Frequently asked questions about health insurance
coverage options in North Dakota
North Dakota uses the federally-run exchange, so enrollments are completed via HealthCare.gov or an approved enhanced direct enrollment entity. Read more about the North Dakota health insurance marketplace.
In North Dakota, open enrollment for individual/family health coverage runs from November 1 through January 15 (enrollments must be completed by December 15 in order to have coverage effective January 1).
Outside of open enrollment, you’ll need a qualifying life event to be able to enroll or make a change to your plan. But some people can enroll year-round, including Native Americans and subsidy-eligible applicants with a household income of no more than 150% of the poverty level.
In North Dakota’s 2023 individual health insurance marketplace, there are three health insurance carriers:
- Medica
- Blue Cross Blue Shield of North Dakota (Noridian)
- 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 and central areas 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).
North Dakota’s three individual market insurers implemented an overall weighted average rate increase of 4.4% for 2023, before any subsidies are applied.
Most enrollees receive subsidies, and their net premium changes depend on how subsidies change as well as how the rates for their plan change and whether they pick a different plan for 2023. The American Rescue Plan’s subsidy enhancements continue to be in effect through 2025, as a result of the Inflation Reduction Act. So subsidies are larger and more widely available than they were prior to 2021.
During the open enrollment period for 2022 coverage, a record-high 29,873 people enrolled in private qualified health plans (QHPs) through the North Dakota exchange. Enrollment in North Dakota’s exchange had previously peaked the year before, when 22,709 people enrolled.
Nationwide enrollment hit a record high in 2022 as well, driven in large part by the subsidy enhancements created by the American Rescue Plan. These subsidy enhancements will continue to be in effect through at least 2025.
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 29,000 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% of poverty to be eligible for Medicaid benefits starting in 2014. The state opted for a federally facilitated marketplace however, so HHS is running the exchange in North Dakota, using the HealthCare.gov platform.
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, Medicaid expansion enrollment in North Dakota had exceeded 25,000 people. And enrollment in Medicaid/CHIP has continued to grow (nationwide, as well as in North Dakota), due to the COVID pandemic. As of mid-2022, total Medicaid/CHIP enrollment in North Dakota was 79% higher than it had been in 2013, and many of those individuals are enrolled under Medicaid expansion rules.
The COVID pandemic has driven Medicaid enrollment much higher than it was in 2019. This is due in large part to the fact that routine eligibility redeterminations have been paused throughout the COVID public health emergency period, meaning that people have not been disenrolled from Medicaid during the pandemic. Once the public health emergency ends (expected to happen in 2023), eligibility redeterminations will resume.
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 August 2022, Medicare enrollment in North Dakota stood at 140,571 people. Most of these residents are eligible for Medicare due to their age (being at least 65), but about 10% 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.
