North Dakota has many affordable health insurance solutions to protect your health and finances, including employer-sponsored health plans, Medicare, and Medicaid. The state coordinates with the Health Insurance Marketplace to provide affordable individual and family health insurance and funds several low-income assistance plans.

This guide explains your North Dakota affordable health insurance options in detail.

What to know about insurance in North Dakota

  • Open enrollment: The enrollment period for 2022 health insurance in North Dakota runs from November 1 through January 15, 2022.
  • Special enrollment: Changes to your family or residency status may permit you to modify plans at other times of the year. Some examples include the death of a plan-covered family member, birth or adoption of a child, marriage, divorce, or a move. In addition, if you lose health insurance coverage due to ineligibility or loss of a job, you may qualify for a special enrollment period.
  • Marketplace plans: North Dakota partners with the Health Insurance Marketplace to offer residents affordable health care. On the website, you can view and compare plans available in your zip code.
  • Direct enrollment: You can purchase a health insurance plan directly from an insurance carrier. If you choose this route, make sure to compare more than one company.
  • Coverage types: Most North Dakotans, over 55%, belong to an employer-sponsored health plan. The remaining residents’ insurance status is as follows: Medicare 13.8%, Medicaid 12.2%, non-group 9.0%, uninsured 7.4%, and military 2.1%.

How do I enroll in the North Dakota health insurance marketplace?

Most states, including North Dakota, use HealthCare.gov to help you find, compare, select, and enroll you in affordable health insurance plans. After you’ve created an account on the website, you’ll answer questions to verify your identity based on your credit record.

You can browse plans without creating an account, but you must log in to enroll. The website tool requires basic information about you before it can provide plans that fit your circumstances, including:

  • Age
  • Gender
  • Family situations, such as legal guardians, pregnancy, etc.
  • Medicaid or Medicare eligibility status
  • Income
  • Tobacco use

Based on your answers, the Health Insurance Marketplace will indicate if you qualify for tax premium credits. Some of the questions are optional, but the more information you provide, the better your chances of finding a suitable plan. You can even filter by options like premium, deductible, and plan type, and sort based on the lowest premium or lowest deductible.

Some of the insurers managing health plans for North Dakota include:

  • Blue Cross Blue Shield of North Dakota
  • Medica
  • Sanford Health Plan

How do I enroll in North Dakota individual and family insurance?

Premiums vary based on age and the number of people insured. For example, the rate for a single young adult will be considerably different from the rate for a couple in their 50s or a family of six. So make sure you’re comparing apples to apples when looking at affordable health insurance plans in North Dakota and consider the health needs of all the people the plan will cover.

Insurance for individuals in North Dakota

It’s always easier to shop just for yourself, as you only have your own needs to consider. Are you in good health, only visiting a doctor for a rare cold or injury, or do you have a chronic condition that requires expensive medication and regular tests? The answers will help you decide if you can save premiums by opting for a high deductible plan or if you should invest in higher premiums with lower out-of-pocket expenses.

The type of insurance plan will also determine where you receive health care and how certain aspects of your care are handled.

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in North Dakota

You’ll want to consider each family member’s health status and age to determine whether a strict in-network-only policy is worth the lower rate or if your family needs access to a wider variety of providers. Some things to look into with family insurance include pediatricians and children’s hospitals if you have young family members, obstetricians and their associated hospitals if your family is growing, and out-of-state care if you or a family member attends college away from home or travels.

Deductibles are assigned on a family and individual basis. Once each individual meets their deductible, the insurance begins to pay claims for that person. The family deductible is a maximum amount that, once met, allows all individual claims to be paid, even if that specific family member didn’t meet their individual deductible.

How much does health insurance cost in North Dakota?

As you budget for health insurance, consider not only the monthly premiums but the deductible and coinsurance. A plan with a lower premium may end up costing you more if you have high out-of-pocket expenses. Making a list of annual health needs can help you decide if a low deductible is more beneficial than a low premium.

The Health Insurance Marketplace categorizes plans — Bronze, Silver, Gold, and Platinum — to make it easier for you to compare similar service offerings. Plans in the Bronze category typically have the lowest premiums and those in the Platinum the highest, though there may be exceptions.

You may receive a premium tax credit when enrolling via the Health Insurance Marketplace based on your annual income. This amount can vary each year and can be applied directly to the insurance company to help lower monthly premiums.

Average premiums in North Dakota 2018 2019 2020 2021 2022
Most affordable Bronze plan $299 $309 $273 $273 $288
Most affordable Silver plan $368 $438 $372 $464 $478
Most affordable Gold plan $451 $468 $409 $432 $448

  • Bronze plans can be the most affordable health insurance option, as the plans have the lowest monthly premiums. But Bronze plans have higher deductibles and only pay 60% of covered medical costs. If you don’t have a chronic health condition and only want coverage for emergencies, a Bronze plan gives you basic coverage at an affordable price. In 2022, the most affordable Bronze plan in North Dakota costs $288 per month.
  • Silver plans have higher premiums than Bronze plans but also have lower deductibles and coinsurance requirements. The plans pay around 70% of your covered costs. In 2021, the most affordable Silver plan in North Dakota costs $478.
  • Gold and Platinum plans have the highest monthly premiums but also have lower deductibles and insurance requirements. If you have a chronic health condition, you may want to spend a little more per month to get a plan that gives you extra coverage. Gold plans generally cost more than Bronze or Silver plans, but they also cover about 80% of your covered costs (90% for a Platinum plan). As of 2021, the most affordable Gold plan in North Dakota costs $448.

What kind of low-income health insurance is available in North Dakota?

North Dakota helps low-income individuals obtain affordable health insurance through Medicaid, Children’s Health Insurance Program, CHAND, and Indian Health Services.

Medicaid in North Dakota

Eligible persons can apply to the state for Medicaid health insurance coverage which offers benefits such as hospital, medical, vision, dental care, therapy treatments, and prescription medication. The state’s Health and Human Services website lists the requirements for applicants, including those with low income, in foster care, and disabled. State residents can complete an application online or in-person at a county social service office.

The state updates the income levels of individuals and families yearly and offers an expanded access program to aid more North Dakotans up to 138% of the federal poverty level.

Children’s Health Insurance Program (CHIP)

CHIP provides health insurance coverage for children below 18 years of age whose parents or guardians aren’t eligible for Medicaid yet still can’t afford to purchase a health insurance plan. In many cases, an employer’s plan may only cover the working adult. Income guidelines and applications are available on the North Dakota DHS website.

Comprehensive Health Association of North Dakota (CHAND)

If you’re having a hard time finding affordable health insurance due to high-risk medical conditions or if you’ve been denied coverage through your employer’s plan, you may be eligible for CHAND. Through CHAND, you can enroll in major medical care or Medicare supplemental coverage. State and federal funding help subsidize the program to keep premiums affordable.

Health insurance through CHAND can include major medical care with deductibles from $500 to $1,000 or a Medicare supplement plan. The major medical portion has creditable prescription drug coverage.

Indian Health Service

North Dakota has four designated reservations, and numerous American Indians live throughout the state independent of the reservations. Indian Health Service provides health care to eligible members of federally recognized tribes. However, you can choose an affordable health insurance plan through the Health Insurance Marketplace, where cost-sharing benefits (for tribal membership) are available to help offset the cost of premiums.

What are North Dakota's Medicare options for seniors and people with disabilities?

Medicare is the federal health plan that pays for medical care for seniors and disabled individuals. North Dakota residents have several options for Medicare coverage, some of which they can mix and match.

  • Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D.
  • Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision.

If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.

Eligibility

  • To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

Trained counselors can help explain Medicare basics to seniors and their family members through North Dakota’s State Health Insurance Counseling (SHIC) program. The counselors aren’t affiliated with any insurance carrier, so you can be sure of objective, unbiased advice.

Are there short-term health insurance plan options in North Dakota?

Short-term health insurance plans can offer cheap health insurance coverage, but these plans are limited. In 2021, North Dakota enacted a bill concerning short-term health insurance (ND SB2073). Plans for an individual can be in effect for up to 12 months, and association health plans can last as long as 36 months. While short-term health insurance may be necessary for certain circumstances, it carries risks.

  • Coverages may be capped, leaving you with large outstanding bills
  • The plan may not cover preexisting conditions, such as cancer or heart disease
  • Short-term plans don’t have to meet the Affordable Care Act’s (ACA) required coverages

If a short-term plan seems too good to be true, it probably is.

North Dakota Insurance FAQs

Does North Dakota require health insurance?

No – the Affordable Care Act removed the penalty for not having health insurance in 2019, and North Dakota doesn’t have a mandatory health insurance law in place.

Do I have to use the Health Insurance Marketplace in North Dakota?

You can contact insurers directly in North Dakota without using the Health Insurance Marketplace. However, if you’re hoping to receive a premium tax credit, you’ll need to apply through the marketplace website. Additionally, marketplace plans are federally approved to provide necessary coverage.

What types of alternative health insurance plans (like cost-sharing plans) are available in North Dakota?

The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to Affordable Care Act’s standards and don’t cover pre-existing conditions, mental health care, or pregnancy.

Do I need health insurance if I have HSA/FSA?

Yes, although the accounts apply to different situations. A Flexible Spending Account helps pay out-of-pocket medical expenses associated with an employer’s health plan. It doesn’t carry over from year to year, although there are some exceptions. A Health Savings Account works in tandem with a high-deductible health insurance plan. The monies saved can be used for out-of-pocket costs, and an HSA can roll over each year. With either type of account, you’ll still need health insurance to reduce the cost of medical expenses.

Do I need short-term disability coverage in North Dakota if I have health insurance?

If you’re seriously injured and can no longer work, your health insurance may cover the cost of the medical bills, but it won’t pay for car loans, utility bills, and other fees. Short-term disability pays a percentage of your salary, typically for three to six months, depending on the policy.

Do I need long-term disability coverage in North Dakota if I have health insurance?

Your health insurance pays hospital and medical expenses, not your costs of living. So it’s a good idea to sign up for long-term disability coverage to help you continue to meet mortgage payments or rent if you’re unable to work. Long-term policies vary in length, anything from two to 10 years and may also differentiate between continuing to do your trained job and another type of job. Long-term policies usually have a short grace period before starting up, which is why many people opt for both long-term and short-term disability.

author-img
Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

Sources