North Dakota Health Insurance

Health insurance in North Dakota

● North Dakota uses the federally managed health insurance market to HealthCare.gov.

● Open enrollment for 2021 health insurance plans is from November 1 to December 15, 2020. Residents with eligible events can purchase coverage or make changes to their health plan outside of that registration window.

● Short-term health plans are available in North Dakota with initial plan terms of up to 185 days.

Three insurers offer plans for 2020 through the North Dakota exchange.

● More than 20,000 North Dakotas had effective coverage in 2020 coverage through the state exchange.

● North Dakota adopted the ACA's Medicaid expansion in 2013.

● North Dakota regulations limit short-term plans to 185 days. Plans can be renewed for up to a total of 12 months.

This page is dedicated to helping consumers quickly find health insurance resources in the state of North Dakota. Here you will find information about the many types of health insurance coverage available. You can find the basics of north Dakota's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in North Dakota; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for North Dakota residents.

North Dakota's health insurance market

North Dakota has not established its own health insurance market, so individuals and families who shop for health insurance HealthCare.gov for enrollment.

21,666 people enrolled in private plans through the North Dakota exchange during the open enrollment period for 2020 health plans. This was slightly lower than the 21,820 people who signed up in 2019.

20,062 subscribers had made their coverage in February 2020. Among enrollees, 85% received premium subsidies (based on household income) that made their monthly premiums cheaper, and 37% received cost-sharing reductions that make their out-of-pocket medical costs (deductible, copays, coinsurance) more affordable.

In most states that use HealthCare.gov, enrollment peaked in 2016 and has declined every year since then. But in North Dakota, the first drop in enrollment (by about 3 percent) occurred in 2019. The year before, in 2018, 22,486 people had been enrolled and enrolments had increased each year from 2014 to 2018.

North Dakota open enrollment and dates

Open enrollment for 2021 health plans runs from November 1, 2020 to December 15, 2020. The open enrollment period is an opportunity for people with individual/family coverage to make changes to the plan or renew the existing plan, and for new enrollees to select a plan for 2021. Outside of that window, North Dakota residents need a qualifying event to enroll or make changes to the plan, in return or out of the bag.

North Dakota Health Insurance Companies and Premiums

In north Dakota's individual health insurance market, there are three health insurance companies: Medica, Blue Cross Blue Shield of North Dakota (Noridian) and Sanford.

Blue Cross Blue Shield of North Dakota and Sanford both have service areas that include the entire state, while Medica covers all but a few counties in the northwest part of the state (residents in those areas can choose between two insurers; residents in the rest of the state can choose from all three insurance companies).

The state created a reinsurance program in February 2020, which led to an average premium decrease of 6% (they would have increased by about 15% without the reinsurance program).

North Dakota Medicaid/CHIP Enrollment

Accepting federal funds to expand Medicaid eligibility in North Dakota was a key aspect of the law's success there. All non-elderly adult residents legally present in North Dakota with incomes of up to 138% of poverty are eligible for Medicaid coverage as a result of the state's decision to expand Medicaid.

The state had initially predicted that 35,000 people would just be eligible for coverage, but by the end of 2018, enrollment in the Medicaid expansion in North Dakota was just over 20,000 people. And by the third quarter of 2019, just under 20,000 people had fallen.

Medicaid enrollment continues year-round. Initial legislation to expand Medicaid eligibility under the ACA was scheduled to expire in July 2017, but the legislature continued to renew the program. The federal government pays 90% of the costs associated with Medicaid expansion, but the state is responsible for the other 10 percent.

Short-term health insurance in North Dakota

North Dakota regulations limit the duration of the short-term health insurance plan to 185 days. The regulations allow for an unsigned renewal, so the duration of the plan can be a total of 12 months.

ND Health ratings

In 2018, the Commonwealth Fund's Scorecard on State Health Care System Performance ranked North Dakota 22nd among the 50 states and the District of Columbia. The North Dakota Scorecard includes more details about health factors and the state's results to show how rankings are calculated.

But the 2019 edition of America's Health Rankings placed North Dakota at the top, in 14th place.

You can view North Dakota's county-wide health data with this interactive map showing North Dakota counties based on public health outcomes and health factors. Counties of high and low rank are well dispersed in the state, without a single region clearly outperforming the others.

How did Obamacare help North Dakota residents?

By the end of 2013, there were about 70,000 uninsured residents in North Dakota. Thanks in large part to the Affordable Care Act and the state's acceptance of Medicaid expansion, 39% of them became eligible for Medicaid. Another 31% were eligible for subsidies in the exchange.

The percentage of residents without health insurance coverage fell from 10.4% in 2013 to 7% in 2016, according to U.S. Census data. It has risen slightly, to 7.3%, by 2018 (this is very much in line with the national trend under the Trump administration and North Dakota's uninsured rate continues to be below the national average).

More than 20,000 people are covered by health plans purchased through the North Dakota health insurance market/exchange. All plans sold in the exchange provide coverage for the ACA's essential health benefits, with no lifetime or annual benefit limits. And most people who are enrolled in the plans in the exchange also receive financial assistance to offset the costs of coverage and/or health needs. And none of them should worry about a complaint being dismissed because it concerns a pre-exist condition.

North Dakota and the Affordable Care Act

In 2010, both U.S. Senators from North Dakota, Democrats Kent Conrad and Byron Dorgan, supported the health care reform law. In the House, Earl Pomeroy, a Democrat and the only representative of North Dakota, also voted yes.

The entire North Dakota congressional delegation has changed since 2010, however, and now includes only Republicans.

Senator John Hoeven, a Republican and former governor, is opposed to the ACA, but was one of 23 Republicans who joined Democrats in voting to end the 2013 debate on a resolution that would defund Obamacare. However, Hoeven voted yes on all three ACA repeal measures that were considered in the Senate during the summer of 2017.

Kevin Cramer, a Republican, is opposed to the ACA and would prefer to see it repealed and replaced with a market-driven solution. He was previously in the House and voted in support of the 2017 American Health Care Act (AHCA) of House Republicans to repeal parts of the ACA.

At the state level, Republicans hold a majority in both the House and Senate. Former Governor Jack Dalrymple, a Republican, said he was opposed to the ACA, but was not a filibuster on the law like many other Republican governors. In 2013, Dalrymple said: "It's not going to help throw a lot of roadblocks in front of this [the ACA] thing and make it fail. That's not the responsible thing to do.

In the spring of 2013, Dalrymple signed a bill to expand Medicaid in the state, allowing all legal residents with incomes of up to 138% of poverty to be eligible for Medicaid benefits starting in 2014. The state has opted for a federally subsidized market, however, and HHS is handling the trade in North Dakota.

Doug Burgum has been governor of North Dakota since December 2016. In late 2017, he joined 19 other Republican governors by writing a letter to Congress urging lawmakers to repeal the ACA.

Does North Dakota have a high-risk pool?

The Comprehensive Health Association of North Dakota (CHAND) was created in 1981 to provide an alternative to residents who were unable to purchase individual private health insurance because of their medical history. The plan is administered by Blue Cross Blue Shield of North Dakota.

Now that Obamacare is in place and all major individual health insurance plans are guaranteed problem, risk pools are not as necessary as before 2014. But CHAND is one of the few state-run pools that is still operational and still accepts new members if they meet eligibility guidelines. CHAND also offers additional coverage for Medicare enrollees under the age of 65 who are unable to get Medigap coverage in the private market.

Medicare coverage and enrollment in North Dakota

As of August 2020, Medicare enrollment in North Dakota was 134,576 people. Most of these residents are eligible for Medicare because of their age (at least 65), but 11% of North Dakota Medicare beneficiaries are under 65 and are eligible for Medicare due to a disability.

Check out our Overview of Medicare in North Dakota for more information about the Medicare Advantage and Part D plans, as well as state rules applicable to Medigap plans.

Useful health insurance links in North Dakota

Children's Health Insurance Program (North Dakota)

North Dakota Insurance Department

North Dakota State Health Insurance Counseling Program - a local service for Medicare beneficiaries, which can provide information and assistance with questions about Medicare eligibility, enrollment, and claims.

North Dakota Health Reform Legislation

At the bottom of this page, you'll see a summary of North Dakota's recent public health and health insurance reform laws (note that there are no legislative sessions in North Dakota in even years).