Here are some details about changes this year to help you get started: 

• Timeline: Open enrollment is a month and a half shorter this year than in previous years. You must take action by December 15, 2018 or you’ll risk not having coverage for 2019 and have to pay a penalty. If you miss this deadline, the only way to get coverage in 2019 is to have a qualifying life event 

• If you already have a plan: Even if you have health insurance through HealthCare.gov already, it’s worth checking out plans again, as plans and prices can change each year, and there may be a more affordable plan available that meets your needs. HealthCare.gov—known as the health insurance marketplace—makes it easy to shop and compare the plans available in your area. You can compare plan benefits and coverage prices and find out if you qualify for financial assistance.

• Most people qualify for financial assistance to afford plans: Most North Dakotans who sign up for coverage through HealthCare.gov qualify for federal assistance to help you afford coverage. As a result, last year, 8 out 10 people qualify for financial help lowering monthly premiums to between $50 and $100.

CONTENTS

For Individuals

For Businesses

Special Assistance

Additional Information

For Individuals

Generally, North Dakotans can only sign up for Marketplace coverage through HealthCare.gov during the open enrollment period, which is November 1, 2018 to December 15, 2018 for the 2019 plan year. The earliest this coverage will begin is January 1, 2019. Afterwards, a health care policy generally goes into effect the month after purchase.

Obtaining Coverage: North Dakotans can shop for plans, determine financial 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. There are five ways – online, by phone, with in-person help, through an agent, or by mail -- to apply for coverage. If you are not comfortable navigating healthcare.gov and/or prefer not to enroll online, paper applications are available for individuals and families.

North Dakota resources: Community Health Association of the Dakotas (CHAD) website GetCoveredNorthDakota.org includes useful tools as well as a calendar of outreach and enrollment events throughout the state. North Dakota’s governor’s office also has a useful website: nd.gov/ndins/healthcarereform

Free, expert help is available: If you have questions about signing up or want to talk through your options with a trained professional, free help is just a call or click away.

• By Phone: Marketplace call center representatives are available to help all day, every day at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in many languages. The call is free.
• Find More In-Person Help: You can find free and confidential local help in your community by visiting: LocalHelp.HealthCare.gov.

Plan Types: Depending on which type of plan you choose - Bronze, Silver, Gold or Platinum - you’ll pay a different percentage of total yearly costs for your care, and your insurance company will pay the rest. Bronze has the highest out-of-pocket costs, but the lowest monthly premiums. Silver is the only plan that qualifies for financial help to lower your out-of-pocket costs - what you pay for your deductible. Platinum plans have the least out-of-pocket costs, but the highest monthly premiums.

Lower your out-of-pocket costs: In addition to financial help that lowers premiums each month, many people also qualify for lower out-of-pockets costs through Cost Sharing Reductions. You must choose a silver plan to get these savings. Qualifying for these savings depends on your income - see if you qualify here. 

Those with coverage: HHS has implemented an automatic re-enrollment process for Marketplace consumers who would like to retain their current plan next year (rather than going back through the entire enrollment process). But it’s always a good idea to browse other options as plans change every year and there may be more affordable options available that fit your needs. 

Medicaid: North Dakotans can apply for Medicaid or Children’s Health Insurance Program (CHIP) coverage any time by applying directly to the North Dakota Medicaid office or filling out a Marketplace application. 

Native Americans: There is no enrollment period for Native Americans to apply for either Medicaid or Marketplace coverage. See below and above for other options for assistance. 

Obtaining coverage outside of open enrollment: HHS has created an online screening tool for those seeking coverage outside of open enrollment as they must have a qualifying life event (see below. A life change must be reported to HHS to qualify. Examples of 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 other 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. 

What is covered by a plan on HealthCare.gov:

• Free preventive care: All plans at HealthCare.gov cover free preventive care with no co-pay. This means free cancer screenings, check-ups, and more.
• Protections for people with pre-existing conditions: Millions of Americans with pre-existing conditions – like asthma, disabetes, cancer, or pregnancy -- no longer have to worry about being denied health coverage or being charged higher premiums because of their health status.
• Free or low cost health insurance: You can find out if you are eligible for low cost health insurance premiums at HealthCare.gov. Last year, 8 out of 10 people qualified who enroll in coverage through HealthCare.gov qualify for financial help to make their premiums lower. And over 7 out of 10 can find a plan for as little as $50 per month.
• Comprehensive coverage: Health plans in the individual and small group markets are required to cover 10 categories of essential health benefits – including emergency services, maternity and newborn care, mental health and substance use disorder services, and prescription drug coverage.
• Emergency care: In an emergency, individuals are covered at any hospital location and his or her insurance company can't charge more for getting emergency room services at an “out-of-network” hospital.

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For Businesses

SHOP Marketplace: Businesses can browse plans, purchase insurance, and receive application assistance by visiting the SHOP website at https://www.healthcare.gov/small-businesses/employers/ or calling 1-800-706-7893. 

Mandate: As of January 1, 2016, employers with 50 or more full-time equivalent employees must offer health insurance or face a penalty. All plans purchased through the marketplace satisfy the mandate. The website has a tool to calculate full-time equivalent employees and determine if it’s required to provide insurance.

Tax Credits: Businesses with fewer than 25 full-time equivalent 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. The website has a tool to determine eligibility.

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