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North Dakota health insurance exchange

84% in ND exchange get subsidies; premiums higher than average

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A report released by HHS in June found that 84 percent of enrollees in the North Dakota exchange received premium subsidies, and the average after-subsidy premium is $132 per month.  This is the second-highest average after-subsidy premium out of the 36 states where HHS is running the exchange (only New Jersey is higher, at $148 per month), and is considerably higher than the $82 per month average across all 36 states.  But the higher average net price in North Dakota is a function of enrollees’ incomes and the plans they selected, as the Obamacare premium tax credits do a very good job of evening out premiums across populations with similar household incomes.  The average pre-subsidy premium in North Dakota is $350 per month, which is very close to the $346 average pre-subsidy premium across all 36 federally-facilitated marketplaces.  Rates for 2015 had to be filed with the North Dakota Insurance Department by June 6, and are currently still under review.

The 2014 open enrollment period ended in April, but enrollment has continued to grow in the North Dakota exchange throughout the summer due to qualifying events that trigger special enrollment periods.  HHS will release an updated enrollment total in November, and the 2015 open enrollment period will also begin in November.  As of April 19, 10,597 people had enrolled in private plans through the North Dakota exchange.  This was the lowest total of any state in the country, but it was still more than double the number of North Dakota residents who had enrolled as of March 1.  Enrollment is expected to be lower in sparsely-populated North Dakota, and the state had a lower percentage of people uninsured (about 11%) than the national average even before the 2014 open enrollment began.

There has been some concern regarding how many of the new private policies have been activated by a premium payment, and one report indicated that as of May 1, premiums had been paid for less than half of the plans.  But we have to bear in mind that more than half of the exchange’s enrollments came after March 1, and people who applied in April may not have received an invoice in time to have paid for their policy by May 1.  Others (those who enrolled after April 15) have policies that are not effective until June 1, so it makes sense that their premiums had not yet been paid as of May 1.

In addition to private plan enrollments, by early June nearly 9,000 low-income North Dakota residents had enrolled in the state’s expanded Medicaid program.  North Dakota has followed a unique public-private partnership model of Medicaid expansion, allowing private health insurance carriers to bid for the opportunity to provide health insurance coverage to the state’s newly-eligible Medicaid population using federal Medicaid funds.  Sanford and Blue Cross Blue Shield of ND placed bids, and ultimately Sanford accepted the job.

Three insurers are participating in the North Dakota exchange: Blue Cross Blue Shield of North Dakota, Medica and Sanford.  Enrollees have an average of 24 plans from which to choose.   Blue Cross Blue Shield of ND fired their CEO, Paul von Ebers, in May 2014 after the carrier reported a loss of nearly $73 million in 2013.  Much of the loss stemmed from subsidiary Noridian Healthcare Solutions’ bungled development of the state-run exchange in Maryland.  The carrier has kept administrative expenses quite low however (7.7% of premiums) and insureds will not see higher premiums based on the Noridian losses, as regulators only allow premiums to be increased based on claims data.

Health insurance carriers are conducting workshops and outreach sessions to help people learn about their options under the ACA.  There are also 17 navigators in ND who are working to educate the public about the policies and subsidies available in the exchange.  The state got about $1 million in federal funding to spend on ACA outreach.

Following President Obama’s announcement in November that existing policies could be renewed into 2014 at the discretion of states and carriers, North Dakota’s Insurance Commissioner Adam Hamm decided to go along with the president’s policy cancellation “fix” and urged carriers to provide an option to renew some 36,000 individual policies that had been scheduled to terminate at the end of the year.  Blue Cross Blue Shield of North Dakota – the state’s largest insurer – opted in December not to renew policies that had been scheduled for termination.  Their insureds had the option to switch to a new ACA compliant BCBS plan, or purchase new coverage from another carrier.

The North Dakota House of Representative voted against a state-run health insurance exchange in 2011, and Gov. Jack Dalrymple’s administration reiterated that position in November 2012.  But North Dakota is expanding its Medicaid program under a provision of the Affordable Care Act.  Dalrymple favors the expansion, and the state House approved the measure in February 2012. About 29,000 uninsured people will be eligible for Medicaid under the expanded guidelines, including childless adults.

About 11 percent of North Dakotans are uninsured, according to Kaiser’s

North Dakota health insurance exchange links

State Exchange Profile: North Dakota
The Henry J. Kaiser Family Foundation overview of North Dakota’s progress toward creating a state health insurance exchange.

North Dakota Insurance Department
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(701) 328-2440 / Toll Free: 800-247-0560 /