Health Insurance in North Dakota

Medicaid in North Dakota

North Dakota expanded Medicaid in 2014, covering adults aged 19 to 64 with household incomes up to 138% FPL (about $20,780 for a single person in 2026). The state administers expansion through its Department of Health and Human Services. Roughly 19,000 North Dakotans are enrolled through Medicaid expansion.

In 2017, the state legislature added a work-reporting requirement for Medicaid expansion enrollees, though implementation and enforcement have varied. Traditional Medicaid covers children, pregnant women, elderly individuals, and people with disabilities at varying income thresholds.

North Dakota's uninsured rate is approximately 6.2%, with about 48,000 residents lacking coverage. The state's strong oil and agriculture-based economy supports a robust employer-sponsored insurance market, keeping the uninsured rate below the national average.

What plans cost in 2026

North Dakota marketplace premiums are moderate. A benchmark Silver plan for a 40-year-old runs roughly $500 to $600 per month before subsidies, though prices vary by county. Western counties near the Bakken oil fields tend to have somewhat higher premiums due to increased demand for healthcare services.

North Dakota had roughly 25,000 marketplace enrollees in 2025. With the enhanced subsidies expiring after 2025, the subsidy cliff returns at 400% FPL (about $62,160 for a family of two). For a small-population state, even modest enrollment drops can affect the risk pool and push premiums higher in future years.

Carriers in North Dakota (2026)

Two insurers offer individual marketplace plans in North Dakota for 2026:

• Medica offers plans across most North Dakota counties. Medica, headquartered in Minnesota, has been a steady marketplace presence in the state. They offer both HMO and PPO options depending on the county, with networks that include many of the state's major healthcare systems.
• Sanford Health Plan is the local option, backed by Sanford Health, one of the largest rural health systems in the country. Sanford operates hospitals, clinics, and specialty centers across North Dakota. Their marketplace plans include direct access to the Sanford network, which is particularly strong in the Fargo and Bismarck areas.

Having two carriers statewide provides some competition, though in remote western counties, the practical choices may be limited by which carrier has a meaningful provider network nearby.

Key regions

Fargo-Moorhead metro

Cass County (Fargo) is North Dakota's largest population center. Sanford Medical Center Fargo and Essentia Health (which operates a major hospital in Fargo) are the anchor systems. Both marketplace carriers operate here, and this area generally has the lowest premiums in the state due to provider competition.

Bismarck-Mandan

Burleigh County (Bismarck) is the state capital area. Sanford Health and CHI St. Alexius Health are the major hospital systems. Both marketplace carriers serve this region. As the government center, Bismarck has a mix of state employees on group plans and individual market consumers.

Western oil counties (Williston, Dickinson)

Williams County (Williston) and Stark County (Dickinson) experienced a population boom during the Bakken oil rush. Healthcare infrastructure was slow to catch up. CHI St. Joseph's Hospital in Dickinson and CHI Mercy Medical Center in Williston serve the region. Premiums may be higher here, and specialist access often requires travel to Bismarck or Minot.

Grand Forks and northeast

Grand Forks County is served by Altru Health System, the major regional provider. The University of North Dakota School of Medicine is based here. Both carriers offer plans in this area, though Altru's network inclusion varies by plan.

Estimate your subsidy

North Dakota-specific things to know

Geography is the biggest access challenge. North Dakota covers nearly 71,000 square miles with fewer than 800,000 people. If you live in a rural area, your nearest in-network hospital might be 60 to 100 miles away. Check provider directories carefully and consider whether the plan's network has adequate coverage near you.

Sanford Health's dual role. Sanford Health is both a major healthcare provider and a marketplace insurer. If you use Sanford doctors and hospitals, the Sanford Health Plan will naturally have those providers in-network. If you prefer non-Sanford providers (like Essentia or CHI), check whether they are covered before choosing the Sanford plan.

Navigator and enrollment help. North Dakota has certified navigators available through community action agencies and tribal organizations. Native Americans in North Dakota may qualify for additional ACA protections, including cost-sharing reductions regardless of income and special enrollment periods.

Resources

• HealthCare.gov for marketplace enrollment (North Dakota uses the federal marketplace)
• ND HHS Medicaid for Medicaid eligibility and enrollment
• Community Action of North Dakota for enrollment assistance and navigator services