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North Dakota Health Insurance

North Dakota Individual Health Insurance

In North Dakota, medical underwriting is allowed. There is a 6 month look back and 12 month exclusionary period for preexisting conditions for those without prior health coverage.

High Risk Pool

North Dakota offers a high risk pool for medically uninsurable individuals called the Comprehensive Health Association of North Dakota. You may be eligible for this high risk pool due to your HIPAA rights, federally, or residentially. Federal requirements include living in North Dakota, being eligible for Trade Assistance and health tax credit or pension benefit guarantee corporation assistance, having at least three months of health coverage, not living in a jail or institution, not being enrolled in North Dakota’s medical assistance program nor having been in the past 12 months, and not having insurance through an employer that covers at least half of the premium or Healthy Steps, Chapter 55, title 10 or Medicare coverage.

Residential, or standard, requirements include residing in North Dakota for the past 183 days, being denied health coverage or offered coverage with restrictions or at a higher rate than the high risk pool, having a specified qualifying medical condition, not being eligible for the federal program, not being an inmate or living in an institution, and not being enrolled in this program in the past 12 months.

Coverage under these high risk pool insurance plans include doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care.

North Dakota Group Health Insurance (Small Business: 2-50 employees)

In North Dakota, medical underwriting is allowed with plus or minus 35% of the indexed rate based on the health status of the group. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare.

North Dakota COBRA Individual Health Coverage

North Dakota offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death or divorce.

Medicaid in North Dakota

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Income requirements

Children
Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level

Pregnant Women and Infants
Pregnant Women-133% of the Federal Poverty Level
Infants (ages 0-1)-133% of the Federal Poverty Level

Parents
Non-Working Parents-4% of the Federal Poverty Level
Working Parents-69% of the Federal Poverty Level

Other populations
Medically Needy Individuals- 66% of the Federal Poverty Level
Medically Needy Couples- 51% of the Federal Poverty Level

Supplemental Security Income Recipients- 65% of the Federal Poverty Level

Covered Services
Hospital, nursing facility services, clinic services, rural health clinic services, hospice, physician services, prescription drugs, chiropractor, health tracks, home health services, durable medical equipment and supplies, dental care, family planning, sterilization, podiatry, mental health, ambulance, transportation, vision, therapies, waivered services - home and community based services, traumatic brain injury, out-of-state services.

Co-Payments
Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about North Dakota Medicaid at http://www.nd.gov/dhs/services/medicalserv/medicaid/

Click here to learn about North Dakota Medicare plans.

Other North Dakota Health Insurance Programs

North Dakota offers two programs to children under the age of 18 who are North Dakota residents and U.S. citizens or legal residents, whose family income is up to 140% of the Federal Poverty Level, and who do not qualify for Medicaid. Please visit the CHIP website for more detailed information at http://www.nd.gov/dhs/services/medicalserv/chip/ and the Caring for Children website at http://www.ndcaring.org/