If you live in North Dakota and need health insurance, the Affordable Care Act (ACA) marketplace could be your best option for 2026 coverage. North Dakota uses the federal marketplace at HealthCare.gov, where three insurance carriers offer plans across the state. Whether you are self-employed, between jobs, or simply do not have employer coverage, understanding your eligibility and what financial help is available can save you hundreds of dollars each month.
This guide breaks down everything you need to know about North Dakota ACA eligibility for 2026, including income limits, premium subsidies, the return of the subsidy cliff, and exactly how to apply.
What Changed for 2026: The Subsidy Cliff Is Back
The biggest change for 2026 is that the enhanced premium tax credits from the American Rescue Plan Act (ARPA) expired at the end of 2025. Congress did not extend them. This means two major shifts:
- The 400% FPL income cap is back. If your household income exceeds 400% of the federal poverty level (FPL) by even one dollar, you no longer qualify for any premium tax credits. From 2021 through 2025, there was no upper income cap on subsidies.
- Subsidies are smaller for those who still qualify. Even for households under 400% FPL, the required premium contribution percentages are higher than they were during the enhanced subsidy period.
According to the North Dakota Insurance Department, Insurance Commissioner Jon Godfread warned that North Dakotans who purchase their own health insurance could face substantial premium increases for 2026 due to these federal changes.
Who Is Eligible for ACA Marketplace Coverage in North Dakota?
To enroll in a marketplace plan through HealthCare.gov in North Dakota, you must meet these basic requirements:
- Be a resident of North Dakota
- Be a U.S. citizen, U.S. national, or lawfully present in the country
- Not be currently incarcerated
- Not have Medicare coverage
Meeting these requirements allows you to purchase a plan. However, qualifying for financial assistance (premium tax credits and cost-sharing reductions) depends on your income and a few additional factors.
Additional Requirements for Financial Assistance
To receive premium subsidies or cost-sharing reductions, you must also:
- Not have access to affordable employer-sponsored health coverage
- Not be eligible for Medicaid or CHIP
- Not be eligible for premium-free Medicare Part A
- File a joint tax return if married
- Not be claimed as a tax dependent by someone else
2026 Income Limits for North Dakota ACA Eligibility
For 2026 marketplace coverage, eligibility for premium tax credits is based on the 2025 federal poverty level (FPL) guidelines. The key income ranges are:
- Below 138% FPL: You likely qualify for North Dakota Medicaid instead of marketplace coverage (since North Dakota expanded Medicaid in 2014)
- 100% to 400% FPL: You may qualify for premium tax credits to lower your monthly premiums
- 100% to 250% FPL: You may also qualify for cost-sharing reductions (CSRs) that lower your deductibles and copays when you choose a Silver plan
- Above 400% FPL: You can still buy a marketplace plan, but you will not receive any premium subsidies
Income Limits by Household Size (2025 FPL, Used for 2026 Coverage)
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 250% FPL (CSR Limit) | 400% FPL (Subsidy Cap) |
|---|---|---|---|---|
| 1 | $15,650 | $21,597 | $39,125 | $62,600 |
| 2 | $21,150 | $29,187 | $52,875 | $84,600 |
| 3 | $26,650 | $36,777 | $66,625 | $106,600 |
| 4 | $32,150 | $44,367 | $80,375 | $128,600 |
| 5 | $37,650 | $51,957 | $94,125 | $150,600 |
| 6 | $43,150 | $59,547 | $107,875 | $172,600 |
For households larger than 6, add $5,500 per additional person to the 100% FPL amount, then multiply by the relevant percentage.
Important note: These income figures are based on Modified Adjusted Gross Income (MAGI), not gross income. MAGI includes your adjusted gross income plus certain items like tax-exempt interest and non-taxable Social Security benefits.
Not sure where you fall? Check your eligibility with our free screener to get a quick estimate of the programs you may qualify for.
How the Medicaid and Marketplace Boundary Works
Because North Dakota expanded Medicaid in 2014, there is a clean handoff between Medicaid and marketplace coverage:
- Income at or below 138% FPL: You are generally eligible for North Dakota Medicaid. Adults ages 19 to 64 can qualify through the expansion program. You can apply for Medicaid any time of year.
- Income between 138% and 400% FPL: This is the range where marketplace premium tax credits apply. You would purchase coverage through HealthCare.gov.
- Children up to 205% FPL: May qualify for North Dakota CHIP (Children's Health Insurance Program), which provides coverage even above the standard Medicaid income threshold.
- Pregnant women up to 175% FPL: May qualify for Medicaid coverage, with 12 months of postpartum coverage.
If your income is near the 138% FPL line, it is worth applying through HealthCare.gov, which will automatically check your Medicaid eligibility and route you to the right program.
Premium Tax Credits: How They Work in 2026
Premium tax credits (also called subsidies) reduce your monthly health insurance premium. The amount you receive depends on your income relative to the FPL and the cost of the benchmark Silver plan in your area.
How Your Contribution Is Calculated
Under the 2026 rules (with enhanced subsidies expired), you are expected to contribute a percentage of your household income toward your health insurance premium. The general structure is:
| Income Level (% of FPL) | Expected Premium Contribution (% of Income) |
|---|---|
| 100% to 150% FPL | Approximately 2.0% to 4.0% |
| 150% to 200% FPL | Approximately 4.0% to 6.5% |
| 200% to 250% FPL | Approximately 6.5% to 8.5% |
| 250% to 300% FPL | Approximately 8.5% to 10.0% |
| 300% to 400% FPL | Approximately 10.0% to 8.5% |
These percentages are approximate and based on the IRS-published applicable percentage table for 2026. Check HealthCare.gov for your exact premium estimate.
The premium tax credit covers the difference between what you are expected to pay and the actual cost of the second-lowest-cost Silver plan (the benchmark plan) in your area.
Cost-Sharing Reductions (CSRs)
If your income falls between 100% and 250% FPL, you may also qualify for cost-sharing reductions. These lower your out-of-pocket costs like deductibles, copayments, and coinsurance. To get CSRs, you must enroll in a Silver-level plan.
CSR levels vary by income:
- 100% to 150% FPL: Highest level of cost-sharing reductions (plan functions similar to a Platinum plan)
- 150% to 200% FPL: Moderate cost-sharing reductions
- 200% to 250% FPL: Lower cost-sharing reductions
Insurance Carriers in North Dakota for 2026
Three insurance companies offer individual marketplace plans in North Dakota for 2026:
- Blue Cross Blue Shield of North Dakota (approved average rate increase of 8.30%)
- Sanford Health Plan (approved average rate increase of 5.12%)
- Medica Health Plan (approved average rate increase of 23.09%)
The North Dakota Insurance Department approved these rates for the 2026 plan year. When shopping for plans, compare options from all three carriers, as premiums, networks, and covered services can vary significantly.
Also new for 2026: catastrophic health plans are now available to individuals of any age who meet eligibility requirements, not just those under 30. These plans have lower premiums but higher out-of-pocket costs and could be worth considering if you are generally healthy.
How to Apply for ACA Coverage in North Dakota: Step by Step
Step 1: Gather Your Information
Before you start, collect the following:
- Social Security numbers for everyone in your household
- Immigration documents (if applicable)
- Employer and income information (pay stubs, W-2 forms, or tax returns)
- Information about any current health coverage
- Your most recent tax return
Step 2: Visit HealthCare.gov
Go to HealthCare.gov and create an account or log in. North Dakota uses the federal marketplace, so this is where you will shop for plans and apply for financial assistance.
Step 3: Complete Your Application
Fill out the marketplace application, which asks about your household size, income, and current coverage. The application will determine:
- Whether you qualify for Medicaid or CHIP
- Whether you qualify for premium tax credits
- Whether you qualify for cost-sharing reductions
Step 4: Compare Plans and Enroll
Once your eligibility is determined, you can browse available plans. Compare them by:
- Monthly premium (after subsidies)
- Deductible amount
- Out-of-pocket maximum
- Provider network (make sure your doctors are included)
- Prescription drug coverage
Select the plan that fits your needs and budget, then complete your enrollment.
Step 5: Pay Your First Premium
Your coverage does not start until you pay your first monthly premium. Set up payment directly with your insurance carrier.
Get Help Enrolling
You do not have to navigate this process alone. Free help is available:
- HealthCare.gov call center: 1-800-318-2596 (TTY: 1-855-889-4325), available 24/7
- Get Covered North Dakota: Local navigators who provide free enrollment assistance
- Licensed insurance agents and brokers: Can help you compare and enroll in plans
- Community health centers: Many North Dakota community health centers have certified application counselors
Open Enrollment and Special Enrollment Periods
For 2026 coverage, the open enrollment period ran from November 1, 2025 through January 15, 2026. During that window, about 41,014 North Dakotans selected marketplace plans.
Important change ahead: Starting in fall 2026 (for 2027 coverage), a new federal rule shortens open enrollment to November 1 through December 15. This is a tighter window, so plan accordingly.
Can You Still Enroll After Open Enrollment?
If you missed open enrollment, you may still qualify for a Special Enrollment Period (SEP) if you experience a qualifying life event, such as:
- Losing health coverage (from a job, Medicaid, or other source)
- Getting married or divorced
- Having or adopting a child
- Moving to a new area with different plan options
- Losing eligibility for Medicaid or CHIP
- Turning 26 and aging off a parent's plan
You typically have 60 days from the qualifying event to enroll. Native Americans and Alaska Natives can enroll in marketplace coverage at any time throughout the year.
Medicaid and CHIP enrollment is open year-round, so if your income falls below 138% FPL (or 205% FPL for children), you can apply at any time through HealthCare.gov or directly through the North Dakota Health and Human Services portal at hhs.nd.gov/applyforhelp.
Tips for Reducing Your 2026 Health Insurance Costs
With the return of the subsidy cliff, managing your costs takes more planning. Here are some strategies:
- Shop around every year. Plan premiums change annually. Even if you liked last year's plan, a different carrier might offer a better deal this year.
- Consider Silver plans if CSR-eligible. If your income is under 250% FPL, Silver plans with cost-sharing reductions can dramatically lower your out-of-pocket costs.
- Look at Bronze and catastrophic plans. If you are healthy and mainly want protection against major medical expenses, these lower-premium options could save money.
- Watch the 400% FPL line carefully. If your income is near the subsidy cutoff, even a small increase could eliminate your tax credits entirely. Consider contributions to retirement accounts or HSAs to manage your MAGI.
- Use free local help. Navigators and certified application counselors can identify savings you might miss on your own.
Frequently Asked Questions
What is the income limit for ACA subsidies in North Dakota in 2026?
For 2026, you must have a household income between 100% and 400% of the federal poverty level to qualify for premium tax credits. For a single person, that means an annual income roughly between $15,650 and $62,600 (based on 2025 FPL guidelines). For a family of four, the range is approximately $32,150 to $128,600.
Does North Dakota have its own state health insurance exchange?
No. North Dakota uses the federally facilitated marketplace at HealthCare.gov. You apply, compare plans, and enroll through the federal website.
What happens if I earn too much for Medicaid but cannot afford marketplace premiums?
If your income is above 138% FPL but below 400% FPL, you should qualify for premium tax credits that reduce your monthly cost. If you earn above 400% FPL, you can still buy a marketplace plan at full price. Consider looking at Bronze or catastrophic plans for lower premiums.
Can I get ACA coverage if I am offered insurance through my employer?
You can always buy a marketplace plan, but you will only qualify for subsidies if your employer's coverage is considered unaffordable (costs more than about 9.02% of your household income for employee-only coverage in 2026) or does not meet minimum value requirements.
What if my income changes during the year?
Report income changes to the marketplace as soon as possible. If your income goes up, your subsidy may decrease. If your income goes down, you may qualify for more help or even Medicaid. Failing to report changes could result in owing money back at tax time.
When is the next open enrollment period?
For 2027 coverage, open enrollment is expected to run from November 1 through December 15, 2026 under the new federal rules. This is a shorter window than previous years, so mark your calendar.
Are Native Americans eligible for special ACA benefits in North Dakota?
Yes. Native Americans and Alaska Natives can enroll in marketplace coverage at any time during the year without needing a qualifying life event. They may also be eligible for zero cost-sharing plans if their income is at or below 300% FPL.
Next Steps
The best way to find out what you qualify for is to check your eligibility. Use our free benefits screener to see which programs you may be eligible for, including ACA marketplace subsidies, Medicaid, SNAP, and more.
For more information about all the benefits programs available in your state, visit our North Dakota Benefits Overview.
If you need help enrolling, contact HealthCare.gov at 1-800-318-2596 or reach out to a local navigator through Get Covered North Dakota or your nearest community health center.
