North Dakota Health Insurance Guide

Health Insurance Overview in North Dakota

North Dakota expanded Medicaid in 2014. North Dakota uses the federal HealthCare.gov marketplace. North Dakota's small population and rural character mean marketplace insurer options are very limited — the state has had issues with single-insurer counties. The state's energy sector provides employer-sponsored coverage for many residents.

Average Health Insurance Costs in North Dakota

Marketplace Enrollment in North Dakota

North Dakota residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in North Dakota

Medicaid in North Dakota

North Dakota Medicaid expanded in 2014, covering adults with incomes up to 138% of the federal poverty level.

Children's Health Insurance (CHIP) in North Dakota

Healthy Steps covers children under 19 in families with incomes up to 175% of the federal poverty level.

What Makes North Dakota Unique

North Dakota's oil boom in the Bakken region provided employer-sponsored coverage to many workers through energy company benefits, reducing pressure on the individual marketplace. However, the volatility of the energy sector means workers who lose oil industry jobs also lose their employer coverage, creating temporary marketplace demand.

ACA Subsidies: What North Dakota Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

North Dakota’s Marketplace for 2027: Insurers, Rates, and Dates

North Dakota residents enroll through HealthCare.gov. Full-price premiums rose about 8.1% on average for 2026, before subsidies. 3 insurers sold plans for 2026. Proposed 2027 changes average about 19.2% before subsidies.

About 41,000 people enrolled for 2026. About 70% received premium tax credits, and the average net premium after credits was about $126 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in North Dakota

North Dakota’s three insurers — Blue Cross Blue Shield of North Dakota, Medica, and Sanford Health Plan — all return for 2027. A 2025 update to the state’s essential health benefits benchmark added coverage of weight-loss medications. Reinsurance has operated since 2020.

Tips for Choosing Health Insurance in North Dakota

North Dakota residents may have very limited marketplace plan options — comparing available plans carefully is important. Medicaid covers low-income adults. Energy sector workers should plan for coverage during potential employment transitions. Telehealth is particularly valuable for rural North Dakota residents with limited provider access.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.

Frequently Asked Questions

How many insurers sell marketplace plans in North Dakota?

Three insurers sold North Dakota marketplace plans for 2026, with proposed 2027 changes averaging about 19.2% before subsidies.

When is open enrollment in North Dakota for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do North Dakota marketplace enrollees pay after subsidies?

In 2026 about 70% of North Dakota enrollees received premium tax credits, and the average net premium was about $126 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.