North Dakota Health Insurance 2026
Health insurance in North Dakota is sold through Federal (Healthcare.gov), with an estimated 10-20 plans available for 2026. The average Silver-tier premium is $490/mo before subsidies for a 40-year-old non-smoker. Medicaid status: Expanded.
Marketplace
Federal HC.gov
Federal (Healthcare.gov)
Avg Silver Premium
$490/mo
Before tax credits, age 40
Medicaid
Expanded
Affordable Care Act status
North Dakota 2026 Health Insurance Quick Facts
| Field | Value | Notes |
|---|---|---|
| Marketplace | Federal (Healthcare.gov) | Apply via Healthcare.gov |
| Open Enrollment 2026 | Nov 1, 2026 – Jan 15, 2027 | Special enrollment for QLEs year-round |
| Plans available | 10-20 | Bronze/Silver/Gold/Platinum tiers |
| Medicaid expansion | Expanded | Up to 138% FPL |
Premium and plan counts are estimates for 2026 based on prior-year filings and pending rate approvals. Always verify pricing on the marketplace itself before enrolling.
North Dakota's Small ACA Market and Quiet Bipartisan Medicaid Expansion
North Dakota has one of the smallest ACA marketplaces by enrollment, with 10–20 plans statewide. Sanford Health Plan and BCBS ND are the dominant carriers. Silver premiums average $480–$505/month for a 40-year-old before subsidies, reflecting the state's small risk pool and rural geography. North Dakota's oil patch communities in the west have seen population swings that complicate insurer planning. The state uses Healthcare.gov for marketplace enrollment. Network adequacy in the western oil country and the Native American reservation communities is a recurring concern.
North Dakota expanded Medicaid in 2014 with bipartisan support, a notable early expansion in a Republican-controlled state. The expansion has covered a relatively small number of residents given North Dakota's small population, but has had meaningful impacts on coverage rates in low-income communities and on reservation lands. The state has no state-based exchange or reinsurance program. North Dakota's strong economy relative to the rural Midwest means its uninsured rate is lower than many comparable agricultural states.
What to Know About Health Insurance in North Dakota
Top marketplace carriers
Leading 2026 ACA carriers in North Dakota: Sanford Health Plan, Blue Cross Blue Shield of North Dakota, Medica. Plan selection and network breadth vary widely by ZIP code — use the marketplace's plan-finder tool with your ZIP and household income for accurate availability.
Notable state rule
North Dakota expanded Medicaid in 2014 under a Republican-controlled legislature — one of the early bipartisan expansions — and has maintained it since.
Medicaid eligibility
North Dakota expanded Medicaid under the ACA. Adults under 138% of the Federal Poverty Level (FPL) qualify — about $20,800/yr for an individual or $43,000/yr for a family of 4 in 2026.
North Dakota Pro Tip
Health Insurance FAQs — North Dakota
Who runs the health insurance marketplace in North Dakota?
+
North Dakota uses the federal marketplace at Healthcare.gov. The state does not operate its own exchange.
How much does Silver-tier health insurance cost in North Dakota before subsidies?
+
A 40-year-old non-smoker in North Dakota typically pays about $480–$505/month for a Silver plan before subsidies.
Is Medicaid expanded in North Dakota?
+
Yes. North Dakota expanded Medicaid in 2014. Adults earning up to 138% FPL are generally eligible.
Related Guides
Marketplace data sourced from state and federal exchange filings for North Dakota, April 2026. Premium estimates are 2026-projected.
Jennifer Walsh
Editorial Lead, Health & Medicare
This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.
Reviewed April 2026
Get Insurance Rate Alerts
We monitor rate filings in all 50 states. Get notified when rates change in your area — and discover new ways to save.
- ✓State-specific rate change alerts
- ✓Seasonal enrollment deadline reminders
- ✓Expert tips to lower your premiums
- ✓New coverage options in your state
Free forever. Unsubscribe with one click. No spam, ever.
Important Disclaimer
This site provides general educational information only and is not a substitute for professional insurance advice. All rates, data, and coverage details are estimates and may not reflect your actual premiums. Insurance availability and pricing vary by state, insurer, and individual risk factors. Always consult a licensed insurance professional in your state before making coverage decisions.