North Dakota Health Insurance
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Place in State
Health Report Card 12th
- Insured 557,318
- Uninsured 70,800
Primary Care Physicians NSD
Average Cost of
Health Insurance* $754
- Employer-sponsored health insurance 64%
- Private plans 10%
- Medicaid 10%
- Medicare 15%
- Others 1%
In the past year, the rate of preventable hospitalizations decreased
from 69.0 to 64.1 discharges per 1,000 Medicare enrollees.
In the past year, the percentage of children in poverty increased from 14.4 percent to 16.1 percent of persons under age 18.
In the past ten years, diabetes increased from 5.2 percent to 7.4
percent of adults. There are now 39,000 adults with diabetes in the
In the past ten years, obesity increased from 20.4 percent to 27.9
percent of adults; now, there are 146,000 obese adults in North Dakota.
While smoking has decreased from 23.2 percent to 17.4 percent of
adults in the past ten years, 91,000 adults still smoke in the state.
North Dakota health insurance companies and set premiums. But there are a few exceptions. If you are HIPAA-eligible, insurers cannot impose restrictions on coverage or deny your application. HIPAA is a federal law that protects individuals who have recently left a group health plan with an employer. You can learn more about HIPAA here. North Dakota state law also requires every insurance company to offer a basic standardized health plan. These plans are required to provide coverage for certain medical services, such as screening for breast and prostate cancer. North Dakota health insurance companies must follow “mental health parity,” which means mental health conditions must have the same coverage benefits and physical conditions. Uninsured residents of North Dakota who cannot find a plan in the private market can purchase coverage through the state’s high-risk pool, the Comprehensive Health Association of North Dakota (CHAND).
Small business tax credits. 17,700 small businesses in North Dakota could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 9,050 Medicare beneficiaries in North Dakota hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in North Dakota who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 6,320 people from North Dakota retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 403,000 North Dakota residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 63,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across North Dakota peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 340,000 residents of North Dakota with health insurance from their employer, along with anyone who signs up with a new insurance plan in North Dakota.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 2,630 individuals in North Dakota who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $7.9 million federal dollars are available to North Dakota starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 23 Community Health Centers in North Dakota but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 22% of North Dakota’s population who live in an underserved area.
New Medicaid options for states. For the first time, North Dakota has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.
Comprehensive Health Association of North Dakota (CHAND) www.chand.org
Coverage: CHAND: Two comprehensive coverage options with $500 or $1000 deductibles including: Doctor visits, Prescription drugs, Outpatient and in-hospital care, Maternity, Ambulance, Labs and x-rays, Skilled nursing care, Hospice, Home health visits, Rehabilitation, Durable medical equipment, Mental health and substance abuse, Physical, speech and occupational therapy, Preventive care, and other services. Covered services have a lifetime limit of $1,000,000. Eligibility: CHAND: You must have resided in North Dakota for at least 183 days. You have written evidence of denial of coverage from at least one carrier due to health reasons, or offered coverage with substantially restricts benefits for specific conditions, or with rates exceeding the CHAND rate. Must have written evidence from a medical professional of the existence of a qualifying condition and proof of exhausting most recent coverage within 90 days of application. Must be ineligible for health benefits under North Dakota’s medical assistance program, COBRA or other government programs. A Medicare supplement plan is also available.
Covers Hospital, Nursing facility, clinics, Rural health clinics, Hospice, physicians, Prescription drugs, Chiropractor, EPDST, Home health, Durable medical equipment and supplies, Dental, Family planning, Sterilization, Podiatry, Mental health, Ambulance, Transportation, Vision, Therapies, Waivers for certain services, Home and community based services, Traumatic brain injury, out-of-state services Eligibility: Must be a North Dakota resident and a U.S. citizen or legal permanent resident. Some legal permanent residents may have to wait for 5 years for full Medicaid benefits but there is no waiting period for emergency services. Income limits: Pregnant women and children ages 0–6: 133% FPL. Children ages 6–19: 100% FPL. Parents/caretakers living with children ages 0–18: 59% FPL. Aged, blind and disabled: 75% FPL for singles and 83% FPL couples, with asset limit of $3,000 for singles and for $6,000 couples. Medically-needy: 83% FPL for singles and couples. People with high medical expenses that when subtracted from income they may be eligible.
Healthy Steps offers health coverage to uninsured children of North Dakota who have low income. Services covered include inpatient and outpatient hospital services, preventive services, clinic services, prescription drugs, dental and vision, orthodontia, prenatal, mental health, and substance abuse. Eligibility: 1. Must be a U.S. citizen or qualified resident living in North Dakota. 2. Must be uninsured. 3. Must be 18 years old or younger. 4. Must not exceed income of 160% of the federal poverty level (FPL).
Women’s Way Program in North Dakota was created to help screen and diagnose breast and cervical cancer among women living in the state. Services covered include cancer screening and follow-up care including clinical breast exams, mammograms, Pap tests, and pelvic exams. Eligibility: 1. Must be a woman and a U.S. citizen residing in North Dakota. 2. Must be between 40 and 64 years old. 3. Must be uninsured or current health insurance does not cover services offered by the program; or you cannot afford to pay for deductibles and co-payments. 4. Must not be enrolled or eligible for Medicaid or Medicare Part B. Women 65 or older may qualify for the program provided they are eligible for Medicare or cannot afford Medicare Part B.
North Dakota Medicare
Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.