Frequently asked questions about health insurance
coverage options in North Dakota
Enrollment and plan changes for individual and family health insurance are normally only available during the annual open enrollment period in the fall (November 1 to December 15), or during a special enrollment period triggered when a person experiences a qualifying life event. But to address the COVID pandemic and the American Rescue Plan’s additional premium subsidies, an additional — and lengthy — enrollment opportunity is being offered in 2021.
The COVID/ARP enrollment window runs through August 15, 2021. North Dakota residents can enroll or make a plan change during this time, even if they haven’t experienced a qualifying event.
This window gives people a chance to newly obtain coverage, or switch from off-exchange coverage (directly through an insurance company) to on-exchange coverage — which is necessary in order to access the American Rescue Plan’s new subsidies. And existing exchange enrollees might find that they want to switch to a different plan in order to best take advantage of the newly enhanced subsidies – if so, they can do that anytime until August 15.
After August 15, 2021, North Dakota residents will need a qualifying event in order to enroll or make a plan change for 2021 coverage. Open enrollment for 2022 coverage will start on November 1, 2021, with plan selections effective January 1, 2022.
Read more about the North Dakota health insurance exchange.
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).
For 2021, premium increases were modest and mostly applied to silver plan rates, resulting in substantially larger premium subsidies – and that was before the American Rescue Plan boosted premium subsidies nationwide.
North Dakota did not establish its own health insurance marketplace, so individuals and families shopping for health insurance use HealthCare.gov for enrollment.
22,709 people enrolled in private plans through North Dakota’s exchange during the open enrollment period for 2021 health plans.
That was a record high, and enrollment is expected to further increase during the special enrollment period that continues through mid-August. During the first two and a half months of that enrollment window, nearly 2,400 North Dakota residents signed up for coverage through the marketplace — more than double the normal enrollment volume during the same timeframe in prior years.
In most states that use HealthCare.gov, enrollment peaked in 2016, declined each year through 2020, and then increased slightly in 2021. But in North Dakota, the first enrollment decline (of about 3%) happened in 2019. Enrollment declined again in 2020, but rebounded to a record high in 2021.
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% of them became eligible for Medicaid. Another 31% were eligible for subsidies in the exchange.
The percentage of residents without health insurance coverage dropped from 10.4% in 2013 to 7 percent in 2016, according to US Census data. It climbed slightly, to 7.3 percent, by 2018, which was very much in line with the nationwide trend under the Trump administration. But although the nationwide uninsured rate continued to climb in 2019, North Dakota’s dropped to 6.9% and continues to be quite a bit 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.
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.
Accepting federal funds to expand Medicaid eligibility in North Dakota has been a key aspect of the law’s success there. Non-elderly adult residents in North Dakota with incomes up to 138% of poverty are eligible for Medicaid coverage as a result of the state’s decision to expand Medicaid. (As is the case nationwide, premium subsidies in the exchange are available for lawfully present immigrants who have not been in the U.S. long enough to qualify for Medicaid, if their income would otherwise make them eligible for 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.
By late 2020, however, total Medicaid/CHIP enrollment in North Dakota was up more than 36,000 over where it had been in 2013 – a 51% increase – and many of those individuals are enrolled under Medicaid expansion rules. Nationwide, the COVID pandemic and resulting job/income losses have driven Medicaid enrollment much higher than it was in 2019.
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% of the costs associated with Medicaid expansion, but the state is responsible for the other 10%.
Read more about Medicaid in North Dakota.
North Dakota enacted legislation in 2021 that allows association short-term health plans to have a total duration of up to three years, in line with federal rules that the Trump administration finalized in 2018 (prior to the 2021 legislation, North Dakota limited all short-term plans to initial terms of up to 185 days, and a maximum of one renewal).
But North Dakota’s 2021 legislation also imposes a variety of state mandates and regulations on the longer association short-term plans, including essential health benefit requirements. The legislation also allows regular individual short-term plans to have initial terms of up to 12 months, but keeps their total duration, including renewals, capped at 12 months as well.
Learn more about short-term health insurance in North Dakota.
As of March 2021, Medicare enrollment in North Dakota stood at 135,404 people. Most of these residents are eligible for Medicare due to their age (being at least 65), but 11% 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 and financial assistance available to Medicare beneficiaries with limited income and assets.
- 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.
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.