North Dakota’s residents are known for their resilience. Everyone needs a little help sometimes, though, especially when it comes to health. Here’s everything about health insurance North Dakota residents need to know.
Get Heath Insurance in North Dakota
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The Best Health Insurance in ND:
- Best Overall in ND: Sanford Health Plan
- Best for Perks: Medica
- Best for Supplement Plans: BCBS of North Dakota
- Best for Seniors: UnitedHealthcare
- Most Affordable in ND: Humana
What is Health Insurance?
Health insurance is an arrangement between you and an insurance company. You agree to pay a premium. If you buy a policy on your own, you might pay monthly, quarterly or annually. You could have your employer deduct your premiums from your pay if you buy health insurance through your employer.
Health insurance companies agree to help pay your health care costs in exchange for your premiums. Health insurance companies usually have you pay a portion of the costs, though. These costs are called your out-of-pocket expenses. Most health insurance plans have you pay one or more of the following:
- A deductible: A deductible is an amount you pay for benefits covered by your plan before the plan starts paying. A $1,000 deductible means you pay $1,000 for covered services and items like prescription drugs or visits to a specialist. Deductibles are annual, which means you need to pay your deductible every year.
- A copayment: Your copayment (or copay) is a set dollar amount you pay for an item or service. You could have a $20 copay for brand-name prescription medications, for example.
- Coinsurance: Coinsurance is a percentage that you pay for covered services. Coinsurance usually starts after you meet your deductible. Your plan might require you to pay 20% of any ambulance rides, for example.
Your plan might cover some services before you meet your deductible. Let’s say you want to get your annual checkup. Many plans allow you to see your primary health care provider for preventive care if you pay your copay. This applies even if you haven’t met your deductible.
Average Cost of Health Insurance in North Dakota
Several factors impact your health insurance premiums:
- The number of people on your plan: Family plans are more expensive than individual plans.
- Tobacco use: People who don’t use tobacco products pay less in premiums.
- Age: Younger people have lower health insurance premiums than older people.
- Where you live: Each state can set rules regarding health insurance.
When it comes to how to get health insurance, many people get health insurance through their employers. In North Dakota, the average employee contribution for an individual plan is $1,246 per year, which is lower than the national average. The average employee contribution to a family plan is $4,982 per year, which is also lower than the national average.
If you don’t have access to employer-sponsored insurance, you may be able to purchase a plan through North Dakota’s health insurance marketplace. People 65 or older or on Social Security disability may qualify for Medicare. Low-income North Dakota residents might be eligible for Medicaid.
Insurers typically don’t offer discounts for health insurance. Some companies offer incentives for doing wellness-related activities like exercise or getting preventive screenings. These incentives vary by plan.
Types of Health Coverage
Another factor that impacts the cost of health insurance is the type of plan. Here are the most common plan options:
- HMO: The most affordable health insurance plans are often through health maintenance organizations (HMOs). HMOs have a network of providers. The insurance company contracts with providers and sets rates, which helps control costs. You need to get a referral to see a specialist. You may be able to see providers outside the network, but you may pay a lot more.
- PPO: A preferred provider organization (PPO) also has a network. PPOs are a bit more flexible than HMOs. You don’t usually need a referral to see a specialist. You will pay more if you see out-of-network providers, though.
- POS: POS plans have qualities of an HMO and a PPO. You have a network. You don’t need a referral to see in-network specialists, but you do need a referral to see out-of-network specialists.
- HDHP: High-deductible health plans can be an HMO, PPO, POS or any other type of plan. These plans have high deductibles, but they usually come with the option to open a health savings account. You can use a health savings account to set aside money to pay your deductible and other health costs.
When you’re considering plan options, keep the type of plan in mind. If you see specialists frequently, you may want a PPO instead of an HMO. If you don’t go to the doctor often, you might prefer an HDHP, since those plans usually have a lower premium.
What Does Health Insurance Cover?
In general, health insurance covers medically necessary care. Federal law has a standard set of services for plans offered through the state health insurance marketplace. Most insurance plans, even those offered outside the marketplace, cover these services:
- Services for children: Health insurance plans often cover a more extensive range of services for children than for adults. In addition to checkups and other health care services, health insurance plans usually cover vision and dental care for children.
- Prescription medications: Insurance plans usually cover prescriptions to manage or treat health conditions.
- Preventive care: Preventive care is essential to uncovering potential health issues. Most health insurance plans cover a wide range of screenings, which may vary by age, gender and lifestyle. For example, people who use tobacco or who used tobacco in the past may be eligible for lung cancer screenings.
- Lab tests: Lab tests are an important part of preventive care. Lab tests also help doctors diagnose illnesses and inform treatment.
- Inpatient care: Health insurance plans usually cover medically necessary inpatient care, which is care in a hospital or skilled nursing facility.
- Outpatient care: If you need an outpatient procedure, insurance will cover it as long as it’s necessary.
- Emergency services: Insurance plans are usually more flexible in emergencies. They allow you to seek care at the nearest facility rather than one that’s within your network.
- Mental health care: Most insurance plans cover behavioral health services. This may include counseling, psychiatric care and care for substance use disorders.
- Maternity care: This includes prenatal care, delivery, newborn care and breastfeeding support.
- Rehabilitative services and items: Insurance typically covers care to help people recover from an injury and manage disabilities and chronic health conditions. This includes coverage for items such as wheelchairs and walkers.
Some plans cover more, but these are the standard services you’ll see with most health plans.
What Does Health Insurance Not Cover?
Health insurance doesn’t cover elective services. Insurance companies don’t consider most elective services medically necessary, although many improve your quality of life. Services that aren’t usually covered include:
- Dental care for adults: Oral care is important, but most health insurance plans don’t cover it. You may be able to buy a separate dental plan, though.
- Vision care for adults: Vision exams for glasses and contacts aren’t covered unless you buy a vision plan. Health insurance plans usually cover eye conditions like cataracts.
- Hearing aids: Most health insurance plans don’t cover hearing aid fitting exams and hearing aids.
- Cosmetic surgery: Health insurance plans may cover cosmetic surgery related to a health condition. Most plans will not cover elective cosmetic surgeries.
Medicare doesn’t cover acupuncture or massage therapy. Other health insurance plans might cover these and other alternative services.
Best Health Insurance Providers in ND
Curious about North Dakota’s top health plans? Here are the 5 best health insurance providers, based on our research:
1. Sanford Health Plan
Sanford Health Plan received high marks from the NCQA for preventive care and treatment. The NCQA is a health insurance rating agency. Sanford offers a range of plans with varying deductibles.
You can also choose between HMO and PPO plans. You can manage many aspects of your plans via its website. Sanford also offers health coaching to help you manage any chronic health conditions.
Medica tied with Sanford Health Plan in its overall NCQA rating. Medica offers a wide range of plans, including catastrophic health plans and cost-share reduction plans.
Medica also offers different regional network options, so you can tailor your coverage to where you live. It provides several perks too, including personal health advocates, virtual care, online health programs and care at Mayo Clinic.
3. Blue Cross Blue Shield of North Dakota
Blue Cross Blue Shield of North Dakota offers individual and family plans. It also has Medicare supplement plans and employer plans. Its members rate the plan highly and it offers service centers throughout the state.
It has a range of plans, including catastrophic health plans and high-deductible health plans, which help keep your costs down. Blue Cross Blue Shield also has a history of paying claims fast, which will make your health care providers happy.
UnitedHealthcare offers Medicare Advantage plans and Medicare Supplement plans in North Dakota. AARP endorses its Medicare plans. Its Medicare Advantage plans are all PPOs, which give more flexibility when it comes to choosing a provider.
Its plans also include extras such as dental coverage, vision benefits, hearing aid coverage and chiropractic coverage. UnitedHealthcare also sells individual vision and dental plans to those who aren’t eligible for Medicare.
Humana also offers Medicare Advantage plans with and without prescription coverage. Its plans all have relatively low monthly premiums and are PPOs. Humana also includes vision and dental coverage. What sets it apart, though, is that it also offers a transportation benefit. Humana also offers Medicare prescription plans (known as Medicare Part D).
Choosing the Right Plan for You
Choosing a health insurance plan is a big decision. If you have access to insurance through an employer, review those plan options. Purchasing coverage through an employer is usually less expensive than purchasing it on your own. If you have limited means, consider applying to Medicaid. Its benefits can be a big help.