North Dakota Health Insurance Consumer Guide

To enroll in private health coverage through the Marketplace in North Dakota, you must:⁶

• Be a North Dakota resident
• Be either a United States citizen or national, or be lawfully present 
• Not be incarcerated
• Not have Medicare coverage 

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
• Not be eligible for Medicaid or CHIP.

In North Dakota, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.⁷

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁶

Outside of the open enrollment window, you may be eligible to enroll if you meet the following requirements: 

• You experience a qualifying life event, such as giving birth or losing other health coverage. If you already had prior coverage, you can enroll in a new plan due to certain qualifying life events such as marriage or moving to an area where different health plans are available.
• You belong to a federally recognized American Indian tribe.
• You’re eligible for subsidies in the Marketplace and your income doesn’t exceed 150% of the poverty level.⁸

In addition, enrollment in Medicaid/CHIP is available year-round, so if you’re eligible for North Dakota Medicaid or CHIP, you can enroll anytime.

To enroll in an ACA Marketplace plan in North Dakota, you can: 

• Visit HealthCare.gov, which is North Dakota’s health insurance Marketplace. HealthCare.gov provides an online platform to shop, compare, and buy health plans. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁹

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

You may find affordable health insurance options in North Dakota by signing up through HealthCare.gov – especially if you’re eligible for subsidies. 

Under the Affordable Care Act, there are income-based subsidies – a type of financial assistance – called Advance Premium Tax Credits (APTC). APTCs can help lower your premium payments each month.¹⁰

As of 2023, more than 90% of North Dakota Marketplace enrollees were receiving premium subsidies that saved them an average of $436/month. After subsidies were applied, the average enrollee’s monthly cost was about $96/month.¹¹

If your household income is below 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR). These reductions can lower your deductibles and out-of-pocket expenses as long as you select a Silver-level plan. As of 2023, 24% of North Dakota Marketplace enrollees were receiving CSR benefits.¹²

If it looks like you’re eligible for Medicaid based on the income you report to the Marketplace, they will refer you to North Dakota Medicaid Services. 

Combining APTCs and CSRs might make an ACA plan the most budget-friendly health insurance choice for you. 

Depending on your income and circumstances, you may find that you’re eligible for free or low cost health coverage through Medicaid or CHIP. Check to see if you meet the criteria for Medicaid in North Dakota. 

Source: CMS.gov¹³

In 2023, there are three private insurers that offer coverage through the North Dakota Marketplace, and all three plan to continue to offer coverage in 2024:¹⁴

• Blue Cross Blue Shield of North Dakota 
• Medica Health Plans
• Sanford Health Plans

In most counties, plans are available from all three insurers for 2023, although there are six counties where only two insurers offer plans.¹⁵

 (This was also the case in 2021, although all three insurers had statewide coverage areas in 2022.)

North Dakota’s individual market insurers have proposed the following average rate increases for 2024:¹⁴

Source: North Dakota Rate Review Submissions¹⁴

These rate proposals are under review by state regulators, and final rates will be published in October 2023, before the start of open enrollment.

Average rate changes are calculated 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 during open enrollment.

The American Rescue Plan, enacted in March 2021, increased the size of premium subsidies and made the subsidies more widely available.¹⁶ Fortunately for exchange enrollees, those subsidy enhancements have been extended through 2025 by the Inflation Reduction Act. 

Keep in mind that these average rate increases are for full-price plans. However, 91% of the people enrolled in North Dakota Marketplace plans in 2023 are receiving premium tax credits that help reduce their monthly payments.¹²

In the open enrollment period for 2023 coverage, 34,130 people signed up for private plans through the North Dakota Marketplace.¹⁶ And as of early 2023, there were 32,970 people with effectuated coverage through the North Dakota Marketplace.¹²

Effectuated enrollment numbers are always a little lower than the number of people who sign up during open enrollment, because some enrollees never pay their first premium to effectuate their coverage, and others choose to cancel their coverage instead of keeping it for the full year. 

Source: 2014,¹⁷  2015, ¹⁸ 2016,¹⁹ 2017,²⁰ 2018,²¹ 2019,²² 2020,²³ 2021,²⁴ 2022,²⁵ 2023,¹⁶ 2024²⁶

HealthCare.gov: The Marketplace in North Dakota, where residents can enroll in individual/family health coverage and receive income-based subsidies. You can reach HealthCare.gov at 800-318-2596.

North Dakota Department of Human Services: The North Dakota Department of Human Services administers Medicaid and CHIP, as well as other social services programs. You can reach them at 701-328-2310 (For TTY, use relay North Dakota at 711 or 1-800-366-6888).

North Dakota Insurance Department: Regulates the insurance industry in North Dakota, and provides assistance to consumers and businesses with insurance-related questions and concerns. 

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.