Health Insurance Marketplace in North Dakota
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the Arkansas insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
North Dakota will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in North Dakota 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
The Great Plains Tribal Chairmen’s Health Board (GPTCHB) is a community based consumer focused non-profit that will provide enrollment assistance to American Indians residing on and near the eight Reservations in South Dakota and the four Reservations and one Indian Service Area in North Dakota and those residing in major urban areas served by Urban Indian Health Centers in these two States.
The North Dakota Center for Persons with Disabilities will use grant funds to establish a collaborative network of regional Navigators who already have established the trust of their neighbors. NDCPD will hire Regional Navigators stationed in each of the state’s eight Human Service Regions. Navigator support will be provided to currently uninsured and underinsured people, specifically targeting those most at risk of being uninsured in North Dakota, including people with mild disabilities, people with mental health disorders, farmers, young adults, Native Americans, small business persons, people who are unemployed and people who are drug or alcohol addicted.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in North Dakota
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Northland Healthcare Alliance ND – Health Care Innovation Award
- Sanford Health ND – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- Essentia Health Fargo Fargo, ND – BPCI Initiative: Model 2
- Family HealthCare Center Fargo, ND – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Coal Country Community Health Center Beulah, ND – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in North Dakota
In November 2012, Governor Jack Dalrymple (R) announced that North Dakota was not planning a state exchange.1 In the previous year, North Dakota had explored the possibility of a state-based exchange, spurred in part by enacted legislation stating North Dakota’s intent to create a health insurance exchange.2 The Insurance Department collected stakeholder feedback and identified a vendor to analyze the state’s demographics, insurance market, and policy options.3,4However, planning efforts halted after a second 2011 bill to establish an exchange failed.5
The legislative Health Care Reform Review Committee continues to receive regular updates from the Insurance Commissioner and Department of Human Services regarding the state’s planning and implementation of the Affordable Care Act.6 The Committee’s July meeting included a discussion of a state-federal partnership exchange and the possibility of the state taking over a federally-run exchange at a later date.7
Information Technology (IT): Although the state is not currently moving forward with building an exchange, it is focusing on improvements to North Dakota’s Medicaid eligibility system with the goal of ensuring a seamless connection with an exchange.8 The legislature passed HB 1475 which provides for an IT update of the Medicaid eligibility system within the Department of Human Services.9 This legislation, considered necessary for either a state- or federally-run exchange in North Dakota, was signed into law by Governor Dalyrmple on November 11, 2011.
In addition, the Health Benefit Exchange Interagency Planning Committee was formed by the Insurance Department in 2011 and includes the Department of Human Services, Information Technology Department, the Department of Human Services, the Governor’s Office, and the Office of Management and Budget.10 In 2012, the Committee shifted its focus away from exchange planning and towards upgrading the Medicaid eligibility IT system.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. The Health Care Reform Review Committee discussed EHB benchmark options after receiving a subcontractor analysis and public comments. On October 1, 2012, the North Dakota Insurance Department submitted Sanford Health Plan, an HMO plan, as the EHB benchmark.11 The state also submitted the Children’s Health Insurance Program (CHIP) as supplemental benefits for pediatric dental and vision services.
In September 2010, the North Dakota Insurance Department received a federal Exchange Planning grant of $1 million. The Department was denied the appropriation to use the funds until the legislature appropriated the funds during 2011 legislative session. The appropriation became available on July 1, 2011.
As of January 25, 2012, over three-quarters of the Planning Grant funds remained unspent.12 The Insurance Department proposed transferring the remaining funds to the Department of Human Services to allow for additional planning and development of the tools necessary to create a one-stop eligibility system for Medicaid and the exchange.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
North Dakota is participating in Medicaid expansion.
The federal government will assume full responsibility for running a health insurance exchange in North Dakota beginning in 2014.
1. Wetzel D. “ND GOP Leader Rethinking Options on Health Care Law, Says State Administration Possible.” The Republic. November 15, 2012.http://www.therepublic.com/view/story/a769f030589848afad9db0d40ae69867/ND–Health-Care-North-Dakota
2. HB 1126, North Dakota’s 2011 act announcing the state’s intent to create a Health Benefit Exchange. http://www.legis.nd.gov/assembly/62-2011/documents/11-8110-05000.pdf
3. Odney Advertising. “North Dakota Health Benefit Exchange Stakeholder Final Report.” September 23, 2011. http://www.nd.gov/ndins/uploads%5Cresources%5C689%5Cfinal-stakeholder-meeting-report.pdf
4. Health Technology Management Services (HTMS). “Health Benefit Exchange Planning Services: Narrative Summary.” December 2, 2011. http://www.nd.gov/ndins/uploads/resources/700/final-hbe-planning-narrative.pdf
5. HB 1474. North Dakota’s 2011 act to establish a Health Benefit Exchange.http://www.legis.nd.gov/assembly/62-2011/special-session/documents/11-0806-08000.pdf
6. North Dakota Health Care Reform Review Committee. http://legis.nd.gov/assembly/62-2011/docs/committeestructure/hc.pdf (Accessed September 5, 2012).
7. Minutes of the Health Care Reform Review Committee meeting on July 25, 2012.http://legis.nd.gov/assembly/62-2011/interim-info/minutes/hc072512minutes.pdf
8. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.
9. HB 1475. North Dakota’s 2011 Act to Provide Appropriations for Certain Medical Services, Health Insurance, Economic Assistance, and Information Technology and Programs.http://www.legis.nd.gov/assembly/62-2011/special-session/documents/11-0836-02000.pdf
10. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.http://www.nd.gov/ndins/uploads/resources/702/final-report.pdf
11. North Dakota EHB Communication (Accessed November 16, 2012).http://www.statereforum.org/sites/default/files/ehb_communication.pdf
12. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.
Also of interest
Provided by the Henry J. Kaiser Family Foundation