North Dakota Health Insurance in 2026

North Dakota expanded Medicaid and enrolls Marketplace shoppers through HealthCare.gov. Carrier choice is limited statewide, so network fit matters more than plan tier.

Where you enroll. North Dakota uses the federal Marketplace, HealthCare.gov. Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 — the shortened enrollment window proposed for this year was vacated by a federal court, so the usual dates apply.

Medicaid vs. subsidies. Because North Dakota expanded Medicaid, adults up to about 138% of the federal poverty level generally qualify for North Dakota Medicaid at little or no cost. Above that line, you shop subsidized Marketplace plans — the calculator above shows which side of the line you're on.

The biggest lever on your North Dakota premium is the ACA premium tax credit. It caps what you pay for a benchmark silver plan at a percentage of your income — the lower your income, the larger the credit — and the government pays the rest directly to your insurer.

If your income is under about 250% of the poverty level, look at Silver plans first: they come with cost-sharing reductions that shrink your deductible and copays, which no other tier gets. Our guide to Bronze vs. Silver vs. Gold walks through it.

One important change for 2026: the enhanced pandemic-era subsidies expired unless renewed, so the “400% cliff” may return for higher earners. That makes comparing plans with a licensed North Dakota agent more valuable than ever. Prefer to read up first? Start with our ACA health insurance overview or the subsidy calculator.