North Dakota may not be among the most populous U.S. states, but as a resident you still have a variety of options when it comes to choosing health insurance, whether you’re an individual, a small business owner or looking for coverage for your family.
You can get insurance through your job, buy an individual plan privately or through the Affordable Care Act (ACA) Health Insurance Marketplace, or you may be eligible for coverage through Medicare, Medicaid and/or North Dakota’s Children’s Health Insurance Program (CHIP).
Despite the implementation of the ACA (aka Obamacare) and its expansion of Medicare to cover more people, the number of uninsured North Dakota residents only dropped by about one thousand from 2014 to 2018. The percentage of uninsured people among the state’s 760,000 residents has held steady at 8%.1
Here are answers to some questions you might ask as you’re trying to decide on health insurance as a North Dakota resident.
When Is North Dakota’s Open Enrollment Period?
The state’s Open Enrollment Period (OEP) takes place from November 1 to December 15. If you’re already enrolled through the Health Insurance Marketplace and don’t choose a plan for the following year, you will be re-enrolled in the same or similar plan, but may face higher costs. If you’re enrolling through the Marketplace, keep in mind that you will also need to re-enroll each year to avoid the possible loss of coverage.2
Insurance companies and brokers can help you find a plan that’s right for you. But you should know that you’ll need to buy your ACA policy directly from the Marketplace (which in North Dakota means going through healthcare.gov) to qualify for help in paying for your insurance. If you’re eligible for subsidies (also called premium tax credits) based on your income, you’ll get help paying your monthly premium.3 In 2020, almost 22,000 North Dakotans enrolled in an ACA policy, similar to the number in 2019.4
If you miss the OEP, you might qualify for what’s called a Special Enrollment Period (SEP). This lets you sign up for health insurance at any time of the year. Events that qualify you for a SEP include losing your job, having or adopting a baby and getting married. You have 60 days from the date of the event to apply for a health plan.5
How Do I Enroll in the North Dakota Health Insurance Marketplace?
As mentioned above, you can enroll in ACA health coverage directly through the North Dakota Health Insurance Marketplace at the federal government’s healthcare.gov website.
The Marketplace offers ”metal” plans in bronze, silver and gold (the more valuable the metal, the more coverage you get and the higher the cost of the plan). All metal plans include what are called “essential health benefits,” as required by the ACA. Catastrophic (high-deductible) plans are also available for people up to age 30 and those with hardship exemptions.6
How Much Does North Dakota Individual Health Insurance Cost?
In fall 2019, North Dakota’s Insurance Commissioner passed a state-based reinsurance program, which resulted in a 20% decrease in 2020 rates on North Dakota’s individual health insurance market.7
Whether you choose a plan within or outside the Marketplace, all are organized by the “metal” tiers of gold, silver and bronze mentioned above. The lowest-cost silver plan, called the “benchmark,” is the baseline plan used to calculate your state’s cost assistance when you buy through the Marketplace. In North Dakota, that plan costs $383 a month for 2020, down from $457 in 2019 and slightly up from $377 in 2018.8
These are the average monthly premiums for health insurance plans in 2020 for a 40-year-old resident of North Dakota:9
- $273 for the lowest-cost bronze plan
- $372 for the lowest-cost silver plan
- $409 for the lowest-cost gold plan
Remember: These are the costs before any savings you might be eligible for based on your family size and household income. Your monthly premium could be much less if you qualify for an ACA subsidy.
How much you pay also depends on the type of plan you choose. For instance, bronze-level coverage typically has the cheapest monthly premiums but the highest out-of-pocket costs.
Which Companies Offer Individual Health Insurance Plans in North Dakota?
You can choose among three health insurance companies for 2020 individual and family plans on the Marketplace (through www.healthcare.gov) and off the Marketplace (through a licensed and appointed agent):10
- Blue Cross and Blue Shield of North Dakota (Noridian)
What Are My Coverage Options If I’m Low-Income and Live in North Dakota?
ACA Marketplace Plans (Obamacare)
When you fill out the application at North Dakota’s Health Insurance Marketplace (via healthcare.gov), you can see what savings you might qualify for. You could save money on the monthly premiums you pay for your Marketplace plan and/or you could qualify for coverage through Medicaid and/or the Children’s Health Insurance Program (CHIP).11
Remember: You can only qualify for premium tax credits (subsidies) on ACA plans purchased through the Marketplace. And your household income must be between one and four times the federal poverty level (FPL).12 That means, for example, that a family of three’s household income would have to be between $21,720 and $86,880 in 2020 to qualify for North Dakota subsidy assistance.13
In 2019, almost nine out of 10 of the 22,000 North Dakotans enrolled through the Marketplace received this help.14
Cost-sharing reductions (CSRs) are another way you can save money on premiums. They go to pay for copayments (a pre-set amount you pay for certain medical services), prescription drugs and other out-of-pocket expenses, but they only apply to silver plans you buy through the ACA Marketplace. Generally, you must earn between 100% and 250% of the FPL to qualify for CSRs.15
Check a 2020 subsidy chart and calculator to see which subsidies you might qualify for.
More than 90,000 North Dakotans are enrolled in the state’s Medicaid program as of April 2020.16To qualify, besides annual household income limits, you must also be either responsible for children under 21 years of age, be pregnant, have a household member with a disability, or be 65 or older.17
In 2013, North Dakota expanded access to Medicaid to cover more residents, adding people between ages 19 and 64 with a household income of up to 138% of the federal poverty level.18 Since then, nearly 21,000 more people have been added to the state’s expanded Medicaid rolls.19
If you’re eligible, your coverage through Medicaid expansion will come from Sanford Health Plan and its provider network. Full details are explained under “Who is eligible?” at the state government’s website. If you have more questions, contact your county’s Human Service Zone office.
Children’s Health Insurance Program (CHIP): Healthy Steps
Your family may earn too much money to qualify for Medicaid. But if it’s not more than 175% of the federal poverty level and you have uninsured children who are 18 or younger, they may qualify for low-cost comprehensive insurance through CHIP. (Having Indian Health Services healthcare is not considered insurance coverage, so it does not disqualify you from accessing CHIP.)21
How Do I Apply for Help Paying for My Health Insurance in North Dakota?
Your eligibility for financial assistance for a Marketplace plan will be determined as you go through the application process at healthcare.gov. Through the same application you can determine if you’re eligible for Medicaid and CHIP, too. (You can enroll in Medicaid or CHIP at any time, by the way.)
The local office for your county (called a Human Service Zone) can be found through this locator map.
Here are three ways to apply for North Dakota’s Medicaid program:22
- Online: Complete and submit an Application for Assistance. It will be directed automatically to the right social service office in your county.
- In Person: Complete one these forms and return it to a Human Service Zone office: If you’re under age 65 and not disabled, complete the Application for Health Care Coverage and Help Paying Costs form. If you’re 65 or over, blind or disabled, complete the Health Care Application for the Elderly and Disabled form.
- By Mail: Contact a Human Service Zone office and request an application by mail.
What About Medicare for North Dakota Seniors and People With Disabilities?
Medicare is a federal health insurance program that covers most seniors age 65 and over and younger adults with disabilities. As of 2018, more than 130,000 North Dakotans — or one-fifth of the population — had Medicare Part A (hospital insurance) and Part B (medical insurance).23
More than eight in 10 Medicare enrollees get their Part A and Part B coverage through the federal government’s Original Medicare program; the rest get these benefits through private Medicare Advantage (Part C) plans.24 Part C plans bundle in other benefits, including Part D prescription drug coverage.
If you get your Part A and Part B coverage through Original Medicare, you may also want to buy an individual Part D prescription drug plan from a private insurer. (Medicare doesn’t include coverage for medications.) In 2018, more than 84,000 North Dakota residents had a standalone Part D drug plan.25
Original Medicare only covers about 80% of approved costs. If you choose coverage through Original Medicare, you can add a Medicare Supplement Insurance plan (also called a Medigap policy) to help pick up those other costs.26
Like most states, North Dakota offers 10 standardized Medigap plans that help pay some to all of your uncovered, out-of-pocket costs. These include copayments, coinsurance and deductibles.
The federal government sets the benefits for each standardized plan. That makes the basic benefit structure for each type of plan the same no matter where you buy it. But since the insurance company can charge what it wants for its policies, premiums can vary depending on the insurer you buy it from.
Any questions you have about Medicare can be answered by the State Health Insurance Counseling (SHIC program) by calling (888) 575-6611.
What Are My Coverage Options if I’m a Native American?
If you’re a Native American living in North Dakota, eligible for healthcare through the Indian Health Service (IHS) and meet the financial requirements, you’re also eligible for Medicaid and CHIP programs.
Native Americans who are eligible include: those who are under 21; pregnant women; women with breast or cervical cancer; people who are blind or disabled; residents who are 65 or older; and those who are part of a family with children.27
If you enroll in health coverage through the Marketplace, Medicaid or CHIP, you have better access to services that may not be provided by the Indian Health Service, tribal programs or urban Indian programs. Your costs may be lower, too, and you could have more flexible eligibility rules (like being able to enroll any time of year and change plans monthly), and you won’t give up your IHS benefits.28 For more information, visit healthcare.gov.
Can I Buy Short-Term Insurance in North Dakota?
North Dakota does allow short-term plans with an initial term limit of 185 days and a maximum duration of 12 months.29 Once you have a policy, your insurer cannot refuse your one allowable renewal because of any medical condition.30
Be aware that short-term health insurance is not the same as comprehensive major medical coverage, and it doesn’t need to comply with protections that are part of all Obamacare plans (what’s called “minimum essential coverage”).
In North Dakota, the law requires that you buy temporary health coverage only through a company that has been approved by the state’s Insurance Department to sell that product.
1. Kaiser Family Foundation. “Health Insurance Coverage of the Total Population.” kff.org (accessed July 17, 2020).
2. North Dakota Insurance Department. “Godfread Announces Decrease of 20 Percent on Average in Individual Health Insurance Rates with Reinsurance Program.” insurance.nd.gov (accessed July 17, 2020).
4. Centers for Medicare and Medicaid Services. “2020 Marketplace Open Enrollment Period Public Use Files.” cms.gov (accessed July 17, 2020).
5. U.S. Government Website for the Federal Health Insurance Marketplace. “Getting health coverage outside Open Enrollment.” healthcare.gov (accessed July 17, 2020).
6. U.S. Government Website for the Federal Health Insurance Marketplace. “Catastrophic health plans for people with hardship exemptions.” healthcare.gov (accessed July 17, 2020).
8. Kaiser Family Foundation. “Marketplace Average Benchmark Premiums.” kff.org (accessed July 17, 2020).
9. Kaiser Family Foundation. “Average Marketplace Premiums by Metal Tier, 2018-2020.” kff.org (accessed July 17, 2020).
11. U.S. Department of Health and Human Services. “Health Insurance Marketplace.” benefits.gov (accessed July 17, 2020).
12. Centers for Medicare & Medicaid Services. “APTC and CSR Basics.” cms.gov (accessed July 17, 2020).
13. “APTC and CRS Basics.”
14. Kaiser Family Foundation. “State Health Care Snapshots: North Dakota.” kff.org (accessed July 17, 2020).
15. U.S. Government Website for the Federal Health Insurance Marketplace. “Cost Sharing Reduction (CSR).” healthcare.gov (accessed July 17, 2020).
16. U.S. Government Website for Medicaid. “April 2020 Medicaid & CHIP Enrollment Data Highlights.” medicaid.gov (accessed July 17, 2020).
17. U.S. Department of Health and Human Services. “North Dakota Medicaid Program.” benefits.gov (accessed July 17, 2020).
18. North Dakota Human Services. “Medicaid Expansion.” nd.gov (accessed July 17, 2020).
19. Kaiser Family Foundation. “Medicaid in North Dakota.” kff.org (accessed July 17, 2020).
21. North Dakota Human Services. “North Dakota Medicaid and Children’s Health Insurance Program.” nd.gov (accessed July 17, 2020).
22. North Dakota Human Services. “Apply for Medicaid.” nd.gov (accessed July 17, 2020).
23. Kaiser Family Foundation. “Total Number of Medicare Beneficiaries.” kff.org (accessed July 17, 2020).
25. Kaiser Family Foundation. “Medicare Prescription Drug Plans: Stand Alone PDP Enrollment.” kff.org (accessed July 17, 2020).
26. North Dakota Insurance Department. “Medicare Supplement.” insurance.nd.gov (accessed July 17, 2020).
28. U.S. Government Website for the Federal Health Insurance Marketplace. “Health coverage for American Indians & Alaska Natives.” healthcare.gov (accessed July 21, 2020).
29. N.D.C.C. section 26.1-36.4-02. Statecodesfiles.justia.com. Retrieved July 17, 2020, from https://statecodesfiles.justia.com/north-dakota/2013/title-26.1/chapter-26.1-36.4/chapter-26.1-36.4.pdf
30. Bulletin 2018-2 Rules and regulations for offering short-term, limited duration insurance policies in North Dakota. (Sep. 2018). Nd.gov. Retrieved July 17, 2020, from https://www.nd.gov/ndins/sites/www/files/documents/Bulletins/2018/20180919%20Bulletin%202018-2.pdf