Orlando Harmon
If you're looking to apply for medical insurance in North Dakota, there are a few options available to you. Firstly, you can visit HealthCare.gov, which is North Dakota's health insurance marketplace, where you can shop, compare, and buy health plans. Here, you can also find out if you're eligible for Medicaid, a federal and state program that provides health coverage for those with low incomes. If you're aged, blind, or disabled, you can apply for Medicaid coverage by filling out the SFN 958 form. Additionally, North Dakota has Navigators who can help you find and enroll in health insurance plans, as well as answer any questions you may have. For those with Medicare, the Senior Health Insurance Counseling (SHIC) program can provide assistance with any queries.
| Characteristics | Values |
|---|---|
| How to apply for medical insurance in North Dakota | Visit HealthCare.gov, North Dakota's health insurance marketplace, to shop, compare, and buy health plans |
| Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator, or a certified application counselor | |
| Enroll via an approved enhanced direct enrollment (EDE) entity | |
| Call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325) | |
| Contact the North Dakota Insurance Department by mail or phone | |
| Contact the North Dakota Medicaid Customer Support Center by phone or email | |
| Visit your local Human Service Zone office | |
| Contact a North Dakota Navigator by phone or online | |
| Contact Senior Health Insurance Counseling (SHIC) by mail or phone |
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What You'll Learn
Eligibility criteria for Medicaid
To apply for medical insurance in North Dakota, you must meet the eligibility criteria for Medicaid. North Dakota Medicaid provides health care coverage for people who submit an application and qualify for coverage.
To qualify for Medicaid in North Dakota, individuals must meet specific eligibility requirements, including income limits, residency status, and other factors. Here are the key criteria:
- Income Limits: Medicaid in North Dakota is available to low-income adults and children. The income limits are based on a percentage of the federal poverty level and vary depending on family size and composition. For example, adults with a household income up to 138% of the federal poverty level and children with a household income up to 175% are eligible.
- Pregnant Women and Newborns: Pregnant women with incomes up to a certain threshold, typically around 147% to 162% of the poverty level, are eligible for Medicaid coverage. Additionally, newborns automatically qualify for Medicaid for the first year if their birth mother was covered by Medicaid at the time of birth.
- Age, Disability, and Medical Conditions: The aged, blind, and individuals with disabilities are eligible for Medicaid coverage. This includes people aged 65 and older, individuals with blindness, and those who meet the Social Security Administration's definition of disability.
- Children in Specific Circumstances: North Dakota Medicaid provides coverage for children in specific groups, such as those in foster care, subsidized adoptions, or those who have aged out of foster care.
- Asset Limits: There are also limits on countable assets for eligibility. Individuals must have less than a certain amount in savings, checking accounts, stocks, bonds, and other assets. The specific limit varies, such as $3,000 for a single person and $6,000 for a couple, with adjustments for additional household members.
- Refugee Status: Legally admitted refugees who do not qualify for Medicaid or other health care services may be eligible for short-term coverage for their first 12 months in the United States.
- Waivers: North Dakota offers Medicaid waivers to individuals who need assistance to remain at home rather than move to a nursing home or medical facility. These waivers target specific populations and provide a range of services.
It is important to note that eligibility guidelines may change, and North Dakota updates its Medicaid eligibility rules annually. Therefore, it is recommended to refer to the official North Dakota Health and Human Services website or contact the Medicaid office directly for the most current and complete information on eligibility criteria.
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How to fill out the application form
To apply for medical insurance in North Dakota, you will need to fill out an application form for Medicaid.
Firstly, you will need to determine your eligibility for Medicaid. To be eligible, you must be a US citizen or a qualified alien, and you must not have other health insurance coverage. You must also meet certain income and asset limits. If you are aged, blind, or disabled, and you only want Medicaid coverage, you will need to fill out the Health Care Application for the Elderly and Disabled form (SFN 958).
Next, you can choose to apply online or by using a paper application. Paper applications can be requested by contacting the Customer Support Center or a human service zone office. If you are applying online, you will need to create an account on the Self-Service Portal. All applications are fillable PDFs, and you will need to complete the appropriate form and return it to a human service zone office.
Make sure to fill out the entire application packet, providing all the required information, and sign the signature pages for the packet to be considered complete. If you are a provider, you will also need to include the application tracking number (ATN) from the online enrollment application and any required taxonomy codes.
If you need assistance with the application process, you can contact a federally-funded enrollment assistance grant program called ND Navigators. They can help you gather additional information, appeal coverage denials, and interpret any letters you receive regarding your application.
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Where to send your application
If you are applying for Medicaid in North Dakota, there are several options for where to send your application. Firstly, you can apply online at www.applyforhelp.gov. Alternatively, you can apply in person by visiting your local Human Service Zone office. You can also request an application by mail by contacting the Customer Support Center at 866-614-6005 or 701-328-1000; 711 (TTY). If you need assistance with your application, you can contact a North Dakota Navigator, either by phone at 800-233-1737 or by visiting their website.
If you are applying for Medicare in North Dakota and have questions or concerns, you can contact the Senior Health Insurance Counseling (SHIC) program. Their mailing address is 600 E Boulevard Avenue Bismarck, ND 58505, and their phone number is 888-576-6611 or 701-328-2440 for TTY.
For general questions about health insurance in North Dakota, you can contact the North Dakota Insurance Department. Their mailing address is also 600 E Boulevard Avenue Bismarck, ND 58505, and their phone number is 701-328-2440 or 800-247-0560 for TTY.
If you are a veteran with questions about your health care benefits, you can contact the US Department of Veterans Affairs at 877-222-VETS (8387) or visit their website at https://www.va.gov/health-care/.
Finally, if you are applying for the Children's Health Insurance Program (CHIP), you can call 844-854-4825 or email [email protected].
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What to do if your application is denied
If your application for medical insurance in North Dakota is denied, there are a few things you can do to explore your options and potentially obtain coverage. Firstly, it is important to understand the reason for the denial. Review the denial notice carefully to identify the reason, which may be related to eligibility criteria, income requirements, or other factors. Understanding the reason for the denial will help you determine your next steps.
If you applied for Medicaid and were denied, you can consider alternative options or seek assistance with appealing the decision. North Dakota's Marketplace, operated by the federal government, offers plans with different coverage levels, including platinum, gold, silver, and bronze, as well as a catastrophic plan for young adults. Insurers participating in the Marketplace are prohibited from discriminating against individuals with pre-existing conditions, and subsidies are available for those with qualifying incomes. You can explore these plans and compare prices to find a suitable option. Additionally, you can contact the North Dakota Department of Human Services Medicaid Division to discuss your specific situation and explore other avenues for obtaining coverage.
If you have children, they may still be eligible for the Children's Health Insurance Program (CHIP) even if your Medicaid application was denied. CHIP provides coverage for children from birth through age 18 and helps meet the needs of families who cannot afford private health insurance but have incomes above the Medicaid eligibility threshold. You can apply for CHIP at any time during the year, and coverage typically starts on the first day of the month following approval.
In some cases, you may be eligible to enrol in your parent's health insurance plan. Contact their insurance carrier to determine if you meet the eligibility requirements. Additionally, if you have maintained prior qualified health insurance coverage, you may be able to re-enroll with the Comprehensive Health Association of North Dakota (CHAND) under the provisions of the Health Insurance Portability and Accountability Act (HIPAA).
If you have specific questions or concerns about your health insurance options, you can seek assistance from various resources. The North Dakota Insurance Department can provide information and answer questions about different types of coverage. Additionally, the Senior Health Insurance Counseling (SHIC) program can assist seniors with Medicare-related inquiries. For veterans, the US Department of Veterans Affairs is a dedicated resource for health care benefits and related matters. These organizations can provide guidance and support as you navigate your health insurance options in North Dakota.
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Additional support and resources
If you need help applying for medical insurance in North Dakota, there are several resources available to you. Firstly, you can utilise the HealthCare.gov Plan Finder to help you find and compare healthcare coverage options in your area. This is a useful tool to understand the different types of coverage available to you.
If you have questions about insurance you purchased for yourself or your family, or if your insurance is provided by an employer who does business only in North Dakota, you can contact the North Dakota Insurance Department by mail, phone, or email:
- Mailing Address: 600 E. Boulevard Avenue Bismarck, ND 58505
- Phone Number: (701) 328-2440 (or (800) 247-0560 for TTY)
- Email: [email protected]
If you are on Medicare and have questions or concerns, or if you have a disability or end-stage renal disease and want to know about enrolling and eligibility, you can contact the Senior Health Insurance Counselling (SHIC) team:
- Mailing Address: 600 E Boulevard Avenue Bismarck, ND 58505
- Phone Number: (888) 576-6611 (or (701) 328-2440 for voice and (800) 366-6888 for TTY)
- Website: http://nd.gov/ndins/shic
If you are a veteran with questions about your healthcare benefits, you can contact the US Department of Veterans Affairs:
- Phone Number: (877) 222-8387
- Website: https://www.va.gov/health-care/
If you are not eligible for Medicaid, your child may still be eligible for the Children's Health Insurance Program (CHIP). You can contact them with any questions about eligibility or benefits:
- Phone Number: (844) 854-4825
- Website: http://www.nd.gov/dhs/services/medicalserv/chip/
- Email: [email protected]
- Mailing Address: 600 E. Boulevard Ave., Dept. 325 Bismarck, ND 58505-0250
If you have a hard time affording health coverage and have questions about eligibility or current Medicaid benefits, you can contact the North Dakota Medicaid Program:
- Phone Number: (701) 328-2321 (or (800) 472-2622 for TTY)
- Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
- Email: [email protected]
You can also suggest changes to ND Medicaid coverage by filling out the SFN 905 form with as much detail as possible and submitting it to the above email address.
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Frequently asked questions
You can apply for medical insurance in North Dakota by visiting HealthCare.gov, which is North Dakota's health insurance marketplace. Here, you can shop, compare, and buy health plans.
North Dakota offers ACA Marketplace (exchange) plans for individuals and families who don't have access to Medicare, Medicaid, or employer-sponsored plans.
Eligibility for Medicaid in North Dakota is based on income, with families falling below 138% of the current Federal Poverty Level (FPL) for their tax household size usually eligible for Medicaid Expansion.
When you fill out an application on the Marketplace, if it appears that you may qualify for Medicaid, your application will be sent to ND Medicaid for review by an eligibility worker.
If you are denied Medicaid coverage, you can review your options on the Marketplace, including Advanced Premium Tax Credits, which can help make the plans more affordable. You can also contact a North Dakota Navigator, who can assist with the enrollment application and help gather additional information or appeal coverage denials.
