Senator Heidi Heitkamp United States Senator for North Dakota

Affordable Care Act

In 2000, I was diagnosed with breast cancer.  It was terrifying, but I was fortunate – I had good health insurance so I could afford the care I needed.  But too many families aren’t so lucky.  The health care reform law is not perfect, but it will extend affordable health coverage to more than 20 million uninsured Americans, including thousands of North Dakotans.  If you already have health coverage, the law makes your coverage even stronger so you are better protected.  No family should be in a position where they have to choose between getting health care for a loved one or paying their bills.  Since the Affordable Care Act is law, I want to make sure North Dakotans understand their options and how the law could impact them.  This webpage will serve as a resource if you have questions about what health coverage is available to you.  If you have other questions, please contact my office or any of the contacts listed in the “Help Center” on the side of this page.

Important Dates for 2016 Coverage

November 1, 2015: The first day of the open enrollment period to sign up for health care coverage through the Marketplace. The open enrollment period ends on January 31, 2016. 

January 1, 2016: The date 2016 coverage can start if you apply by December 15, 2015 or if you accept automatic enrollment in your 2015 plan or a similar plan. 

The earliest coverage will begin is January 1, 2016; afterwards, a policy generally goes into effect the month after purchase. You can buy a plan outside the Marketplace and still comply with the individual mandate, but you will not be eligible for premium tax credits or other savings based on your income. North Dakotans seeking health insurance outside of the enrollment period may qualify for special enrollment. The online screening tool can assist folks seeking coverage outside of open enrollment. 

 

Click here to learn more about the tax provisions of the Affordable Care Act.

About the Affordable Care Act

FAQ for Individuals and Families

How do I sign up for health care coverage?
North Dakotans can shop for plans, determine premium assistance eligibility, sign up for coverage, and receive application assistance or appeal a decision by visiting www.healthcare.gov/ or calling 1-800-318-2596. If you're not comfortable navigating healthcare.gov and/or prefer not to enroll online, click here for a paper application. .:More return to top
How do I get assistance choosing health insurance?

Agents and Brokers continue to play an important role in assisting consumers in understanding coverage options both in and out of the Marketplace. A list of certified agents/brokers can be found here. 

Navigators are individuals and organizations trained to help consumers, small businesses, and their employees look for health coverage options through the Marketplace and complete eligibility and enrollment forms. They are required to be unbiased, and their services are free to consumers. North Dakota's Navigators conduct outreach and enrollment events, and include the following organizations:

Certified Application Counselors (CACs) help people understand, apply, and enroll for health coverage through the Marketplace. Designated professionals in each organization complete required training, comply with privacy and security laws, and other program standards. All Community Health Centers and Indian Health Service facilities have CACs, but additional organizations providing social services in the community also have CACs. Contact information can be found here. 

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What if I already have insurance?


If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to Marketplace coverage if you want to. .:More

For North Dakotans currently enrolled in the Marketplace, you must complete an automatic re-enrollment process to retain your current plan next year.  

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What if I'm self-employed?
If you're self-employed with no employees, you're not considered an employer. You can use the individual Marketplace to find coverage that fits your needs. .:More return to top
What if I have a pre-existing health condition?
Starting in 2014, most health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition. .:More return to top
What are my health coverage options if I'm unemployed?
If you're unemployed you may qualify for Medicaid, the Children's Health Insurance Program, or lower costs on Marketplace insurance based on your income. .:More return to top
What if I'm a part-time employee without health coverage?
If you're a part-time worker without job-based coverage, you may be able to buy health insurance in the Marketplace and get lower costs based on your income. .:More return to top
What if I'm losing job-based insurance?
If you lose your job-based health insurance, you have 2 primary options for health insurance coverage: a Marketplace plan or COBRA continuation coverage. .:More return to top
Can I keep my own doctor?
Depending on the plan you choose in the Marketplace, you may be able to keep your current doctor. .:More return to top
How do I apply for Medicaid or CHIP coverage?
You can apply for Medicaid or CHIP coverage any time by applying directly to the North Dakota Medicaid office or filling out a Marketplace application. .:More return to top
Are there benefits specific to Native Americans?
Yes. There is no enrollment period for Native Americans to apply for either Medicaid or Marketplace coverage. More specifics can be found in the Great Plains Tribal Chairman's Health Board's brochure. .:More return to top
What happens if I choose not to get any coverage?
North Dakotans who go without insurance might have additional tax obligations. .:More return to top
After the open enrollment period ends in January, what happens if I still need health care coverage?
You can only enroll in health coverage on the Marketplace after the enrollment period ends on January 31, 2016, if you qualify for a life event. Qualifying life events include:
  • Marriage or divorce
  • Having a baby, adopting a child, or placing a child for adoption or foster care
  • Moving your residence, gaining citizenship, leaving incarceration
  • Losing your health coverage - due to losing job-based coverage, COBRA expiration, aging off a parent's plan, losing eligibility for Medicaid or CHIP, and similar circumstances. Important: Voluntarily ending coverage doesn't qualify you for a Special Enrollment Period. Neither does losing coverage that doesn't qualify as minimum essential coverage. 
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year. 

A life change must be reported to the U.S. Department of Health and Human Services to qualify. .:More

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FAQ for Small Businesses

What do small businesses need to know?

Starting in 2014, businesses with 50 or fewer full-time equivalent employees can use the Small Business Health Options Program to offer coverage to their employees. You control the coverage you offer and how much you pay toward premium costs. .:More

Businesses can browse plans, purchase insurance, and receive application assistance by clicking here to visit the SHOP website or calling 1-800-706-7893. 

Click here for useful outreach and webinars for small employers. 

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What is considered a small business?

As of January 1, 2016, employers with 50 or more full-time equivalent employees (FTEs) must offer health insurance or face a penalty. All plans purchased through the Marketplace satisfy the mandate. Click here for help to calculate FTEs. 

Businesses with fewer than 25 FTE employees whose average wages are less than $50,000 a year that purchase coverage through the SHOP may be eligible for a tax credit to help pay for the insurance. Click here for a tool to help determine eligibility. 

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Do I have to offer health coverage to my employees?
No employer has to offer coverage. Some large businesses that don't offer coverage meeting certain standards may have to make a shared responsibility payment in 2015. .:More return to top
How do I choose coverage that's right for my business?
There are 4 categories of plans in the SHOP Marketplace. They offer similar benefits, but differ based on how enrollees and the plan share the costs of care. .:More return to top
Will I qualify for small business health care tax credits?

You may qualify for employer health care tax credits if you have fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less. .:More

Click here for helpful information from the Internal Revenue Service. In addition, there is helpful tax information for employers as well as materials on the individual mandate. 

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FAQ about the Health Insurance Marketplace

Apply for health insurance online here.

How

What is the Health Insurance Marketplace?
The Marketplace is a new way to find quality health coverage. It can help if you don't have coverage now or if you have it but want to look at other options. .:More return to top
How can I get ready to enroll in the Marketplace?
To prepare to enroll, you can learn about types of health coverage, research your questions, and figure out what you need to know before open enrollment begins. .:More return to top
How will prices be determined for Marketplace insurance plans?
All insurance plans available through the Marketplace will be offered by private insurance companies. They will decide which plans to offer and how much each will cost. .:More return to top
How can I get an estimate of costs and savings on Marketplace health insurance?
You can use tools like the Kaiser Family Foundation calculator to get a rough estimate of how much health insurance may cost in 2016. .:More return to top
Will I qualify for lower costs on monthly premiums?
When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size. .:More return to top

Still Have Questions?

If you still have questions about the health care reform law, healthcare.gov and getcoveredamerica.org have more resources to assist you. If you would like to talk to someone for assistance, please refer to the numbers listed below in the Help Center.