North Dakota Health Insurance Marketplace

In North Dakota, the federal government operates the health insurance Marketplace.

North Dakota now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.

North Dakota Plans, Benefits, and Costs


North Dakota, Fargo 2015 2016
Monthly Silver Premiums for a 40 Year Old Non-Smoker $272 $304
Average Tax Credit Amount as of March 31, 2016: $231 $262

Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $41 per month after tax subsidies. See if you qualify for a free or low cost plan.

Companies can offer three types of plans: bronze, silver, and gold. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.

Tobacco Surcharge: North Dakota allows insurance companies to charge tobacco users 50% more than non-tobacco users.

Who Is Selling Insurance in the North Dakota Marketplace?

On exchange plans in North Dakota

Off exchange plans in North Dakota

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What's Covered:

All approved plans in the state must cover the same package of benefits, called essential health benefits. In North Dakota, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays, including weight loss surgery
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Lab tests
  8. Rehab and habilitative services, such as those that help people recover from an accident or injury and those that help people with developmental issues. The extent of services covered remains to be determined in North Dakota.
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care

Some services not included: private-duty nursing, long-term nursing at home, non-emergency care outside the U.S., infertility treatment, cosmetic surgery, routine eye exams for adults, hearing aids, acupuncture, and weight loss programs.

Will These Benefits Be in All Plans?

Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.

Financial Aid

You may be eligible for financial aid to help pay for insurance. Here’s what North Dakota will offer:

Medicaid Expansion: Some states, including North Dakota, are expanding Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is below $16,243 for one person or $33,465 for a family of four.

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.

Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.

Calculator: You can also use our calculator to learn about costs and whether you'll qualify for subsidies or other financial aid.

CHIP: The Children's Health Insurance Program, called Healthy Steps in North Dakota, provides coverage for children of some families who have a low income but are not eligible for Medicaid.

 

Ready to obtain the right health insurance? Check your eligibility for free or low cost health insurance through the marketplace in 4 simple steps...