Are you searching for comprehensive coverage for you and your family at an affordable price? Doing so in North Dakota is actually a lot easier than you might think. You have a ton of options – from major medical, to short-term health insurance, to health share plans, and more – all available at your fingertips. We’re going to discuss these options in greater detail below. So if you’re struggling to find a plan that fits your needs and your budget, we’ve got the info you need to make the best possible decision.
Major Medical Insurance in North Dakota
Major medical coverage is another name for the special types of health insurance policies which are sold through the federal Health Insurance Marketplace. The Health Insurance Marketplace was established once the Patient Protection and Affordable Care Act was passed into law back in 2010. The Marketplace opened for business and started selling major medical coverage to consumers in 2014. People who need affordable and comprehensive healthcare coverage can go there every year starting on November 1st during Open Enrollment and fill out an application on HealthCare.gov to see if they qualify for coverage, as well as federal subsidies that make these policies more affordable.
But what happens if you need health care coverage outside of the Open Enrollment period? Then you might have to wait until the next Open Enrollment period comes around, relying upon something like short-term health insurance or a health share plan in the meantime. Or you might qualify for a Special Enrollment Period If you have extenuating circumstances. Sometimes those circumstances can be something as simple as the birth of a child or moving to a new zip code. But you won’t know unless you go to HealthCare.gov and read about Special Enrollment Periods or contact a representative who can answer more of your questions.
Major medical coverage sold through the Health Insurance Marketplace is very different from coverage sold outside of the Marketplace. One of the main reasons for this is that the major medical coverage sold in the Marketplace is guaranteed issue. This means that once you apply and qualify for coverage, no provider can reject you if you decide to purchase their policy. This is true even if you have a pre-existing condition or poor health. Guaranteed issue policies are also not allowed to cost more in monthly premiums based on your health status. The only things which can make a guaranteed-issue major medical policy cost you more in monthly premiums is if one of the following four factors makes it more costly to ensure you:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Then there are the guaranteed Essential Health Benefits promised by the ACA. These guaranteed benefits come with every single health insurance product sold through the Federal Health Insurance Marketplace. The legislation mandates these benefits because when consumers have access to things like preventative care, lab tests, and mental health counseling (among other benefits), it helps them manage their care in ways that lower the total costs of their healthcare over the long term:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
For most Americans, guaranteed issue major medical policies with such a comprehensive list of benefits would be prohibitively expensive – if not for the federal subsidies, that is. If you make at least 138% of the federal poverty limit in the state of North Dakota, you will likely qualify for a premium tax credit. Premium tax credits are a direct payment from the government to your insurance provider which makes the cost of your monthly insurance premiums much, much more affordable. Without these tax credits, many people wouldn’t be able to afford such good insurance. You can use the chart below to figure out whether or not you and your household qualify for one of these beneficial tax credits:
|Household Size||Annual Income (138% of FPL)|
Some people might be surprised to learn this, but North Dakota was one of the earliest adopters of the Medicaid expansion program that came with the ACA legislation. This means that anyone who makes less than 138% of the federal poverty limit may be eligible to apply for Medicaid within the state of North Dakota. Before the ACA was passed into law, the maximum annual income to qualify for Medicaid was much lower. But qualifying for Medicaid in the state of North Dakota is based on more than just income alone. To find out more information on what those qualifications are and whether or not they apply to you, you should visit the North Dakota Medicaid official state website.
Short Term Health Insurance in North Dakota
If a state doesn’t impose its own laws, rules, and regulations on short-term health insurance products, then the law defaults to federal regulations. For the most part, short-term health insurance in North Dakota does default to the federal standards – with the exception health plan duration. In the state of North Dakota, short-term health insurance is only allowed to last 6 months, and you might not be able to renew with the same company if you would like to extend your coverage. Other than that, short-term health insurance in North Dakota is pretty standard – especially when it comes to things like a medical underwriting, annual and lifetime caps on your benefits, and the fact that these plans are not as comprehensive as a major medical policy.
Medical underwriting is a fancy way of saying that your short-term health insurance provider can choose to deny you coverage if they feel you are in poor health or if they believe you have pre-existing medical conditions. Because this would make you very expensive to insure and therefore a risky Investment, they will either deny you coverage in order to protect their profit margins or charge you a substantially higher monthly premium in order to hedge their bets. Many short-term health insurance policies come with high deductibles, sometimes as high as $5,000 or more, which means you will have to pay $5,000 out-of-pocket before your insurance provider starts paying out your claims. Still, it can be beneficial to purchase a short-term health insurance policy if you cannot afford or choose not to purchase major medical coverage through the Marketplace. And having to pay a $5,000 deductible in the face of a medical emergency you weren’t expecting can be substantially cheaper than having no coverage at all and having to pay 100% of your medical costs out-of-pocket.
Christian Health Plans/Health-Sharing Plans in North Dakota
If you’re looking for health care coverage outside of the ACA Marketplace, another option you might want to look at as a Christian health plan. Also known as health share plans, Christian health plans provided consumers with a less expensive exemption to the individual mandate back when it was the law of the land. Now that the individual mandate is no longer a requirement for North Dakota residents, short-term health insurance is much more competitive with Christian health plans because they offer consumer protections that health share plans don’t. But for those who find solace in their particular faith, finding a health share plan organization that celebrates their chosen faith might provide a better incentive than a short-term health insurance plan.
The funny thing is that most Christian health plans actually have a lot in common with short-term health insurance. For example:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed essential health benefits
One thing Christian health plans will have that short-term health insurance won’t are participation guidelines that you must follow in order to be a part of the organization. At the bare minimum, this involves declaring a specific faith and usually also involves the elimination of all tobacco use. Quitting tobacco is one of the best ways you can improve your health and also lower your total medical costs. But certain health share plan providers may require you to follow more intricate participation guidelines than that, and they are usually based on biblical practices and teachings. Lastly, the lingo is a little bit different. You’ll be paying a monthly share amount instead of a monthly premium; and instead of a copay, coinsurance fee, or deductible, you’ll be paying an uninsured amount or a personal responsibility amount. These differences may seem pretty minor, but for some consumers, they can make a big difference.
Fixed Indemnity Plans in North Dakota
Were you thinking about a fixed indemnity plan in North Dakota? Fixed indemnity plans can make a great supplement if you already have something like major medical coverage; if not, they fall pretty far short of being an adequate replacement for major medical coverage (but that doesn’t always stop people from using them for this purpose). Fixed indemnity plans pay out a fixed amount as opposed to a total percentage of your medical costs for things like doctor visits, hospital care, dental services, or more. These payouts are usually based on a per day, per week, per month, per visit, or per-incident basis depending on your plan.
Unlike major medical coverage, fixed indemnity plans will require medical underwriting. This means that if you don’t get rejected for coverage based on pre-existing conditions, having a poor health status will mean that you get charged a significantly higher premium for your coverage. Fixed indemnity plans also come with lifetime caps on your benefits with no caps whatsoever on your total medical costs. But fixed indemnity plans are a good way to get the care you need if your current health plan has a restrictive HMO or PPO network (there are no networks with fixed indemnity plans) or if you need help with your out-of-pocket costs due to things like high deductibles and co-pays. And, yes, fixed indemnity plans can take the edge off of your out-of-pocket costs if you have no other form of coverage – but they certainly won’t cover as much as most of the other options we have discussed so far.
Discount Cards in North Dakota
Are you thinking about purchasing a membership with a medical discount card in North Dakota? Most medical discount cards pertain to prescription expenses only, but you might be able to also get discounts on doctor visits and other medical care if you find the right provider. They work similarly to something like the AARP or the AAA Club. You pay a monthly or annual membership fee and receive a discount card in the mail. When you present that card at participating medical establishments, such as a pharmacy or a doctor’s office, you’ll get a small discount off your total cost. You won’t have to file any claims or wait for reimbursements. It’s a great way to supplement your care if you already have major medical coverage or something similar and want to save a little money.
But medical discount cards are not major medical coverage, nor are they an adequate replacement for it, and they should never be misconstrued as such. There are unfortunate numbers of scams associated with medical discount cards that consumers need to be aware of before they purchase one. Be sure that the company who is offering you the card is not advertising it as a health insurance replacement, because it is absolutely not. Also double-check to make sure that they work with the providers they say they do, and that they offer the discounts they say they will. You could end up losing money if the membership fee you pay costs you more than the amount of money you saved in discounts. But there are plenty of medical discount card companies out there who will save you a good deal of money in discounts compared to the monthly or annual membership fee, which can help you take a little bit of the sting out of your out-of-pocket medical costs.