Do you need health coverage?
North Dakota Navigators can help you find and enroll in health insurance. In health insurance through the Marketplace, Medicaid Expansion, or CHIP, 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 access to healthcare.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace, or just Marketplace, can be found at: www.healthcare.gov. It was created through the Affordable Care Act and which was enacted in 2013. The Marketplace lets you compare health insurance plan options from various companies and offers tax credits to help pay the cost of monthly premiums for those who qualify for savings. Most people use the Marketplace when they don’t have coverage through a job or the benefits their company offers is too expensive. Marketplace savings are based on your estimated income for the year you’re getting coverage, not last year’s income.
Who is eligible for a plan on the Marketplace?
You could be eligible for a Marketplace plan if you are not able to get health insurance through your job or a family member’s employer. You could also be eligible if your employer plan is too expensive (based on pre-determined rates). To review your eligibility and plan options, contact us and set up a virtual, phone, or in-person appointment. ND Navigators will not pressure you to sign up for a plan, we only want you to know what’s available to you and your family.
How much does a plan cost?
The cost for coverage can vary greatly for each family. Monthly premium costs can vary based on available premium tax credits and the cost of the plan you choose. Premium tax credits are based on your annual income. Deductibles, copays, and coinsurance will can also be very different for each situation. Navigators can explain these costs further to help you understand which plan might work best for you and your family.
Getting help from ND Navigators with enrolling in and choosing a plan is 100% free, paid for by federal grant funds from the Centers for Medicare & Medicaid Services (CMS).
Here are a few common situations in which people are looking for affordable health insurance options:
Self-Employed
You can enroll through the Marketplace if you’re a:
- Gig-Worker
- Freelancer
- Consultant
- Independent Contractor
- Other self-employed worker who doesn’t have any employees
Immigrants
Most lawfully present immigrants can buy health insurance through the Health Insurance Marketplace. This group includes lawfully present immigrants who cannot enroll in Medicaid based on immigration status, for example, because they are in the five-year waiting period for Medicaid or CHIP coverage. Certain lawfully present non-immigrants, such as people with work (H1) and student visas, are also eligible to purchase Marketplace plans.
Undocumented immigrants may not purchase coverage through the Health Insurance Marketplace.
Turning 26
Incarcerated
If you’re incarcerated, you can’t buy a Marketplace plan. Once you’re released, you can use the Marketplace to get health coverage. You have a 60-day Special Enrollment Period to apply for and select a plan.
For the Marketplace, “incarcerated” means serving a term in prison or jail. You’re not incarcerated if you’re:
- On probation
- On parole
- House arrest — living at home
- Halfway house (under supervision of the criminal justice system or voluntarily)
- In jail or prison pending disposition of charges (being held but not convicted of a crime)
Pregnant
All Marketplace and Medicaid plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage starts.
Maternity care and newborn care — services provided before and after your child is born — are essential health benefits. This means all qualified health plans inside and outside the Marketplace must cover them.
Being pregnant doesn’t qualify your household for a Special Enrollment Period, but the birth of a child does.
New to North Dakota
In order to get a Special Enrollment Period, you must:
- New home in a new ZIP code or county
- The U.S. from a foreign country or United States territory
- Place you attend school (if you’re a student)
- Place you both live and work (if you’re a seasonal worker)
- Shelter or other transitional housing
You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.
What is the enrollment process?
When you apply for a plan on the Marketplace, you will need to enter your household income. If your income is low enough, you may qualify for Medicaid. If it’s higher, you will be shown available Marketplace plans. Your income data will determine how much you could get in Premium Tax Credits (PTCs). These tax credits make the monthly cost of a health insurance plan (your Premium) more affordable.
To get an estimate of your plan costs, try the calculator on our Home Page
Do I need to prepare anything for an appointment with a Navigator?
To help you prepare for a meeting with a Navigator, review these to to see what kinds of documents you’ll need to have ready:
Healthcare.gov link
Marketplace enrollment checklist
Get Ready to Apply
Questions When Choosing a Plan
Appeals
When 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-open-enrollment/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:
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
This 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.