Do you need health coverage?
North Dakota Navigators can help you find and enroll in health insurance. Our assisters are local, unbiased, and helping to break down barriers to care. We are trained to understand the details so that you don’t have to, making the enrollment process easier and teaching you how health insurance works. We want all North Dakotans to have better access to healthcare.
What if I am low-income and can’t afford health insurance?
When you fill out an application on the Marketplace, it also determines if you might be eligible for North Dakota Medicaid. If you are eligible for Medicaid, Marketplace will send your application to the ND Medicaid office for review. If you’re eligible for Medicaid, you will not have any premium tax credits available to purchase a plan on the Marketplace. Even if you don’t qualify for Medicaid based on income, you should apply. You may qualify for your state’s program if you have children, are pregnant, or have a disability.
What are Medicaid and CHIP?
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to some low income people, families and children, pregnant women, the elderly, and people with disabilities. You can apply for Medicaid and CHIP any time of year. Details for the ND Medicaid program can be found here:
(www.applyforhelp.nd.gov).
Sometimes only part of your household qualifies for Medicaid, or your children-only qualify for CHIP. If this happens, the other members of your household may still qualify to enroll in a separate Marketplace plan.
What can North Dakota Navigators do if I need help with a Medicaid application?
ND Navigators can assist with applications for enrollment in Medicaid Expansion, which is an income-based program that’s less restrictive than . Note: Navigators are not fully trained in Medicaid eligibility. Traditional Medicaid applications need to be processed with your local Human Service Zone.
What are the different types of North Dakota Medicaid coverage?
Medicaid Expansion
Medicaid Expansion was enacted in 2014. The program increased the number of people who are eligible for Medicaid financial assistance.Eligibility for Medicaid Expansion is income-based.Families that fall below 138% of the current Federal Poverty Level (FPL) for their tax household size are usually eligible for Medicaid Expansion (see chart below). Members don’t need to meet any age or disability requirements and do not need to claim assets.
Your family may be qualified for Medicaid Expansion if:
- You have qualifying incomes
- Are North Dakota residents
- Are U.S. citizens or qualified aliens
- Do not have other health insurance coverage (IHS is not health insurance)
Blue Cross Blue Shield
Medicaid Expansion
Traditional Medicaid
Traditional Medicaid provides coverage to qualifying individuals in the following groups:
- Individuals within income limits
- Children in foster care or subsidized adoption
- Former foster care children up to age 26, under certain circumstances
- Children with disabilities (birth to 19)
- Pregnant women
- Individuals with breast or cervical cancer
- Workers with disabilities
- Other blind and disabled individuals
- Low-income Medicare beneficiaries (Medicare Savings Programs)
Traditional Medicaid recipients must also meet asset limits. Enrollment in Traditional Medicaid should be done directly with an eligibility worker at your local Human Service Zone or online at
www.applyforhelp.gov.
Navigators may be able to answer some questions, but are not fully trained on Traditional Medicaid eligibility and asset limits.
Find your local Human
Service Zone here
Children’s Health Insurance Program (CHIP)
CHIP is intended to meet the needs of working families, who cannot afford health insurance coverage for their children, yet earn too much to qualify for Medicaid. CHIP is for children who do not have health insurance coverage. Household income levels are higher for CHIP than for Medicaid (210% of FPL).
Children may qualify for CHIP if they:
- Live in families with qualifying incomes
- Are North Dakota residents
- Are U.S. citizens or qualified aliens
- Do not have other health insurance coverage (IHS is not health insurance)
- Are 18 years of age or younger (Single 18-year-olds with eligible incomes may also apply)
CHIP coverage is for children only. The application is the same as for Medicaid. Parents who need health insurance coverage can contact ND Navigators to discuss other coverage options, such as plans on the Health Insurance Marketplace.
Find your local Human
Service Zone here
Medicaid (Expansion and Traditional) and CHIP Income Levels
Effective April 1, 2023 -Amounts listed in the table below are MONTHLY income levels for each category
| Family Size | Medicaid Expansion | Full Coverage for Entire Family | Medically Needy* | Children Ages 0-6 | Pregnant Women | Children Ages 6-19 |
|---|---|---|---|---|---|---|
| 1 | $1,732 | $517 | $1,130 | $1,908 | $2,197 | $2,573 |
| 2 | $2,351 | $694 | $1,533 | $2,590 | $2,981 | $3,492 |
| 3 | $2,970 | $871 | $1,937 | $3,271 | $3,766 | $4,411 |
| 4 | $3,588 | $1,048 | $2,340 | $3,952 | $4,550 | $5,330 |
| 5 | $4,207 | $1,226 | $2,744 | $4,634 | $5,335 | $6,250 |
*Aged, blind, disabled, and families who may be responsible for a portion of their medical bills
For additional eligibility details, visit https://www.hhs.nd.gov/healthcare
Where can I sign up for health insurance?
Open Enrollment period for the Health Insurance Marketplace.
Enroll by 12/15: Coverage 01/01
Enroll by 01/15: Coverage 02/01
After January 15, you can enroll in or change plans only if you qualify for a Special Enrollment Period.
What is a Special Enrollment Period?
This is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including: losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
https://www.healthcare.gov/coverage-outside-openenrollment/your-options/
Looking for Medicare?
Medicare is health insurance coverage that is mostly for those 65 or older or people with disabilities. It isn’t part of the Health Insurance Marketplace. Medicare’s annual Open Enrollment Period is October 15 – December 7.
For questions or local help applying for Medicare, visit:
Contact information for North Dakota Medicaid and CHIP
Medicaid Member Case Information and Updates
Contact a Human Service Zone worker to change your case information, update contact info, or find ride options for medical appointments:
Call: 1-866-614-6005 711 (TTY)
Email: applyforhelp@nd.gov
Questions about Eligibility for Medicaid/CHIP
For questions about getting on Medicaid or other Medicaid-related help:
Call: 1-844-854-4825 711 (TTY)
Email: medicaidcc@nd.gov
Medicaid Member Questions about Billing and Coverage
For existing Medicaid members, if you have questions about covered services or claims:
Call: (Toll free): 1-877-328-7098
Email: mmisinfo@nd.gov
To fill out an application for ND Medicaid, start by making an account on the Self-Service Portal login here: https://www.hhs.nd.gov/applyforhelp/ssp-help
For questions or help filling out Medicaid Expansion applications, contact us through any of the options shown below.
For help with Traditional Medicaid, contact 1-866-614-6005 or visit your local Human Service Zone
For more information about affordable healthcare plans or to request enrollment assistance, call us at 1-800-233-1737
or locally at 701-858-3580.
You can also email us at: NDNavigators@MinotStateU.edu
Health Insurance Marketplace
his grant is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,049,340 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS or the U.S. Government.