With the passage of the Patient Protection and Affordable Care Act in 2010, insurance regulations in each of the states began a transitional process to come into full compliance with federal requirements. Major initial changes affect children, including the provision that they may remain on their parents’ health policies up to age 26 regardless of either marital or educational status. Additionally, children may no longer be excluded from insurance coverage based on the presence of a pre-existing condition.
Adults with pre-existing conditions are temporarily protected by high-risk pools, a system that will be replaced on January 1, 2014 when the planned health care exchanges become fully operational.
General Insurance Regulations
Currently insurers in North Dakota can exclude coverage for a pre-existing condition for up to 12 months, but the look-back period is only 6 months. Policy renewal is guaranteed if the premiums are being paid, and insurers are not allowed to terminate coverage based on health condition.
If a health insurance company in North Dakota offers a health insurance policy, they must also provide consumers with two state subsidized options to choose from as well. North Dakota insurance companies can deny coverage or raise rates based on age and health status.
Health Care Exchanges
There has been no significant activity in North Dakota toward the establishment of a health care exchange. If North Dakota has not created a state-based exchange by January 1, 2013, the U.S. Department of Health and Human Services will assume responsibility for the task.
Pre-Existing Condition Insurance
The U.S. Department of Health and Human Services administers the Pre-Existing Condition Insurance Plan in North Dakota, which provides coverage for both primary and specialty care, hospital stays, and prescription drugs. Depending on age and option chosen, the monthly premiums range from $133 to $571 with deductibles of $1000 to $3000 and the potential for a separate drug deductible. Maximum annual out-of-pocket expenses are capped at $7000.
Eligibility for Medicaid and Children’s CHIP-funded Medicaid Expansions are figured by income as a percentage of the Federal Poverty Level. From birth to age 5, children in North Dakota are Medicaid eligible at 133% FPL. Infants under one year of age qualify for CHIP aid at 133%, while those age 1-5 are at 100% FPL. In the 6-19 age bracket, the percentage is 100% for both programs.
Pregnant women may draw Medicaid benefits at 133% FPL, parents at 38%, and disabled Social Security recipients at 65%.
Approximately 16 percent of residents in North Dakota draw Medicare assistance, with more than 132,000 receiving assistance with their prescription medication costs.
North Dakota offers a Long Term Care assistance to Medicare recipients as well as Nursing Facility Services. Counseling and educational programs for Medicare beneficiaries are available through the Senior Health Insurance Program.