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North Dakota Health Insurance

North Dakota Medical Insurance Overview
The state of North Dakota has a high ranking when it comes to the overall health of its residents. In 2012, it was ranked in eighth place, but it has since dropped to 12th when compared to the other states in the country.  With the implementation of the Affordable Care Act, the population of insured residents in North Dakota is expected to see growth.

Along with that growth, the rest of the nation will see individuals who are insured numbering in the millions throughout the year 2020.  While the percentage of people without insurance coverage is lower than the national average, there are residents in this state who don’t have coverage at all.

The Affordable Care Act is a step in the right direction when it comes to the healthcare of people living in this country.  As the legislation mandated health benefits exchanges across the country, many people in North Dakota and nationwide will see benefits for years to come.

North Dakota’s Health Care Issues
The overall health of the residents in North Dakota is pretty good, but there are challenges that residents in this state face with regard to health care and insurance.  When compared to the rest of the country, North Dakota ranks in 12th place, according to statistics revealed by the United Health Foundation.  The information below represents some of the strengths and weaknesses that are exhibited in the state of North Dakota:

Low levels of air pollution
Few poor physical health days
Low rate of drug deaths

High prevalence of excessive drinking
High occupational fatalities rate
High prevalence of obesity

Understanding North Dakota’s Uninsured Population
According to information provided by the Kaiser Family Foundation, 9% of residents in North Dakota are uninsured as of 2014.  This is roughly in line with the national average.

The number of uninsured residents is represented as follows:

  • 0% of children up to age 18 are uninsured, which is a plus for the state
  • Of adults aged 19 to 64, 11% have no insurance coverage
  • 44% earn between 100% and 199% of the Federal Poverty Level
  • 9% earns between 200% and 399% of the FPL
  • 4% earns over 400% of the FPL and are still not covered by insurance

Group Health Plans
In the state of North Dakota, 59% of workers are covered under group plans provided by their employers or trade unions.  These plans provide the best possible opportunity for coverage that is affordable and offers many coverage options.  This is a great option if you are employed in North Dakota because the insurance company can spread the amount of risk over a pool of participants.  Another benefit is that companies usually pay part of the premiums associated with coverage.

In the state of North Dakota, the Insurance Department regulates private insurance companies.

Signing Up
Signing up for coverage can usually be done during the company’s designated enrollment period.  These periods usually take place once every year and you can glean this information from a representative in your Human Resources department.

When you sign up for your employer’s group plan, your premiums will be automatically deducted from your pay each pay period.  Typically, group plans include two or more options from which you can choose and have different coverage and prices.  Keep the following factors in mind before you decide to enroll for coverage in your employer’s group plan:
Dependents: Do you need to cover your spouse and/or children?
Health condition: Are you suffering from a pre-existing condition?  Do you foresee having any medical needs in the future?
Costs: Is the coverage affordable?  You will have to pay monthly premiums to get coverage.

Pre-Existing Condition Exclusion Periods
Insurance providers of group plans cannot exclude you from getting coverage altogether, but they can apply a pre-existing condition exclusion period if this is applicable to your situation.  This exclusionary period is usually 12 months before you can use your insurance benefits.  In addition, the look back period is six months that an insurance provider can use to determine whether or not you have a pre-existing condition.

Affiliation or Waiting Periods
Waiting periods can usually last two to three months, depending on if you enroll in time or late.

Individual Health Plans
If your employer does not offer health insurance or you can’t otherwise obtain group health coverage, you can apply for coverage under an individual insurance plan.  This plan type is great for self-employed people to get coverage, but there are higher deductible amounts that go along with this sort of coverage.

According to estimates, a healthy young person residing in North Dakota can get an individual plan for roughly $50 monthly.  In North Dakota, pre-existing conditions may be covered, but there are limitations associated with coverage under this plan type.  Elimination riders are not permitted under individual policies in North Dakota.

Continuation Coverage
For those who lose insurance coverage due to a job loss or divorce, COBRA coverage is available.  Under COBRA, you can receive benefits for up to 18 months.  Eligibility is strictly dependent on the amount of employees the issuing company had under their employ.

A conversion plan is also available for those who want the same benefits that were provided under a group plan.  Conversion plans transform the plan’s benefits to an individual policy, allowing you to keep the same insurance provider.

North Dakota Health Benefit Exchange
The state of North Dakota has defaulted to a federally managed benefits marketplace and as such, the marketplace was active for residents in 2014.  A state-run exchange was under consideration in 2011, but failed to pass.  Inquiries into a state-run exchange stemmed from the mandates on all of the states under the Affordable Care Act.

Each benefits exchange has been implemented in order to provide health insurance options for the state’s residents.  See the information provided by the Henry J. Kaiser Family Foundation for more details on the health benefits marketplace in North Dakota.

North Dakota State Insurance Programs
In the state of North Dakota, 24% of the residents are covered by state-sponsored health insurance options.  These plans offer a variety of coverage options for people in the state who have low incomes and are unable to get coverage through other means.  In order to qualify for these options, factors like age, income, health status and sex are all used in determining eligibility.

Provided below is a detailed summary of each program available to North Dakota residents:

Comprehensive Health Association of North Dakota (CHAND)
This program offers coverage to people who have had trouble getting insurance benefits because of a pre-existing medical condition.  CHAND has two options available that are comprehensive in nature and have either a $500 or $1,000 deductible.  Using this program, you can have doctor’s visits, prescription medications, labs, x-rays, home health visits, skilled nursing care services and more.  In order to be eligible, you must show proof that you have a pre-existing medical condition.

Pre-Existing Condition Insurance Plan (PCIP)
This program is a comprehensive plan that offers coverage to people who have pre-existing conditions.  In order to qualify, you must have gone without insurance benefits for a period of six months before enrolling into the program.

The Medicaid program is for low income earners so they can get coverage for basic medical services, preventive medicine and prescription medications.  In order to be eligible, your income will be taken into consideration.  New residents in North Dakota may have to wait a period of five years before they are eligible for coverage under Medicaid in North Dakota.

Healthy Steps
Healthy Steps offers comprehensive coverage to kids whose families earn low incomes.  Included in the medical services covered are prescription medications, prenatal care, preventive medicines, substance abuse and mental health care.  To qualify, a child must be under the age of 19 whose families earn 160% of the Federal Poverty Level.

Women-Infants-Children (WIC)
WIC offers low income pregnant women and new mothers the ability to get supplemental foods, educational resources and breastfeeding support.

Caring for Children
This program offers children whose families earn moderate levels of income the ability get medical services covered.  To qualify, income guidelines must be met and coverage includes doctor’s visits, vaccinations, diagnostic tests and emergency accident care.

Children’s Special Health Services
Children who are uninsured and have pre-existing conditions who have families that earn moderate levels of income are able to get coverage through this program.  In order to be eligible, you must be under 21 and have a qualifying condition.  Also, your family must earn under 185% of the FPL, but if the family unit earns a higher income, a contribution to the costs will be required.

Women’s Way
This program offers help for women with breast cancer screening services.  Covered under Women’s Way are pelvic exams, breast exams, and pap tests.  Eligibility is based on income, age, and enrollment in Medicaid or Medicare.

Indian Health Services
Individuals part of the Indian community or women pregnant by a qualifying member can get health benefits through IHS.  Included in the covered services are pediatric, optometry, diabetes care, emergency care, medical supplies and more.

Health Coverage Tax Credit
This is a tax credit that helps those receiving trade assistance get health insurance benefits.  This covers medical care services such as in and outpatient care, doctor’s visits, major medical care, durable medical equipment and preventive care services.

Medicare and the Medicare Prescription Drug Program
For seniors and the disabled in North Dakota is the availability for coverage under the Medicare program.  There are four parts to Medicare, with each offering a different level of service or product.  In order to be eligible, you must be over the age of 65 and have worked in a Medicare covered job for at least ten years (or have a spouse who meets this condition).  Also covered are persons suffering from end-stage renal disease.

VA Medical Benefits Package
For military veterans, there is the VA Medical Benefits Package.  This program is comprehensive in nature and offers a great deal of services to vets who have completed at least 24 months of consecutive service.  To qualify, you must have received an honorable discharge from any branch of the military.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance is a free program that offers to connect consumers with 475 programs to get help with paying for prescription costs.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a nationwide program aimed at helping the mentally ill get access to resources and information pertaining to their illness.

The Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 to guarantee the protection of private medical information for consumers.  It also offers a great deal of protections to consumers with regard to health insurance providers.  It prohibits group coverage from being denied to those suffering from pre-existing conditions, controls costs of premiums and regulates waiting and exclusionary periods.