Best Health Insurance in North Dakota (2026)

Key Takeaways

Sanford Health Plan offers the best health insurance in North Dakota for HMO plans, while Blue Cross Blue Shield has the best PPO plans in the state.

Sanford Health Plan also provides the cheapest health insurance in North Dakota, though its deductibles rank as the second most affordable option.

When shopping for health insurance in North Dakota, gather quotes from several insurers, review coverage limits and plan benefits, and confirm that your preferred doctors and healthcare providers are included in the network.

North Dakota's individual health insurance market has only three carriers offering plans on HealthCare.gov for 2026. When we analyzed all available plans, one figure shaped the comparison: Sanford Health Plan's Silver-tier HMO costs $484 per month for a 40-year-old, while Blue Cross Blue Shield's comparable PPO costs $667.

That $183 gap is the full spread in North Dakota's market: Sanford is the cheapest carrier and Blue Cross Blue Shield is the most expensive. Over a year, that spread is $2,196. Whether it's worth crossing depends almost entirely on whether your doctors accept HMO referrals.

North Dakota's geography means many residents have limited access to specialists regardless of plan type, which reduces the practical cost of the HMO referral requirement. Sanford's integrated health system covers much of the state, which makes its network workable for most residents outside the major metros. Most states offer five or more plans from different insurers, which creates more price competition. Here, the comparison is simpler, but your options are limited to three carriers regardless of what you're willing to pay.

Best Health Insurance Companies in North Dakota

Sanford Health Plan is the best health insurance company in North Dakota for HMO plans with reliable plans for residents who want comprehensive care.

If your doctors accept HMO referrals and you don't see specialists regularly, Sanford's Silver HMO at $484 per month for a 40-year-old is almost certainly your best option.

Medica also has strong HMO options for those who want quality coverage. For PPO plans, Blue Cross Blue Shield is the state's leading provider with flexible networks and broader provider access. These insurers give North Dakota residents options across HMO and PPO plans to match different needs.


Sanford Health Plan	$484	$5,881	$2,748	4.5	Sanford Individual True $3,500
Blue Cross Blue Shield	$667	$5,521	$2,181	4.5	Bluedirect Silver 80 Hsa Eligible
Medica	$696	$5,950	$2,305	4	Essentia Choice Care With Medica Silver Share

*Our picks are the best health insurance options for 40-year-olds looking for Silver-tier HMO plans.

Sanford Health Plan

MoneyGeek Rating

4.5/ 5

5/5Affordability

2.5/5Deductible

5/5MOOP

Average Monthly Rate
$484
Average MOOP
$5,881
Average Deductible
$2,748

pros
- Lowest health insurance premiums in North Dakota
- Low $1,406 deductibles available on Gold plans
- Coverage options from Catastrophic through Gold tiers
- Has both HMO and PPO network structures
cons
- Catastrophic plans have high $10,600 deductibles and limits
- Gold plans have higher out-of-pocket maximums than Silver
Sanford Health Plan has both HMO and PPO coverage across all metal tiers in North Dakota. A 40-year-old pays around $315 monthly for Catastrophic coverage, $398 for Expanded Bronze, $484 for Silver and $509 for Gold plans. Deductibles vary by tier.
Catastrophic plans start at $10,600 deductibles. Gold coverage has $1,406 deductibles. Out-of-pocket maximums range from $5,881 to $10,600. Premiums climb with age. 60-year-olds pay $669 to $1,080 monthly based on the metal level. Catastrophic plans are available for younger enrollees who want basic coverage at lower monthly costs.
Sanford's referral model is the real constraint. Residents who see specialists regularly, or whose primary care providers are not in Sanford's network, will deal with more friction than the $183 monthly savings justifies.

Medica is the better fit for residents whose care runs through Essentia Health or Altru Health System facilities in the eastern part of the state. Blue Cross Blue Shield is the right pick for anyone who needs specialist access without a primary care referral. Sanford's top-scoring plan is the Sanford Individual True $3,500.

Sanford Health Plan North Dakota health insurance plans for 2026:

The most counter-intuitive pattern we found in Sanford's tier data: moving from Silver to Gold adds only $25 per month ($300 per year) and cuts the deductible from $2,748 to $1,406, a reduction of $1,342.

If you hit your deductible in a given year, Gold saves $1,042 net of the higher premium. Silver makes more sense for healthy adults who carry coverage mainly for protection against an unexpected, high-cost event.

Data filtered by:


Sanford Individual True $10,600	$315	HMO	Catastrophic	$10,600	$10,600	Yes
Sanford Individual Simplicity $10,600	$383	PPO	Catastrophic	$10,600	$10,600	Yes

Blue Cross Blue Shield

MoneyGeek Rating

4.5/ 5

4.2/5Affordability

5/5Deductible

5/5MOOP

Average Monthly Rate
$667
Average MOOP
$5,521
Average Deductible
$2,181

pros
- HSA-eligible plans across all metal tiers
- Multiple plan options within Gold and Silver tiers for flexibility
- Gold plans have low deductibles starting at $1,460
- PPO network has out-of-network coverage access
cons
- Higher premiums than HMO alternatives from competitors
Blue Cross Blue Shield has the best PPO health insurance in North Dakota with top MoneyGeek scores across multiple tiers. Catastrophic plans have the lowest premiums at $374 per month. They include HSA eligibility but have high $10,600 deductibles that match the out-of-pocket maximum.

Blue Cross Blue Shield's two Gold plans carry different trade-offs. The HSA-eligible plan costs $632 per month with a $2,600 deductible and a $4,300 out-of-pocket maximum. The HSA plan works better for higher earners who can contribute pre-tax dollars to offset the higher deductible and want the lower $4,300 out-of-pocket cap. The non-HSA plan's $1,460 deductible is $1,140 lower, making it the better fit for anyone who expects moderate, regular health care costs and wants coverage to start sooner.

Silver plans cost $667 and $731 per month. They have varied deductible structures based on HSA-eligibility. Blue Cross Blue Shield has flexible networks and competitive pricing. It's the top choice for residents who want PPO coverage with out-of-network access.
At $667 per month for its best Silver plan, the Bluedirect Silver 80 HSA Eligible, Blue Cross Blue Shield costs $183 more per month than Sanford's HMO, or $2,196 per year. That premium also buys a $567 lower average deductible: $2,181 versus Sanford's $2,748.

Healthy adults whose doctors participate in Sanford or Medica networks, and who don't see specialists regularly, will pay more than they need to here. Blue Cross Blue Shield earns its premium for people with pre-existing conditions requiring frequent specialist care, frequent travelers who need out-of-network coverage, or anyone whose providers sit outside both HMO networks.
Explore Blue Cross Blue Shield health insurance plans in North Dakota for 2026:
Data filtered by:
Metal Level
Catastrophic
Blueessential Catastrophic 100 Hsa Eligible $10600 Deductible $374 PPO Catastrophic $10,600 $10,600 Yes


Blueessential Catastrophic 100 Hsa Eligible $10600 Deductible	$374	PPO	Catastrophic	$10,600	$10,600	Yes

MEDICA

MoneyGeek Rating

4/ 5

4.2/5Affordability

5/5Deductible

2.5/5MOOP

Average Monthly Rate
$696
Average MOOP
$5,950
Average Deductible
$2,305

pros
- Low $1,500 deductibles on Gold plans
- Lower maximum out-of-pocket limits on Gold coverage
- Expanded Bronze, Silver and Gold metal tiers
cons
- Limited to HMO network structures only
- Higher deductible exposure on Bronze plan options
Medica has HMO plans across multiple metal tiers in North Dakota for different budgets and healthcare needs. For a 40-year-old, Expanded Bronze coverage averages $479 per month with a $5,750 deductible.

Gold plans cost around $704 monthly with a lower $1,500 deductible. Silver plans run about $696 per month with a $2,305 deductible. Out-of-pocket maximums range from $5,725 for Gold to $7,800 for Expanded Bronze.

Premiums rise with age. 60-year-olds pay between $1,018 and $1,494 per month based on the tier. Catastrophic plans are also available for younger adults who want affordable, basic coverage.
Medica's Silver plan costs $696 per month for a 40-year-old, which is $212 more than Sanford's Silver HMO. The deductible is $443 lower ($2,305 vs. $2,748), but paying $2,544 more per year to save $443 in deductible exposure is a poor trade on cost alone.

Medica's plans are built around two named network products: Essentia Choice Care With Medica and Altru Prime By Medica. Residents whose primary care does not run through one of those two systems will find Sanford's pricing hard to pass up.

Medica North Dakota health insurance plans for 2026:

Data filtered by:


Essentia Choice Care With Medica Expanded Bronze Standard	$423	HMO	Expanded Bronze	$7,500	$5,625	Yes
Essentia Choice Care With Medica Bronze Share	$381	HMO	Expanded Bronze	$7,950	$6,000	Yes
Essentia Choice Care With Medica Bronze $0 Copay Pcp Visits	$416	HMO	Expanded Bronze	$7,950	$5,625	Yes
Altru Prime By Medica Expanded Bronze Standard	$475	HMO	Expanded Bronze	$7,500	$5,625	Yes
Altru Prime By Medica Bronze Share	$427	HMO	Expanded Bronze	$7,950	$6,000	Yes
Altru Prime By Medica Bronze $0 Copay Pcp Visits	$466	HMO	Expanded Bronze	$7,950	$5,625	Yes
Medica Individual Choice Expanded Bronze Standard	$571	HMO	Expanded Bronze	$7,500	$5,625	Yes
Medica Individual Choice Bronze $0 Copay Pcp Visits	$602	HMO	Expanded Bronze	$7,950	$5,625	Yes
Medica Individual Choice Bronze Share	$552	HMO	Expanded Bronze	$7,950	$6,000	Yes

Which Is the Best Health Insurance in North Dakota by Age and Plan Type?

The sharpest pricing pattern in North Dakota's Silver-tier data isn't the difference between carriers. It's the age multiplier. Premiums more than double between 40 and 60 across every plan type we analyzed.

By Age:

Teens (18): Sanford Health Plan HMO plans cost $345 monthly, Blue Cross Blue Shield PPO plans cost $477, and Sanford PPO coverage runs $422.
Young adults (26): Sanford leads with HMO coverage at $387 monthly. Blue Cross Blue Shield charges $535 for PPO plans, while Sanford PPO plans cost $473.
Adults (40): Sanford HMO plans cost $484 monthly, Blue Cross Blue Shield PPO plans run $667, and Sanford PPO plans cost $591.
Seniors (60): Sanford charges $1,027 monthly for HMO plans, Blue Cross Blue Shield charges $1,417 for PPO coverage, and Sanford charges $1,255 for PPO plans.

In our data, the rate increase between age 40 and 60 was the sharpest pattern across all plan types. A 60-year-old pays $1,027 per month for Sanford's Silver HMO, more than double the $484 a 40-year-old pays for the same plan. That's $12,324 per year before deductibles.

Residents considering early retirement before Medicare eligibility at 65 should factor this into their financial planning. At that premium level, income-based subsidies on HealthCare.gov can reduce costs substantially for qualifying households.

By Plan Type:

PPO: Blue Cross Blue Shield offers premium PPO coverage, charging 40-year-olds $667 monthly with a $2,181 deductible and $5,521 MOOP.
HMO: Sanford Health Plan has the lowest HMO premiums in the state, charging 40-year-olds $484 monthly with a $2,748 deductible and $5,881 MOOP.
HSA-eligible: Blue Cross Blue Shield charges 40-year-olds $731 monthly with a $3,500 deductible and $7,500 MOOP.

*All rates are averages based on Silver plans for the given category.

Compare North Dakota Health Insurance Providers

Premiums, deductibles and maximum out-of-pocket costs differ among North Dakota insurers. Use the filterable table below to sort and compare options by age, metal tier, plan type and HSA-eligibility. This helps you find coverage that balances cost, flexibility and financial protection.

Data filtered by:


Sanford Health Plan	$484	HMO	Silver	$5,881	$2,748	40	No
Medica	$696	HMO	Silver	$5,950	$2,305	40	No

Filtered to HMO Silver at age 40, this table shows Sanford at $484 per month versus Medica at $696, a $212 monthly gap for the same plan type. Over a year, that difference is $2,544.

The only reason to choose Medica at that premium is if your care runs through Essentia or Altru facilities, where Medica's named network products cover you.

How to Choose the Best Health Insurance in North Dakota

Choosing health insurance in North Dakota means weighing premiums against deductibles, network access and coverage limits.

1
Assess Your Healthcare Needs
Review your current medications, planned procedures and how often you visit doctors to determine which coverage level makes sense.
2
Compare Multiple Insurer Quotes
North Dakota has only three carriers on the exchange, which makes this comparison faster than in most states. Pull quotes from all three before deciding: Sanford, Medica and Blue Cross Blue Shield each target different buyer profiles at different price points.
3
Check Provider Networks
Verify your preferred doctors, specialists and hospitals accept plans you're considering. Out-of-network care costs more and may require full payment upfront.
In North Dakota, the network access question carries more weight than in most states. Residents in Fargo, Bismarck and Grand Forks have broad access to in-network specialists under any plan.

In rural counties, HMO referral requirements can create real delays because few in-network specialists are nearby.
4
Review Cost-Sharing Terms
Higher deductibles lower monthly premiums but increase upfront costs when you need care. In North Dakota's Silver tier, the HMO-PPO deductible gap runs $567: $2,748 with Sanford versus $2,181 with Blue Cross Blue Shield.

Moving from Sanford's Silver to its Gold plan cuts the deductible from $2,748 to $1,406 for $25 more per month, saving $1,042 net if you hit your deductible in a given year.
5
Evaluate Plan Types
HMOs, PPOs, EPOs and POS plans are found nationwide, and each offers different trade-offs. HMOs require referrals but cost less, while PPOs offer flexibility to see specialists without approval at higher premiums. EPOs and POS plans fall between these options, providing moderate flexibility and costs.
6
Explore Federal Programs
Subsidies on HealthCare.gov can substantially reduce your monthly premium. A 60-year-old in North Dakota pays $1,027 per month for Sanford's Silver HMO before subsidies. Depending on your income, that figure can drop considerably. Check Medicare Advantage and Medicare Supplement options to reduce your healthcare costs .

How Much Does Health Insurance Cost in North Dakota?

Health insurance premiums in North Dakota vary by plan type and metal tier. Expanded Bronze plans are budget-friendly options for cost-conscious residents. HMO Expanded Bronze averages $449 monthly. PPO Expanded Bronze averages $443 per month. These plans have higher deductibles and out-of-pocket maximums but appeal to people who want lower premiums.

HMO plans have the most affordable Silver coverage at $643 monthly. PPO plans have the lowest Gold rates at $621 per month. Silver-tier PPO plans cost around $685 monthly but give you more network flexibility than HMO options.

One finding in this data runs counter to the standard HMO-is-cheaper rule: at the Gold tier, PPO plans average $621 per month while HMO Gold plans average $668.

PPO Gold is $47 less per month than HMO Gold, saving $564 per year. Buyers who need Gold-tier coverage and are also considering PPO flexibility should check both before deciding. EPO and POS plans are unavailable in North Dakota.


HMO	$449	$643	$668
PPO	$443	$685	$621

*Rates are averages for 40-year-olds in North Dakota. Your rates will vary based on your age and location.

Best Health Insurance in North Dakota: Bottom Line

My recommendation for most North Dakota residents is Sanford Health Plan. Its Silver HMO costs $484 per month for a 40-year-old, $183 less than Blue Cross Blue Shield's PPO and its integrated network covers the majority of the state. That premium gap adds up to $2,196 per year. For healthy adults who see a primary care doctor annually and want financial protection against a serious medical event, Sanford's referral requirement is a manageable inconvenience.

Blue Cross Blue Shield is the right call for anyone with an established specialist relationship, those who travel and need out-of-network coverage or anyone managing a condition requiring regular specialist care. Verify that the specialists you need accept Blue Cross Blue Shield before enrolling. Medica is the best fit for residents in eastern North Dakota whose care runs through Essentia Health or Altru Health System.

Open enrollment runs from November 1 through January 15. To enroll in Sanford's Silver HMO, go to HealthCare.gov, select North Dakota and filter by HMO to find the lowest Silver option. Blue Cross Blue Shield and Medica plans are also on HealthCare.gov. Filter by PPO for Blue Cross Blue Shield or search by the Essentia Choice Care With Medica or Altru Prime By Medica plan names for Medica.

Best North Dakota Health Insurance: FAQ

North Dakota residents frequently ask about enrollment deadlines, state coverage requirements and coordinating multiple health plans:

How do I get health insurance in North Dakota?

North Dakota residents can get health insurance through HealthCare.gov, directly from insurance companies, or with help from licensed brokers. Open enrollment runs from November 1 through January 15 for 2026 coverage.

You may qualify for special enrollment after major life changes like marriage, job loss, or moving. Employer group plans are also widely available.

Are you required to have health insurance in North Dakota?

North Dakota doesn't require health insurance, and you won't have penalties for going without coverage. However, being uninsured means you'll pay the full cost of medical care out of pocket.

Can you have multiple health insurance plans in North Dakota?

Yes, you can have multiple health insurance plans in North Dakota. Through coordination of benefits, your primary plan pays first, and your secondary plan may cover remaining eligible expenses. This occurs when both spouses have employer-sponsored coverage or when combining Medicare with supplemental insurance.

What is the cheapest Silver plan in North Dakota?

Sanford Health Plan has the cheapest Silver-tier coverage in North Dakota at $484 per month for a 40-year-old. That rate rises to $1,027 per month at age 60. Medica's Silver plans average $696 per month for the same 40-year-old profile. Blue Cross Blue Shield's Silver plans start at $667 per month.

What is the difference between HMO and PPO health insurance in North Dakota?

HMO plans require you to choose a primary care doctor and get referrals to see specialists. PPO plans don't require referrals and cover out-of-network care, but cost more. In North Dakota, that trade-off costs $183 per month for a 40-year-old: $484 with Sanford's HMO versus $667 with Blue Cross Blue Shield's PPO.

Can I get a subsidy on North Dakota health insurance?

You may qualify for income-based subsidies that reduce your monthly premium on HealthCare.gov. Use the subsidy estimator at HealthCare.gov to check what you'd pay after financial assistance. Subsidies are available to people who don't have access to affordable employer coverage and whose income falls within qualifying ranges

Our Review Methodology

When ranking North Dakota health insurance plans, we focused heavily on monthly premiums since they represent your biggest ongoing expense. We also factored in financial protection limits and upfront costs that affect your total yearly spending.

Our Scoring System

We weighted three cost factors:

Monthly premium (60%): Your recurring monthly payment carries the most weight. Lower premiums earn higher scores.
Maximum out-of-pocket (20%): This caps your total yearly costs beyond premiums. Lower limits score better.
Deductible (20%): What you pay before coverage kicks in. Lower deductibles get higher scores.

Sample Consumer Profile

We reviewed all plans available on the North Dakota HealthCare.gov exchange for the 2026 plan year across five age profiles: 18, 26, 40, 50 and 60. Pricing shows 40-year-old rates unless noted otherwise. Our analysis covers Catastrophic, Bronze, Expanded Bronze, Silver and Gold tiers. Data was collected in early 2026 ahead of open enrollment.

About Mark Fitzpatrick

Mark Fitzpatrick, a Licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has spent nearly a decade analyzing the market, first at LendingTree and now at MoneyGeek, where he has produced original research on hundreds of carriers and millions of rates across auto, home, renters, health and life insurance.

He writes about economics and insurance on MoneyGeek so people can make coverage decisions with confidence. His insurance insights have been featured in The Washington Post, The New York Times and NPR, among other media outlets.

Like all MoneyGeek analysts, he draws on independent cost and consumer experience data, and no insurance company partnership influences his recommendations.

Fitzpatrick earned his degrees from Johns Hopkins University (M.A. Economics and International Relations) and Boston College (B.A.). He began his career in financial risk management at State Street. He's also a five-time Jeopardy champion!

Read Full Bio »

Sources

HealthCare.gov. "Health Insurance Marketplace." Accessed May 21, 2026.

Best Health Insurance in North Dakota (2026)

Best Health Insurance Companies in North Dakota

Sanford Health Plan

Blue Cross Blue Shield

MEDICA

Which Is the Best Health Insurance in North Dakota by Age and Plan Type?

Compare North Dakota Health Insurance Providers

How to Choose the Best Health Insurance in North Dakota

How Much Does Health Insurance Cost in North Dakota?

Best Health Insurance in North Dakota: Bottom Line

Best North Dakota Health Insurance: FAQ

How do I get health insurance in North Dakota?

Are you required to have health insurance in North Dakota?

Can you have multiple health insurance plans in North Dakota?

What is the cheapest Silver plan in North Dakota?

What is the difference between HMO and PPO health insurance in North Dakota?

Can I get a subsidy on North Dakota health insurance?

Our Review Methodology

Related Pages

Sources