Health insurance in North Dakota
40,374 North Dakota residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 48 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
North Dakota uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in North Dakota
North Dakota expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
41,107 under-65 North Dakota residents are uninsured all the same, 6.5% of them — 40th of the 51 states and DC, and 0.7× the 26-state median of 9.9%.
How much choice North Dakota counties get
Counties in North Dakota carry between 2 and 3 insurers, so competition is fairly even across the state without being uniform.
No county in North Dakota is down to a single insurer. Since the previous plan year, 39 counties in North Dakota gained an insurer and none lost one.
How many North Dakota residents buy on the marketplace
40,374 North Dakota residents selected a marketplace plan for 2026. Against the state's under-65 population that is 64 per thousand, below the 26-state median of 79, and 17th highest of the 26 states on this site.
Of those, 5,205 — 13% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (22nd of 26).
The spread inside North Dakota
Cass County is the largest county we publish here, with 166,524 under-65 residents; Grand Forks County is the smallest, with 59,426. Cass County has 3 insurers offering 40 plans, and Grand Forks County has 3 offering 31.
The widest choice in North Dakota is in Cass County — 3 insurers, 40 plans. The narrowest is Grand Forks County, with 3 insurers and 31 plans. Same state, same rules, 9 more plans to choose from.
Uninsured rates range from 5.4% in Burleigh County to 6.0% in Cass County — 1.1 times as high, within one state.
The 3 largest counties in North Dakota
By under-65 population, covering 49% of the state's under-65 residents. North Dakota has 48 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Cass County | 166,524 | 6.0% | 3 | 40 | 39 |
| Burleigh County | 79,314 | 5.4% | 3 | 37 | 55 |
| Grand Forks County | 59,426 | 5.9% | 3 | 31 | 57 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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