Medicaid in North Dakota
North Dakota expanded Medicaid in 2014, covering adults aged 19 to 64 with household incomes up to 138% FPL (about $22,025 for a single person, or $45,540 for a family of four, for 2027 coverage). The state administers expansion through its Department of Health and Human Services. Roughly 19,000 North Dakotans are enrolled through Medicaid expansion.
New federal work requirements apply to expansion adults. States must start them by January 1, 2027 (a state making a good-faith effort can get extra time). Most expansion enrollees ages 19 to 64 will need to show 80 hours a month of work, school, job training, or community service. Parents of children under 14, pregnant people, people who are disabled or medically frail, American Indians, and some others are exempt. 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 2027
The North Dakota Insurance Department approved these average 2027 rate changes for individual plans, trimming two of the three requests:
- Blue Cross Blue Shield of North Dakota: 19.0% (requested 21.4%)
- Medica: 13.27% (requested 17.01%)
- Sanford Health Plan: 7.03% (approved as filed)
Here is the benchmark (second-lowest cost Silver) premium for a 40-year-old before subsidies, from HealthCare.gov plan data:
- Cass County (Fargo): about $494 per month, up from $465 in 2026
- Burleigh County (Bismarck): about $484, up from $456
- Grand Forks County: about $642, up from $604
- Ward County (Minot), Williams County, and Stark County: about $679, up from $628 to $639
About 41,000 North Dakotans picked a marketplace plan during 2026 open enrollment, according to CMS. The enhanced subsidies expired after 2025 and were not renewed, so for 2027 the subsidy cliff sits at 400% FPL ($63,840 for a single person, $86,560 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 (2027)
Three insurers offer individual marketplace plans in North Dakota for 2027, the same three as in 2026:
- Blue Cross Blue Shield of North Dakota offers plans statewide. It had the largest approved rate increase for 2027.
- Medicaoffers plans in 48 of the state's 53 counties for 2027. 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 sells plans statewide and is 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.
Most counties have all three insurers, though in remote western counties the practical choices may be limited by which insurer 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. All three marketplace insurers sell plans here, and Fargo and Bismarck have the lowest benchmark premiums in the state for 2027.
Bismarck-Mandan
Burleigh County (Bismarck) is the state capital area. Sanford Health and CHI St. Alexius Health are the major hospital systems. All three marketplace insurers 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. The 2027 benchmark premium here is about $194 a month higher than in Bismarck for a 40-year-old, 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. All three insurers offer plans in this area, though Altru's network inclusion varies by plan.
Estimate your subsidy
Subsidy Estimator
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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