Health insurance in North Dakota
- North Dakota utilizes the federally-run health insurance marketplace at HealthCare.gov.
- Open enrollment for 2021 ended on December 15, 2020. Residents with qualifying events can purchase coverage or make changes to their health plan outside that enrollment window.
- Short-term health plans are available in North Dakota with initial plan terms up to 185 days.
- Three insurers are offering 2020 plans through the North Dakota exchange.
- More than 20,000 North Dakotans had effectuated 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 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’ll find information about the many types of health insurance coverage available. You can find the basics of the North Dakota health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in North Dakota; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for North Dakota residents.
North Dakota’s health insurance marketplace
North Dakota did not establish its own health insurance marketplace, so individuals and families shopping for health insurance use HealthCare.gov for enrollment.
21,666 people enrolled in private plans through North Dakota’s exchange during the open enrollment period for 2020 health plans. That was just slightly lower than the 21,820 people who enrolled in 2019.
20,062 enrollees had effectuated their coverage as of February 2020. Of those enrollees, 85 percent were receiving premium subsidies (based on their household income) that make their monthly premiums more affordable, and 37 percent were receiving 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 each year since then. But in North Dakota, the first enrollment decline (of about 3 percent) happened in 2019. The year before, in 2018, there had been 22,486 people enrolled, and enrollment had increased each year from 2014 through 2018.
Open enrollment for 2021 health plans ran from November 1 through December 15, 2020. The open enrollment period is an opportunity for people with individual/family coverage to make changes to their plan or renew their existing plan, and for new enrollees to select a plan for 2021. Outside that window, North Dakota residents need a qualifying event in order to enroll or make plan changes, on-exchange or off-exchange.
Read more about the North Dakota health insurance exchange.
North Dakota health insurance companies and premiums
In North Dakota’s individual health insurance marketplace, there are three health insurance carriers: 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 northwestern part of the state (residents in those areas can select from two insurers; residents in the rest of the state can choose from among all three insurance companies).
The state created a reinsurance program as of 2020, which resulted in premiums decreasing by an average of 6 percent (they would have increased by an estimated 15 percent without the reinsurance program).
Read our full overview of the North Dakota health insurance marketplace.
North Dakota Medicaid/CHIP enrollment
Accepting federal funds to expand Medicaid eligibility in North Dakota has been a key aspect of the law’s success there. All legally present non-elderly adult residents in North Dakota with incomes up to 138 percent of poverty are eligible for Medicaid coverage as a result of the state’s decision to expand Medicaid.
The state had initially projected that 35,000 people would be newly eligible for coverage, but as of the end of 2018, enrollment in Medicaid expansion in North Dakota was only a little over 20,000 people. And by the third quarter of 2019, it had dropped a little below 20,000 people.
Enrollment in Medicaid continues year-round. The initial legislation to expand Medicaid eligibility under the ACA was slated to expire in July 2017, but the legislature has continued to renew the program. The federal government pays 90 percent of the costs associated with Medicaid expansion, but the state is responsible for the other 10 percent.
Read more about Medicaid in North Dakota.
Short-term health insurance in North Dakota
Learn more about short-term health insurance in North Dakota.
ND health ratings
In 2018, the Commonwealth Fund’s Scorecard on State Health System Performance rated North Dakota 22nd out of the 50 states and District of Columbia. North Dakota’s Scorecard includes additional details about the state’s health factors and outcomes to show how the rankings are calculated.
But the 2019 edition of America’s Health Rankings placed North Dakota higher, at 14th place.
You can view North Dakota health data on a county level with this interactive map showing the counties in North Dakota based on their public health outcomes and health factors. High-and low-ranking counties are well dispersed in the state, with no single region clearly outperforming the others.
How did Obamacare help North Dakota residents?
At 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 percent of them became eligible for Medicaid. Another 31 percent were eligible for subsidies in the exchange.
The percentage of residents without health insurance coverage dropped from 10.4 percent in 2013 to 7 percent in 2016, according to US Census data. It climbed slightly, to 7.3 percent, by 2018 (this is very much in line with the nationwide trend under the Trump administration, and North Dakota’s uninsured rate continues to be lower than the national average).
More than 20,000 people are covered by health plans purchased through the North Dakota health insurance marketplace/exchange. All of the plans sold in the exchange provide coverage for the ACA’s essential health benefits, without lifetime or annual benefit caps. And the majority of the people who are enrolled in plans in the exchange are also receiving financial assistance to offset the costs of the coverage and/or healthcare needs. And none of them need to worry that a claim will be rejected because it pertains to a pre-existing condition.
North Dakota and the Affordable Care Act
In 2010, both of North Dakota’s U.S. Senators, Democrats Kent Conrad and Byron Dorgan, were supportive of the health reform law. In the House, Earl Pomeroy, a Democrat and the lone representative from North Dakota, also voted yes.
The entire congressional delegation from North Dakota has changed since 2010, however, and now includes only Republicans.
Sen. John Hoeven, a Republican and the former governor, is opposed to the ACA but was one of the 23 Republicans who joined with Democrats in voting to end the debate in 2013 on a resolution that would have defunded Obamacare. However, Hoeven voted yes on all three ACA repeal measures that were considered in the Senate during the summer of 2017.
Sen. 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 House Republicans’ 2017 American Health Care Act (AHCA) to repeal parts of the ACA.
At the state level, Republicans hold the majority in both the House and Senate. Former Gov. Jack Dalrymple, a Republican, stated that he was opposed to the ACA, but he was not an obstructionist about the law the way many other Republican governors have been. In 2013, Dalrymple said, “It’s not going to help to throw a bunch of roadblocks in front of this thing [the ACA] and have 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 up to 138 percent of poverty to be eligible for Medicaid benefits starting in 2014. The state opted for a federally facilitated marketplace however, and HHS is running the exchange in North Dakota.
Doug Burgum has been the governor of North Dakota since December 2016. In late 2017, he joined with 19 other Republican governors in 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 for 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 effect and all individual major medical health insurance plans are guaranteed issue, risk pools are not needed the way they were prior to 2014. But CHAND is one of a few state-run pools that is still operational and still accepts new members if they meet the eligibility guidelines. CHAND also offers supplemental coverage for Medicare coverage enrollees who are under 65 and unable to obtain Medigap coverage in the private market.
Medicare coverage and enrollment in North Dakota
As of August 2020, Medicare enrollment in North Dakota stood at 134,576 people. Most of these residents are eligible for Medicare due to their age (being at least 65), but 11 percent of North Dakota Medicare beneficiaries are under 65 and eligible for Medicare due to a disability.
See our overview of Medicare in North Dakota for more information about Medicare Advantage and Part D plans, as well as state rules that apply to Medigap plans.
Helpful North Dakota health insurance links
- 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 related to Medicare eligibility, enrollment, and claims.
North Dakota health reform legislation
At the bottom of this page, you’ll see a summary of recent North Dakota bills related to public health and healthcare insurance reform (note that there are no legislative sessions in North Dakota in even-numbered years).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.