North Dakota Health Insurance Exchange: A Comprehensive Guide

North Dakota's health insurance exchange, also known as the North Dakota Health Insurance Marketplace, is a platform where individuals and families can purchase health insurance plans. The exchange is a crucial resource for North Dakotans who need health coverage.

The North Dakota Health Insurance Exchange offers a range of health insurance plans from various insurance companies, including Blue Cross Blue Shield of North Dakota and Sanford Health Plan. These plans provide comprehensive coverage for medical expenses, including doctor visits, hospital stays, and prescription medications.

To be eligible for a plan through the exchange, you must be a North Dakota resident and not have access to affordable health coverage through an employer or other means. If you're unsure about your eligibility, you can visit the exchange's website or contact a licensed insurance broker for guidance.

To be eligible for a North Dakota Marketplace health plan, you must be a North Dakota resident, a United States citizen or national, or lawfully present, and not be incarcerated. You also can't have Medicare coverage.

To qualify for financial assistance, such as premium subsidies and cost-sharing reductions, your household income will be taken into account. You must also not have access to affordable health coverage offered by an employer, unless you use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.

You can enroll in a Marketplace plan during open enrollment, which typically runs from November 1 to January 15, or if you experience a qualifying life event, such as giving birth or losing other health coverage. If you need your coverage to start on January 1, you must apply by December 15.

You can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment. This period is a great opportunity to get coverage for the upcoming year.

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.

Outside of the open enrollment window, you may be eligible to enroll if you meet certain requirements. These include experiencing a qualifying life event, such as giving birth or losing other health coverage.

You can also enroll if you belong to a federally recognized American Indian tribe or if you're eligible for subsidies in the Marketplace and your income doesn't exceed 150% of the poverty level.

Here are the specific dates for enrollment:

Keep in mind that enrollment options and deadlines may vary depending on your individual circumstances. It's always a good idea to check with the North Dakota Marketplace for the most up-to-date information.

Short-term coverage is a temporary solution for those without comprehensive insurance. It's available in North Dakota, where you can find more information about these plans.

Short-term health plans are designed to provide temporary health insurance for consumers who may find themselves without coverage.

Under the Affordable Care Act (ACA), no one can be denied coverage because of past health history or gender. This means that pre-existing conditions are no longer a barrier to getting health insurance.

You can get a policy effective immediately, with no waiting periods or look-back periods. This is known as guaranteed issue.

Non-grandfathered plans are subject to this provision, which ensures that you can get coverage without fear of being charged higher premiums or denied coverage altogether.

Policies can only be canceled for non-payment of premiums or fraud, so you don't have to worry about your coverage being taken away unexpectedly.

You can get health insurance in North Dakota through the Marketplace, which has three private insurers offering coverage. Three private insurers offer coverage through the North Dakota Marketplace.

If you're looking for temporary health insurance, short-term plans are available in North Dakota. Short-term plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage.

In North Dakota, you can also buy individual health insurance plans and other options year-round. Individual health insurance plans and other options are available in North Dakota year-round.

If you're between jobs, a new college graduate, have retired early, or experiencing other life events that leave you needing health insurance, a short-term medical plan can be a fast and flexible solution. A Short Term Medical plan can be a fast, flexible insurance solution until you find long-term coverage.

You can also consider supplemental plans for dental, vision, accident insurance, and more to meet your needs and budget. Find ND health insurance and other coverage options that fit your needs and budget.

If you're a small business owner in North Dakota, you can purchase qualifying coverage for your employees through SHOP, the Small Business Health Option Program. If you own a small business in North Dakota (50 or fewer full-time-equivalent employees – FTEs), you can purchase qualifying coverage for your employees through SHOP.

North Dakota's Marketplace health insurance premiums have been increasing over the years, with an average increase of 15.94% for Blue Cross Blue Shield of North Dakota and 16.5% for Sanford Health Plan in 2025.

More than nine out of ten North Dakota Marketplace enrollees receive subsidies, which can significantly lower their premiums. In 2024, the average enrollee's monthly cost was about $128, including those who paid full price.

The American Rescue Plan and the Inflation Reduction Act have extended premium subsidies through 2025, making them more widely available. This is good news for many North Dakotans who rely on these subsidies to afford their health insurance.

If you're eligible for subsidies, you can expect to save around $434 per month on your premiums. This can make a huge difference in your budget and help you afford the care you need.

Here's a breakdown of how full-price premiums have changed in North Dakota's individual/family market over the years:

If you're not eligible for subsidies, North Dakota's reinsurance program can still help keep your premiums lower. Additionally, if your household income is no more than 250% of the federal poverty level, you may qualify for cost-sharing reductions, which can lower your deductibles and out-of-pocket expenses.

In North Dakota, health insurance plans must offer a range of standardized benefits to ensure you get the care you need. These benefits include ambulatory patient services, emergency services, hospitalization, and more.

All qualifying plans must provide these 10 essential benefits, which include maternity and newborn care, mental health services, and prescription drugs. Lifetime dollar limits on these essential benefits have been eliminated.

The ACA requires plans to offer a range of services, but some states mandate additional benefits. In North Dakota, there are three additional benefits that must be provided or offered by private providers.

These benefits include reconstructive breast surgery following mastectomy, off-label prescription drugs, and TMJ disorder treatment. These mandates go beyond the standard ACA requirements to provide more comprehensive coverage for North Dakotans.

Here are the additional mandated benefits in North Dakota:

These mandated benefits can give you peace of mind knowing you have access to more comprehensive care.

In North Dakota, there are three private insurers that offer coverage through the Marketplace: Blue Cross Blue Shield of North Dakota, Medica Health Plans, and Sanford Health Plan. These insurers offer a range of plans to fit different needs and budgets.

For 2025, the average rate increases have been approved for North Dakota's Marketplace insurers. Blue Cross Blue Shield of North Dakota has an approved increase of 15.94%, while Medica Health Plans has an approved increase of 4.6%. Sanford Health Plan has an approved increase of 16.5%.

Here's a breakdown of the approved rate increases for each insurer:

If you own a small business in North Dakota with 50 or fewer full-time-equivalent employees, you can purchase qualifying coverage for your employees through SHOP or a private broker or insurance agent.

You may qualify for tax credits worth up to 50% of your premium costs if you use SHOP, which is especially beneficial for small businesses.

Beginning in 2016, SHOP will be open to employers with up to 100 full-time-equivalent employees, expanding the program's reach and opportunities for more businesses.

All employers with 50 or more full-time-equivalent employees must offer employees at least one plan that is ACA-compliant or face fines of $2,000 per employee starting in 2015.