Free Health Insurance North Dakota: Your 2027 Marketplace & Medicaid Guide
Free health insurance in North Dakota isn't a gimmick — it's a premium tax credit, or it's North Dakota Medicaid. North Dakota uses HealthCare.gov for 2027, and open enrollment runs November 1, 2026 – January 15, 2027. Here are the 2027 income limits, the Medicaid Expansion work requirement that starts January 1, 2027, and how to lock in coverage by December 15.
Get a Free 2027 Quote ↓Health Insurance in North Dakota for 2027: What "Free" Really Means
Quick answer: Free health insurance in North Dakota comes from Medicaid Expansion for adults 19–64 earning up to 138% of the poverty level (about $22,025 for one person), which adds a work requirement on January 1, 2027, or from HealthCare.gov tax credits that can bring some plans to $0. Open enrollment runs November 1, 2026 to January 15, 2027.
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Free health insurance North Dakota residents can actually get comes from two places. The first is a premium tax credit on North Dakota's health insurance marketplace, HealthCare.gov, which CMS lists as a federally facilitated Marketplace for plan year 2027. The second is North Dakota Medicaid, run by the Department of Health and Human Services (ND HHS), which has expanded coverage to low-income adults. If your household income falls between 100% and 400% of the federal poverty level, the credit pays part or all of your monthly premium directly to the insurer, and at lower incomes that math can land on a $0-premium plan. The same federal rules apply statewide, from Fargo and Bismarck to Grand Forks, Minot, and Williston.
Here's what changed for 2027. The extra "enhanced" tax credits of 2021–2025 are gone, and they are not back for 2027 under current law unless Congress acts. Credits are smaller than they were in 2025, and the 400% FPL cliff is back: earn $1 over the line and your credit is $0. On the Medicaid side, North Dakota starts a work requirement for Medicaid Expansion adults on January 1, 2027. That makes getting your North Dakota coverage right this year more important, not less.
FreedInsure LLC is an independent brokerage; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states, North Dakota included. We calculate your exact 2027 credit, compare the plans offered in your county, and enroll you — and our help is 100% free to you. We're a private broker, not HealthCare.gov and not a government agency. Call (844) 788-3733 or see if you qualify.
North Dakota Health Insurance Income Limits for 2027
Marketplace savings for 2027 coverage are based on the 2026 federal poverty guidelines: $15,960 for one person and $33,000 for a family of four. The IRS sets how much of your income you're expected to pay for the benchmark Silver plan, and the tax credit covers the rest.
| 2027 Household Income | Household of 1 | Household of 4 | What You Typically Get |
|---|---|---|---|
| Up to ~138% FPL | Up to $22,025 | Up to $45,540 | Likely Medicaid Expansion for adults 19–64 (ND HHS limits effective April 1, 2026 — see below) |
| ~138–150% FPL | $22,025–$23,940 | $45,540–$49,500 | The biggest credits — you pay no more than 4.30% of income for the benchmark Silver plan, and 94% CSR Silver plans are available |
| 150–200% FPL | $23,940–$31,920 | $49,500–$66,000 | You pay 4.30%–6.78% of income for benchmark Silver, plus 87% CSR Silver plans that shrink deductibles |
| 200–250% FPL | $31,920–$39,900 | $66,000–$82,500 | You pay 6.78%–8.66% of income; 73% CSR Silver plans still trim cost sharing |
| 250–400% FPL | $39,900–$63,840 | $82,500–$132,000 | You pay 8.66%–10.22% of income — credits taper but still cut real dollars off the premium |
| Over 400% FPL | $63,840+ | $132,000+ | No premium tax credit for 2027 under current law — full-price plans, so shopping smart matters most |
Family-of-four marketplace figures are derived from the 2026 guidelines, so treat them as approximate. The Medicaid row uses ND HHS's published limits, the same figures as our Medicaid income limits by state guide; Medicaid uses the current year's poverty guidelines, so those dollar limits will update once the 2027 guidelines take effect.
Income means your projected 2027 household income — W-2 wages, 1099 and gig income, self-employment, everything. Getting it right matters more than ever: for tax years after 2025 there is no cap on repaying excess advance credits, so a low estimate can mean paying back the full difference at tax time. Starting January 1, 2027, federal law also limits premium tax credits to fewer groups of lawfully present immigrants (green-card holders remain eligible). Want a number now? Try the 2027 ACA subsidy calculator or read our full ACA income limits guide.
North Dakota Medicaid in 2027: Medicaid Expansion — Our Honest Take
North Dakota expanded Medicaid. Its Medicaid Expansion covers adults ages 19–64 with household incomes up to 138% of the federal poverty level who don't qualify for Medicare or SSI. ND HHS's limits, effective April 1, 2026, are $22,025 a year for one person and $45,540 for a household of four. Expansion coverage is administered by Blue Cross Blue Shield of North Dakota (member services 1-833-777-5779). Two things to know: ND HHS says Medicaid Expansion coverage does not provide dental or vision care, and people with complex health conditions can apply for medically frail status to get broader coverage. Here is ND HHS's monthly income table for a household of one:
| Group | Income Limit (% FPL) | Monthly Limit, Household of 1 |
|---|---|---|
| Medicaid Expansion (adults 19–64) | 138% | $1,836 |
| Parents and caretakers | 41% | $517 |
| Pregnant women (the unborn child counts in the household) | 175% | $2,328 |
| Children, birth through age 5 | 152% | $2,022 |
| Children, ages 6–18 | 138% | $1,836 |
| CHIP (uninsured children, birth through 18) | 205% | $2,727 |
| Children with disabilities (buy-in; premium is 5% of gross countable income) | 250% | $3,325 |
Pregnant women get 12 months of postpartum coverage, and children approved for Medicaid keep coverage for up to 12 months. To apply, use the ND HHS Self-Service Portal, call the ND HHS Customer Support Center at 866-614-6005 or 701-328-1000 (TTY 711), Monday–Friday, 8 a.m. to 5 p.m. Central, or apply on paper (form SFN 1909) or in person at a Human Service Zone office. Program details are on ND HHS's Medicaid Expansion page.
New for 2027: North Dakota's Medicaid work requirement
Starting January 1, 2027, Medicaid Expansion adults must work, volunteer, go to school, or take part in job training for 80 hours a month; earning at least $580 a month also counts. ND HHS says the new requirements apply only to Medicaid Expansion members, and people already meeting SNAP or TANF work requirements won't need to do more.
ND HHS lists these groups as not required to meet it: pregnant women and members who were pregnant in the last 12 months; members with special health needs that affect daily living; members in substance or alcohol use disorder treatment; parents, guardians, and caregivers of children 13 and under or of someone with a disability; people who are incarcerated or were released within the last 90 days; former foster youth under 26; Native Americans and Alaska Natives; and veterans with a total disability rating.
Other North Dakota Medicaid changes to know
Six-month renewals: starting January 1, 2027, Medicaid Expansion enrollees will complete a redetermination every six months; Tribal members stay on annual renewals. Retroactive coverage: also starting January 1, 2027, coverage can reach back up to one month for Medicaid Expansion members and up to two months for traditional Medicaid members. Cost sharing: starting October 1, 2028, some Medicaid Expansion members above 100% of the poverty level will help pay for their care; primary care, prenatal and pediatric care, and emergency services are excluded. Immigrant eligibility: beginning October 1, 2026, refugees, asylees, humanitarian parolees, and victims of human trafficking no longer qualify for Medicaid (Cuban and Haitian entrants remain eligible), though newly arrived refugees may qualify for Refugee Medical Assistance for their first eight months. ND HHS posts updates on its Stay Enrolled page.
Straight talk: Medicaid is a state program, not something we sell. If it's your best option, we'll tell you exactly that and point you to ND HHS — no charge, no strings. And if your income sits above the Medicaid line, that's precisely where marketplace credits take over, and where a side-by-side comparison of every plan in your county matters most.
Income near the line? North Dakotans with seasonal work, gig income, or variable hours can move between Medicaid and the marketplace from year to year. In most cases, losing Medicaid eligibility opens a 60-day Special Enrollment Period for marketplace coverage. Don't guess at the boundary; a 10-minute call maps it.
Marketplace Insurance in North Dakota: Plans for 2027
North Dakota's marketplace runs on HealthCare.gov, and it stays there for 2027. Every plan sold there is ACA-compliant: the 10 essential health benefits, no pre-existing condition exclusions, and preventive care at no cost. Carriers vary by county and change from year to year, so the only lineup that matters is the one for your ZIP code. We price the 2027 plans actually offered in your county, and check them against your doctors and prescriptions, before recommending anything. (See our carrier partners.)
🪨 Bronze
Lowest premiums — they can be $0 after credits at lower incomes — with the highest deductibles. Exchange bronze plans now count as HSA-eligible, and the 2027 HSA limit is $4,500 for self-only coverage.
🪙 Silver
The sweet spot for most subsidy-eligible households. Under ~250% FPL, Cost-Sharing Reductions can cut a 2027 out-of-pocket maximum from $12,000 to as low as $4,000 for one person.
🥇 Gold
Higher premium, lower out-of-pocket. The smart pick when you know care is coming — a planned procedure, a pregnancy, ongoing prescriptions.
🔹 Add-Ons
Dental & vision, accident, critical illness, and hospital indemnity plans stack alongside your ACA plan — often the difference between covered and comfortable.
One honest warning: a $0 premium is not $0 care. Free bronze plans carry real deductibles, and a 2027 marketplace plan can have an out-of-pocket maximum as high as $12,000 for one person. If your income is under ~250% FPL, a CSR Silver plan is often the far better deal than the "free" one. That's the judgment call a broker exists for.
North Dakota also runs a state reinsurance program, the Reinsurance Association of North Dakota (RAND), which pays part of large individual-market claims under a federal Section 1332 waiver; CMS approved its extension for January 1, 2025 through December 31, 2029. Free enrollment help is also available from ND Navigators at 1-833-545-9448, and the HealthCare.gov call center is 1-800-318-2596 (TTY 1-855-889-4325). Missed open enrollment with no qualifying event? Our short-term health insurance in North Dakota guide covers stopgap options, which are not ACA plans. Protecting your family's income too? See term life insurance in North Dakota.
Obamacare North Dakota Open Enrollment 2027: Key Dates
North Dakota uses the federal Marketplace, so the HealthCare.gov calendar applies: Open Enrollment runs November 1, 2026 – January 15, 2027. Some states run their own exchanges with their own deadlines, but North Dakota isn't one of them. You can compare every state on our 2027 open enrollment deadlines by state page.
📅 November 1, 2026
Open enrollment opens on HealthCare.gov. Compare 2027 plans, premiums, and your new credit amount.
⏰ December 15, 2026
Last day to enroll for coverage that starts January 1, 2027. This is the deadline that matters most.
🏁 January 15, 2027
Open enrollment ends. Enroll between December 16 and January 15 and coverage starts February 1, 2027 — a one-month gap.
🔄 After January 15
You'll need a qualifying life event (losing job coverage, losing Medicaid, moving, marriage, or a birth) to open a 60-day Special Enrollment Period.
Enrolling through FreedInsure takes about 15 minutes: (1) we project your 2027 income and calculate the exact credit, (2) we compare the plans in your county against your doctors and prescriptions, and (3) we submit the enrollment and stay on as your advisor all year. Same plans, same prices as going direct — plus a human who answers. Call (844) 788-3733 or check your North Dakota eligibility. For the national picture, read our Open Enrollment 2027 guide.
Straight talk on auto-renewal: if you do nothing, most enrollees are automatically re-enrolled in the same or a similar plan. But with credits smaller and premiums changing, last year's plan at last year's assumptions can be this year's overpay. Never let a plan auto-renew without a 15-minute re-shop — and do it before December 15 so any change starts January 1.
How FreedInsure Helps
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Ready to get started? Call (844) 788-3733 or complete the form below. A licensed advisor will call within 15 minutes with personalized options. No pressure, no spam, no data selling. Just expert guidance that's 100% free.
Free Health Insurance North Dakota FAQ: 2027 Answers
Official Sources for This Guide
- HealthCare.gov: Dates and deadlines for 2027 coverage
- CMS: States by Marketplace Type for Plan Year 2027
- ND HHS: Medicaid eligibility (income levels effective April 1, 2026)
- ND HHS: Medicaid Expansion
- ND HHS: Stay Enrolled — updates on SNAP and Medicaid (work requirements)
- North Dakota Insurance & Securities Department: Reinsurance Association of North Dakota
- CMS: Section 1332 State Innovation Waivers (North Dakota)
- IRS: Rev. Proc. 2026-26 (2027 premium tax credit percentages)
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