Curious about health care in the Peace Garden State? According to a study by US News, ND has the 14th best health care in the nation. That study considers access, quality, and overall public health.
Health insurance options in North Dakota
According to the North Dakota Insurance Department, there are several ways for residents to access health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most North Dakota residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 57% | ||
| Individual or family | 8% | ||
| Medicaid | 12% | ||
| Medicare | 13% | ||
| Military | 2% | ||
| Uninsured | 8% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Eight percent of North Dakota residents are uninsured, less than the national average. That’s great for policyholders. Why? A high percentage of uninsured people raises costs for insured people.
North Dakota health insurance companies
ND residents have several choices when it comes to health insurance companies in their state. These providers offer individual and family plans in North Dakota:
- Blue Cross Blue Shield of North Dakota
- Medica
- Sanford Health
North Dakota health insurance costs and rate factors
ND residents spend an average of $9,851 per year on health care, more than the national average. So, what determines health care prices in your state? Costs vary person to person, but depend mostly on these factors:
Plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. The higher level of coverage you want, the more you’ll have to pay.
How much should you expect to pay in the Peace Garden State? These are the average monthly premiums for each plan type for a middle-aged ND resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $273 | $372 | $409 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a gold plan cost about 50 percent more than a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available in the health insurance marketplace. Catastrophic plans have low monthly premiums and a yearly deductible of $8,150. Because of that high deductible, it may save you money to invest in a bronze or silver plan if you end up using your insurance. Catastrophic plans aren’t great for day-to-day or preventative care.
Body mass index
According to the CDC, a high body mass makes you more likely to suffer from serious health conditions. That’s why insurers assess your BMI when determining your risk-level. A high BMI leads to higher insurance prices.
In 2019, ND had a 35 percent obesity rate, the 13th highest rate in the country. Of the many ND residents who used QuoteWizard to compare health insurance plans, 40 percent had a BMI in the obese range.
Tobacco use
Smokers tend to pay more for health insurance because of the serious risks from tobacco use. About 20 percent of ND residents are smokers, the 37th lowest rate in the country.
Age
Health care plans can cost up to three times more for older people than younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 38 years old.
Location
Where you live plays a big role in your rates. That’s because every state has different health care rules, laws, and providers.
Also, health insurance companies use community-rating, so your rates are partly based on the combined claims everyone files. If your state files a high number of rates, your prices could go through the roof.
That means how health-conscious your state is helps determine your rates. According to America’s Health Rankings, ND is the 18th healthiest state in the country.
North Dakota health care insurance laws
The Affordable Care Act limits what factors insurance companies can use when pricing your policy.
- Pre-existing conditions: People with pre-existing conditions used to pay significantly more for health insurance. Now, the ACA doesn’t allow pre-existing conditions to be a factor in your premiums.
- Gender: Insurance companies can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to analyze your insurance and medical history. They would charge more to people with lapses in insurance and previous medical problems. Luckily, the ACA doesn’t allow them to use those factors now.
There’s a limit to how much you’ll pay out-of-pocket for marketplace plans. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
ND state law requires health insurance companies to offer at least some coverage for the following services:
- Mental disorder coverage
- Substance abuse coverage
- Breast reconstruction surgery
- Postdelivery coverage for mothers and newborns
- Coverage for off-label uses of drugs
- Dental anesthesia and hospitalization
There are additional services that providers need to offer coverage for. Find the entire list on cms.gov.
Medicare and Medicaid in North Dakota
Medicare and Medicaid are both government-funded programs available to qualifying ND residents. Medicare covers seniors, whereas Medicaid helps low-income families and children.
Medicare
People 65 and older qualify for Medicare. There are several different coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. Residents may also qualify for a Medicare Savings Program:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
North Dakota Insurance Department
- Website:
- Homepage
- Insurance Commissioner:
- Jon Godfread
- Insurance Hotline:
- (800) 247 – 0560
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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