North Dakota
Cheapest ACA plans in North Dakota for 2026
Cheapest Bronze plan in North Dakota, before subsidies: Sanford Health Plan Sanford TRUE Standardized 7500 in Burleigh County at $332/month for a 40-year-old; Sanford Health Plan Sanford TRUE Standardized 7500 in Burleigh County at $1,060/month for a family of four (two 40-year-olds and two kids under 14). North Dakota participates in Healthcare.gov, expanded Medicaid in 2014, and relies on federal APTC with no state premium subsidy or §1332 reinsurance waiver.
Cheapest plans by metal tier
Lowest 2026 monthly premium for a single 40-year-old, on-exchange, before any subsidy. Per-age figures derived from the CMS QHP Landscape file using the HHS standardized age-rating curve (45 CFR 147.102).
| Tier | Cheapest age 40 monthly | Plans statewide |
|---|---|---|
| Catastrophic | $296 | 115 |
| Expanded Bronze | $332 | 501 |
| Silver | $439 | 501 |
| Gold | $472 | 439 |
The actual cheapest plan in major counties
Same data the search returns: carrier, plan name, monthly premium, individual deductible, individual MOOP. Computed for a single 40-year-old, before any subsidy. Catastrophic plans excluded because adults 30+ typically need a hardship-exemption certificate to enroll.
Cass County
$338/moSanford Health Plan · Sanford TRUE Standardized 7500
Burleigh County
$332/moSanford Health Plan · Sanford TRUE Standardized 7500
Grand Forks County
$419/moMedica Health Plans · Altru Prime by Medica Bronze Share
Ward County
$434/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
Stark County
$434/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
Williams County
$434/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
The actual cheapest plan for a family of four
Two 40-year-old adults and two kids in the 0-14 age band, before any subsidy. Carrier, plan name, premium, deductible, and MOOP exactly as the search would return them.
Cass County
$1,081/moSanford Health Plan · Sanford TRUE Standardized 7500
Burleigh County
$1,060/moSanford Health Plan · Sanford TRUE Standardized 7500
Grand Forks County
$1,339/moMedica Health Plans · Altru Prime by Medica Bronze Share
Ward County
$1,388/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
Stark County
$1,388/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
Williams County
$1,388/moBlue Cross Blue Shield of North Dakota · BlueCare Bronze 50
Subsidies: federal APTC only (no state premium subsidy)
North Dakota does not fund a supplemental state premium subsidy or §1332 reinsurance waiver. Marketplace financial help is federal only:
- Federal Advance Premium Tax Credit (APTC). Households 100-400% FPL on the PY2026 standard ACA contribution curve, applied through Healthcare.gov. The ARPA / IRA enhanced subsidies expired 2025-12-31 and are not in effect for 2026.
- Federal cost-sharing reductions (CSRs). Households 100-250% FPL enrolled in a Silver plan receive reduced deductibles, copays, and out-of-pocket maximums automatically.
North Dakota adopted Medicaid expansion effective January 1, 2014. Adults 19-64 up to 138% FPL qualify regardless of parental status or disability, so there is no coverage gap in North Dakota.
Catastrophic plans in North Dakota follow federal rules
North Dakota follows the federal ACA default: Catastrophic plans are available to enrollees under age 30, or at any age with a hardship / affordability exemption. The PY2026 federal auto-expansion applies: adults 30+ automatically qualify when the lowest-cost Bronze plan exceeds the affordability threshold. APTC does not apply to Catastrophic plans.
Tobacco surcharges follow the federal 1.5x default in North Dakota
North Dakota applies the federal ACA default (45 CFR 147.102): carriers may charge tobacco users up to 50% more than non-users (a 1.5-to-1 rate ratio). The ND Insurance Department reviews rate filings under N.D.C.C. Title 26.1. No ND-specific cap below the federal 1.5x ceiling has been identified. Federal APTC does not offset the tobacco portion.
Carriers selling 2026 plans in North Dakota
3 carriers sell 2026 plans on Healthcare.gov. 2,953 plans across 53 counties. Three carriers reach all 53 North Dakota counties for PY2026: Medica, Sanford Health Plan, and BlueCross BlueShield of North Dakota (an independent BCBS licensee).
| Carrier | On-exchange plans | Counties |
|---|---|---|
| Sanford Health Plan | 558 | 53 |
| BlueCross BlueShield of North Dakota | 530 | 53 |
| Medica Health Plans | 468 | 53 |
Enrollment
Open Enrollment for 2026 coverage runs November 1, 2025 through January 15, 2026. Enroll by December 15 for a January 1 effective date; December 16 through January 15 takes effect February 1. Special Enrollment is available year-round for qualifying life events.
Direct enrollment: healthcare.gov.
Frequently asked questions
What is the cheapest ACA plan in North Dakota for 2026?
The cheapest Bronze-tier plan a 40-year-old can enroll in without paperwork is Sanford Health Plan Sanford TRUE Standardized 7500 in Burleigh County at $332 per month before subsidies. Data refreshed 2026-04-19T08:08:55.462Z.
Does North Dakota use Healthcare.gov?
Yes. North Dakota participates in the federally-facilitated Marketplace (FFM), so enrollment and subsidy applications run through healthcare.gov. North Dakota does not operate a state-based exchange for PY2026.
Has North Dakota expanded Medicaid?
Yes, effective January 1, 2014. Adults 19-64 up to 138% FPL qualify regardless of parental status or disability, so there is no coverage gap in North Dakota.
Why is North Dakota's Marketplace so small?
North Dakota has one of the smallest state populations in the country (roughly 800,000 residents) and relatively low uninsured rates, so Marketplace enrollment typically runs 30,000-40,000. Plan availability by county reflects that scale: three carriers statewide (BCBS ND, Medica, Sanford), with the fullest options in Fargo, Bismarck, and Grand Forks.
Which carriers sell Marketplace plans in North Dakota?
PY2026 carriers on Healthcare.gov in North Dakota are Blue Cross Blue Shield of North Dakota (statewide dominant), Medica, and Sanford Health Plan. Exact county-level availability and plan counts are visible on healthcare.gov during Open Enrollment.
Does North Dakota have a state premium subsidy or reinsurance program?
No. North Dakota does not fund a state premium subsidy or §1332 reinsurance waiver. Marketplace help is federal APTC and CSRs only, and the ARPA/IRA enhanced credits expired at the end of 2025.
Compare North Dakota with other states
- Minnesota (shares a border)
- South Dakota (shares a border)
- Montana (shares a border)
- See all 51 jurisdictions side by side
Browse county pages in North Dakota
County-level pricing pages with the cheapest plan in each county.
Browse city pages in North Dakota
City-level pricing pages for major North Dakota cities.
Carriers in North Dakota
Per-carrier 2026 pricing pages with the cheapest plan from each carrier.
Sources
- HealthCare.gov for enrollment, OEP dates, and federal APTC / CSR application.
- North Dakota Insurance Department for rate review, carrier filings, and consumer guidance.
- North Dakota Department of Health and Human Services: Medicaid for ND Medicaid and Medicaid expansion eligibility.
- KFF: North Dakota State Health Facts for Medicaid expansion, enrollment, and benchmark premium context.
- CMS 2026 OEP National Snapshot for federal Marketplace enrollment context.
- CMS QHP Landscape Individual Medical 2026 for plan availability, premiums, and metal tiers.
Plan year 2026, last refreshed 2026-04-19T08:08:55.462Z. Full pricing pipeline + regulatory references at methodology; ACA terminology in the glossary.