NORTH DAKOTA HEALTH INSURANCE
For too long, too many hardworking Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hardworking families in North Dakota the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition. All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.
NORTH DAKOTA MEDICAL INSURANCE STATISTICS
Consider the following statistics about health care coverage in North Dakota:
Total North Dakota Residents – 617,589
North Dakota uninsured residents – 10.97%
Total North Dakota HMO enrollment – 16,667
Avg annual employee premium in ND employer-sponsored plan (after employer contrib): $754
Avg ND hospital cost per inpatient day (before insurance) – $958
NORTH DAKOTA HEALTH PLANS
NORTH DAKOTA INDIVIDUAL HEALTH CARE
In North Dakota, medical underwriting is allowed. There is a 6 month look back and 12 month exclusionary period for preexisting conditions for those without prior health coverage.
HIGH RISK POOL
North Dakota offers a high risk pool for medically uninsurable individuals called the Comprehensive Health Association of North Dakota. You may be eligible for this high risk pool due to your HIPAA rights, federally, or residentially. Federal requirements include living in North Dakota, being eligible for Trade Assistance and health tax credit or pension benefit guarantee corporation assistance, having at least three months of health coverage, not living in a jail or institution, not being enrolled in North Dakota’s medical assistance program nor having been in the past 12 months, and not having insurance through an employer that covers at least half of the premium or Healthy Steps, Chapter 55, title 10 or Medicare coverage. Residential, or standard, requirements include residing in North Dakota for the past 183 days, being denied health coverage or offered coverage with restrictions or at a higher rate than the high risk pool, having a specified qualifying medical condition, not being eligible for the federal program, not being an inmate or living in an institution, and not being enrolled in this program in the past 12 months.
Coverage under these high risk pool insurance plans include doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care.
NORTH DAKOTA GROUP HEALTH INSURANCE (SMALL BUSINESS: 2-50 EMPLOYEES)
In North Dakota, medical underwriting is allowed with plus or minus 35% of the indexed rate based on the health status of the group. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare.
MEDICAID IN NORTH DAKOTA
Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.
Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level
PREGNANT WOMEN AND INFANTS
Pregnant Women-133% of the Federal Poverty Level
Infants (ages 0-1)-133% of the Federal Poverty Level
Non-Working Parents-4% of the Federal Poverty Level
Working Parents-69% of the Federal Poverty Level
Medically Needy Individuals- 66% of the Federal Poverty Level
Medically Needy Couples- 51% of the Federal Poverty Level
Supplemental Security Income Recipients- 65% of the Federal
Hospital, nursing facility services, clinic services, rural health clinic services, hospice, physician services, prescription drugs, chiropractor, health tracks, home health services, durable medical equipment and supplies, dental care, family planning, sterilization, podiatry, mental health, ambulance, transportation, vision, therapies, waivered services – home and community based services, traumatic brain injury, out-of-state services.
Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.