North Dakota is also referred as the Peace Garden State that commemorates the International Peace Garden. Located on the border of North Dakota and Canada, the state’s natural resources play a key role in the state’s economic performance. This Peace Garden State finds itself in 17th place when it comes to health rankings though residents can put little more effort on improving their health. North Dakota has joined the federal marketplace, so residents of the state utilize HealthCare.gov for healthcare plans enrollment. North Dakota in 2020 starting will have a reinsurance program that will reduce health insurance premium for individuals and families by 8-20% than they would otherwise have been. This reinsurance program was created to stabilize the state’s individual insurance market and to ease the heavy burdens that the state health insurance market was facing. This will further results in average premium rate dropping by nearly 6% in 2020, which without reinsurance would have increased by nearly 15%.
Highlights and Updates
- North Dakota uses the federally run health insurance marketplace and so its residents can enroll for health plans at HealthCare.gov.
- North Dakota open enrollment for 2020 coverage started from November 1 and will end on December 15, 2019. Outside this window residents will require a qualifying event to enroll.
- Short-term health plans in North Dakota is available with initial plan terms of up to 185 days, but as per the new state law, insured can renew their short-term plans but the total duration cannot exceed 12 months period.
- The average health insurance premium rate is decreasing by 6% in 2020 due to reinsurance, without it, they would have increased by 15% in the coming year.
- Three insurance carriers are offering health plans through the exchange for 2020 coverage in North Dakota.
- A legislation was enacted by the state to design a reinsurance program and the state received federal approval for their 1332 waiver to implement the health program in 2020.
Individual & Family Health Insurance Plans in North Dakota
North Dakota residents can choose health insurance plans offered to individuals and families from participating private insurers through HealthCare.gov, the federal exchange. As per the Affordable Care Act mandate, all qualifying health insurance plans in North Dakota should be either Gold, Platinum, Silver or Bronze. Each metal plan is based on the average amount of healthcare costs it will cover. Like for all Platinum level plans, the insurance company pays 90% of the healthcare cost and 10% cost is paid by the insured. Platinum is the highest level of metal plan and the Bronze plans are the lowest in which the insurance company pays 60% of the medical cost and insured pay 40% of the cost. The health plan premium amount of the qualifying metal plans usually depends upon the applicant’s age, tobacco use, area where they live and the number of family members enrolling with the applicant. Health insurance plans available for individuals and families in North Dakota include:
PPO – Preferred Provider organization is a managed care organization comprising of healthcare professionals and facilities like primary and specialty physicians, hospitals and other medical professionals. Insurance companies have a contract with these professionals to render services to the subscribed members at an agreed-upon reduced rate. PPO plan members are free to avail healthcare services from any provider within the network. Though, out-of-network care is also available but it costs more for the insured. Members of the PPO plans have to pay a co-payment per provider visit or they need to meet a deductible before insurance companies pays the claim. PPO plans have higher premiums because they are costlier to manage and administer however these plans offer much more flexibility compared to other plans.
HMO – HMO plans are popular in the health insurance marketplace, which provide coverage through a network of physicians. HMO plans require members to choose a primary care physician and to see a specialist, members will require to obtain a referral from their primary care provider. The HMO plans provide coverage for a broader range of preventative services compared to other plans and members may or may not be required to pay a deductibles before the starts of the coverage though they will have to pay a copayment. HMO plans are the least expensive and these plans often appeal to individuals who are looking for health plans with lower premiums and out-of-pocket costs like copays and deductibles.
HDHP with HSA – High Deducible Health Plans usually feature with a Health Saving Account in which members can save money pre-tax to pay for qualified medical expenses. High Deductible Health Plans have lower premiums and generally suit individuals who do not require a lot of medical care and if they are young and healthy. These plans may prove expensive to older individuals. In HDHP, members will pay less upfront casts in terms of premiums and they will pay higher deductibles meaning that they will pay more from their pocket if they need health care.
POS – POS or Point of Service plans are a mix of PPO and HMO plan, which allow plan members to choose whether HMO or PPO services each time they visit a healthcare provider. POS plans are quite similar to HMO plans, as members are required to choose an in-network physician as their Primary Care Provider. However, members are allowed to see an out-of-network physician by paying a higher fee. The POS plans are ideal for individuals who wants to have a Primary Care Physician managing and coordinating their health and who go out of network for receiving healthcare.
Fee-for-Service – Fee-for-service plans or indemnity plans, though not popular in every state but these plans offer greater flexibility to members for choosing doctor and hospital of their choice. The members of this plan have to first directly pay for their healthcare cost and later on they file the paperwork with their insurance companies to avail reimbursement for their charges. Like other health plans even FFS plan require members to pay deductibles and co-payments for their medical services.
Short-term Health Insurance in North Dakota
North Dakota limits short term plans, as these plans are not available for more than 185 days and allows only one renewal, so the maximum duration of the plan can be up to 12 months. The short-term plans are a great solution for individuals who are between jobs, waiting for their group coverage to start or if one is a recent college graduate. The short term plans coverage is not as comprehensive as the coverage of ACA-compliant plans and they do not cover all the types of health care that people get with an ACA compliant plan. Preventive health care or mental health treatment is usually not included in this plan. There is a cap on the coverage of short-term plans and these plans do not cover any pre-existing conditions. People with pre-existing conditions are denied of short-term plans. Insurance companies offering short-term plans use medical underwriting to reduce their risk pools and hence offer coverage to healthier enrollees that also allow them to keep the cost down. If the enrollees of short-term plan develop a new illness or injury, then their plan will not be renewed for an additional term.
Carriers Offering Short Term Policies in North Dakota
- Standard Life
- National General
Dental Insurance Plans in North Dakota
Dental insurance in North Dakota works exactly like the medical insurance, where members have to pay a certain premium amount to receive dental benefits such as cleanings, regular check-ups, x-rays and other dental services that promote general health. Some of the dental plans in North Dakota also provide coverage for some types of oral surgery, dental implants or orthodontia. Dental insurance plans in North Dakota are often categorized as:
Indemnity Plans – Indemnity dental plans in North Dakota provide a broader election of dentists compared to managed care plans. In these plans, insurance companies pay for the covered dental services after receiving the bill, which means that members have to pay upfront and later on obtain reimbursement from their insurance carrier.
Managed-Care Plans – Managed care dental plans maintain a network of dentists, who agree to participate in a network to render dental care services at pre-negotiated rates. Later on they submit their claim to the dental insurance companies on behalf of the plan’s member. This plan has less paperwork and lower out-of-pocket costs.
Vision Insurance in North Dakota
Individuals looking for vision insurance in North Dakota can purchase through the private health insurance carrier who offer some specialized and customized plans designed as per the needs of the masses. Most of the vision insurance plans offered in the state cover preventive, maintenance and surgical procedures that include routine eye exams, corrective eye wear surgeries, regenerative therapies and physical therapies for eye. Cost of the vision insurance plans varies from one insurance carrier to another.
North Dakota Insurance Carriers for 2020 Coverage
Insurance carriers that are operational in North Dakota for offering 2020 coverage include:
- Blue Cross Blue Shield of North Dakota