealthcoreStrategic or Co-development PartnerArkos Health provides Mobile Outreach Services throughout North Dakota to enhance care coordination and support for NextBlue members who may need assistance with their healthcare needs. Mobile Outreach Services provide a safe and private place for members to get connected with local resources.
• NationsOTCstandardTechnology or IntegrationNationsOTC provides the Over-The-Counter (OTC) benefit program for Freedom PPO members, allowing them to order medications, health and wellness items, and first aid supplies with home delivery at no additional cost. Orders can be placed online, over the phone, or through mail order with 2-day shipping guaranteed.
• NationsHearingstandardTechnology or IntegrationNationsHearing provides hearing benefits and claims administration on behalf of NextBlue of North Dakota. The partnership includes one no-cost routine hearing exam per year through in-network providers. Contact: 1-877-617-6863 TTY: 711.
• Vision Service Plan (VSP)standardTechnology or IntegrationVision Service Plan (VSP) provides vision benefits and claims administration for NextBlue members. This includes one no-cost routine vision exam per year, with a 50% coinsurance applying to out-of-network provider visits. Contact: 1-855-492-9028.
• OptumRxcoreTechnology or IntegrationOptumRx serves as the Pharmacy Benefit Manager for NextBlue of North Dakota PPO, handling prescription drug coverage administration, prior authorizations, coverage determinations, appeals, and the Medicare Prescription Payment Plan (MPPP). Contact: 1-855-812-4306 for pharmacy services.
• Connect AmericastandardTechnology or IntegrationConnect America provides the Personal Emergency Response System (PERS) device for Summit PPO and Freedom PPO members. The device includes two-way connectivity to live agents, around-the-clock monitoring, and GPS location capabilities. Members who discontinue coverage can pay monthly costs directly to maintain the service.
• AvailitystandardTechnology or IntegrationAvaility provides the secure provider portal for NextBlue, giving healthcare providers access to tools for checking member eligibility, claims status, and payment policies. Providers can register for the Availity Essentials portal at availity.com/provider-portal-registration.
• HealthXstandardTechnology or IntegrationHealthX provides the secure member portal for NextBlue members, allowing access to view recent claims, digital ID cards, Live Healthy Blue rewards, and plan documents. Members can access the portal at secure.healthx.com.
• InterQualstandardTechnology or IntegrationInterQual provides the nationally recognized medical necessity criteria used by NextBlue for inpatient and post acute care prior authorization requests. The platform is accessed through prod.ds.interqual.com for clinical decision support.

Scale indicators3 records

Broad incumbents

• Humana: Second-largest US Medicare Advantage insurer with significant North Dakota PPO presence. Comparable because of its MA-focused model, agent-driven distribution, and supplemental benefits emphasis that mirror NextBlue's positioning.
• Aetna (CVS Health): National MA carrier offering PPO plans in North Dakota, with integrated PBM and retail pharmacy assets via CVS. Competes with NextBlue on supplemental benefits breadth and provider network scale.
• UnitedHealthcare (AARP Medicare Advantage): Largest US Medicare Advantage carrier with broad PPO and HMO offerings in North Dakota. Competes with NextBlue on plan design, supplemental benefits, and agent distribution, but at far greater scale and with national brand power.

Emerging players

• Devoted Health: Tech-enabled Medicare Advantage plan focused on senior care with rich supplemental benefits and a strong member experience orientation. Comparable as a smaller, growth-stage MA carrier competing on differentiated benefits and service rather than scale.
• Alignment Health: Tech-forward Medicare Advantage plan emphasizing supplemental benefits, concierge service, and member portals. Comparable to NextBlue in competing on supplemental benefits and care-coordination tech rather than scale advantages.
• Essence Healthcare: Regional Medicare Advantage insurer focused on smaller markets with HMO/PPO plans emphasizing provider-network partnerships and supplemental benefits. Comparable to NextBlue as a regionally anchored MA plan competing outside the largest MSAs.

Regional players

• Sanford Health Plan: Provider-sponsored health plan with significant North Dakota and South Dakota presence, offering Medicare Advantage products in the same geography. Compares to NextBlue as a regional integrated plan with strong local provider alignment.

Direct peers

• Blue Cross Blue Shield of Minnesota: Sister Blue Cross Blue Shield plan offering Medicare Advantage products to a similar Upper Midwest demographic. Comparable as a regional Blues MA plan operating in a comparable rural/mid-population geography under the same national Blue association.
• Medica: Regional nonprofit health plan offering Medicare Advantage plans across the Upper Midwest, including border counties near North Dakota. Comparable as a smaller, regionally focused MA carrier competing in rural and mid-population markets.
• Blue Cross Blue Shield of North Dakota: Parent affiliate and most direct peer — operates commercial and other health plan products in North Dakota, shares brand and infrastructure with NextBlue, and serves overlapping Medicare-eligible customers across the same 53-county geography.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/NextBlueND
• Facebookfacebook.com/nextbluend
• LinkedInlinkedin.com/company/nextbluend

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about NextBlue of North Dakota