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

Health insurance premiums in North Dakota vary significantly based on age, plan type (Bronze, Silver, Gold, Platinum), insurer, and income-based subsidies. The figures below represent estimated 2026 benchmark premiums before ACA subsidies for a 40-year-old individual and family of four.

Coverage Type	Monthly Premium	Annual Premium
Individual (benchmark Silver)	$448/mo	$5376/yr
Family of Four (benchmark Silver)	$1,282/mo	$15384/yr
Avg. Annual Deductible	$4,700

Premiums shown are before ACA subsidies. Most marketplace enrollees receive premium tax credits that significantly reduce these costs. Use our Health Insurance Calculator to estimate your net premium after subsidies.

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). Outside of open enrollment, a qualifying life event (job loss, marriage, birth of a child, move to a new state) triggers a Special Enrollment Period during which you can enroll or change plans.

Average Premiums by City in North Dakota

Health insurance premiums vary by location within North Dakota, reflecting local healthcare costs, provider availability, and insurer competition. The following estimated monthly individual premiums are based on a benchmark Silver plan for a 40-year-old non-smoker.

City	Est. Monthly Premium (Silver, age 40)
Fargo	$458/mo
Bismarck	$448/mo
Grand Forks	$445/mo
Minot	$442/mo
West Fargo	$455/mo
Mandan	$445/mo

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

Premium tax credits (subsidies) are available for North Dakota residents who purchase coverage through the marketplace and have incomes between 100% and 400% of the federal poverty level (or higher in states with additional state subsidies). The subsidy amount is based on the cost of the benchmark Silver plan in your area and your income. For 2026, the enhanced subsidies first enacted in the American Rescue Plan have been extended, providing more substantial assistance across a broader income range than before.

Cost-sharing reductions (CSRs) provide additional savings on deductibles and copays for those who enroll in Silver plans with incomes between 100-250% of the federal poverty level. Silver plans with CSRs often provide Gold or Platinum-level value at Silver premiums, making them the best value for eligible enrollees.

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.
• Check both Medicaid eligibility and marketplace subsidy eligibility — your income determines which program you qualify for.
• Don't just compare premiums — also compare deductibles, out-of-pocket maximums, and whether your doctors are in-network.
• Silver plans with cost-sharing reductions (for incomes 100-250% FPL) typically offer the best overall value despite higher premiums than Bronze plans.
• Use our Health Insurance Calculator to estimate your total annual cost (premium + expected out-of-pocket) for different plan options.

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.