With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in North Dakota, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in North Dakota
North Dakota placed 9th in United Health Foundation’s 2014 America’s Health Rankings.7 Its strengths include a low rate of drug deaths, a high rate of high school graduation, and few poor mental and physical health days per month. North Dakota’s biggest health challenges include a high prevalence of binge drinking, a high prevalence of obesity, and a high rate of occupational fatalities.
North Dakota individual and family health insurance
North Dakota voted against a state-based health insurance exchange, thereby defaulting to a federally facilitated health insurance exchange. The state’s residents can buy qualified health plans through the federal Health Insurance Marketplace website and may be eligible for income-based premium tax credits and cost-sharing subsidies when they do. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
North Dakotans may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit North Dakota’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 10,597 individuals in North Dakota selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in North Dakota enrolled in a marketplace plan increased to 18,171 during the open enrollment period.3
|North Dakota’s health insurance exchange:||healthcare.gov|
|North Dakota department of insurance:||nd.gov/ndins/|
North Dakota small group health insurance plans
Small business owners who live in North Dakota and have 50 or fewer employees may offer them access to coverage through the federal exchange’s Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from North Dakota’s federally facilitated exchange.
North Dakota COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
North Dakota’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2–19|
|Maximum continuation period – standard||39 weeks|
|Maximum premium Increase||100 percent|
|State legislation reference||N.D. Cent. Code Sec. 26.1-36-23|
|More information||800-247-0560 — North Dakota Insurance Department|
|Additional notes9||Employee and eligible dependents must be continuously cover under the group policy during the entire three-month period before qualifying event|
North Dakota high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.6
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
North Dakota’s federally run PCIP program ended April 30, 2014. 7
North Dakota Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).8
North Dakota expanded Medicaid to low-income adults without dependents in 2014.9 The information below is specific to North Dakota’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||North Dakota Department of Human Services|
|Where to apply||healthcare.gov / nd.gov/dhs/services/medicalserv/medicaid/apply.html|
|Phone number||701-328-2321 or 800-755-2604 / ND Relay TTY: 800-366-6888 or 711|
|Open-enrollment period||Year-round in all states|
|Eligibility||Based on income in relation to the federal poverty level and specific program eligibility guidelines|
North Dakota CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to North Dakota’s health insurance program for low-income children:
|How to apply||nd.gov/dhs/services/medicalserv/chip/|
|Phone number||877-KIDS-NOW (877-543-7669) / ND Relay TTY: 800-366-6888 or 711|
|Eligibility10||Uninsured children 18 and younger who live in families with qualifying incomes; single 18-year-olds with eligible incomes|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 North Dakota Insurance Department. “Quitting Job Soon and Worried About Losing Health Benefits.” http://www.nd.gov/ndins/consumers/health/#quitting.
5 North Dakota Legislative Branch. “Chapter 26.1-36 Accident and Health Insurance.” http://www.legis.nd.gov/cencode/t26-1c36.pdf?20141023105300.
6 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
7 Pre-Existing Condition Health Insurance Plan. “PCIP Coverage Ended April 30.” N.D. https://www.pcip.gov.
8 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
9 Centers for Medicare & Medicaid Services. “North Dakota.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/north-dakota.html.
10 North Dakota Department of Human Services. “Children’s Health Insurance Program (CHIP).” nd.gov/dhs/services/medicalserv/chip/.