Key threshold: If your income is below $22,025 (individual) or $45,540 (family of 4), you likely qualify for ND Medicaid with free or very low-cost coverage. No premiums, no deductibles.
North Dakota Medicaid Income Limits 2026
The following table shows the key income thresholds for North Dakota in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | $22,025 | $63,840 |
| 2 | $21,640 | $29,863 | $86,560 |
| 3 | $27,320 | $37,702 | $109,280 |
| 4 | $33,000 | $45,540 | $132,000 |
| 5 | $38,680 | $53,378 | $154,720 |
| 6 | $44,360 | $61,217 | $177,440 |
If your household income falls below the 138% FPL column, you qualify for ND Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
About ND Medicaid
Who Qualifies for ND Medicaid
If you're a North Dakota resident looking for affordable health coverage, you have two main options: ND Medicaid or marketplace subsidies through HealthCare.gov. ND Medicaid has expanded its eligibility, so adults with household incomes up to 138% of the Federal Poverty Level (FPL) can qualify. For a single person, this means an annual income of about $20,783, and for a family of three, around $35,221 (based on 2024 FPL figures, which are typically updated in April). Children can qualify with higher household incomes, up to 205% of the FPL. Pregnant women can also qualify with incomes up to 175% of the FPL, and their coverage continues for 12 months postpartum. Other groups like seniors and individuals with disabilities may also be eligible under different rules, though these groups may have asset limits, unlike the expansion group. As of 2024, approximately 110,000 people in North Dakota are covered by Medicaid, demonstrating it's a significant and active program.
If You're Near the Income Line
If your income is just above the ND Medicaid cutoff, you might still find affordable coverage through HealthCare.gov. You could qualify for marketplace subsidies, also known as premium tax credits, which significantly lower your monthly health insurance payments. For example, North Dakota's benchmark Silver plan is around $554 per month. With subsidies, your actual payment could be much lower, depending on your income. It's important to remember that changes in your income can shift your eligibility between ND Medicaid and marketplace subsidies, so reporting any income changes promptly is crucial. North Dakota saw a decrease in Medicaid enrollment after the end of continuous coverage requirements that were in place during the pandemic, with nearly 63,000 people disenrolled during redetermination. If you were among those who lost coverage, you can reapply for ND Medicaid at any time.
What ND Medicaid Covers
ND Medicaid provides comprehensive benefits with no premiums or out-of-pocket costs like co-payments, co-insurance, or deductibles for most services. This can include doctor visits, hospital stays, immunizations, pregnancy and newborn care, emergency services, and mental health and substance use treatment. North Dakota also offers several Home and Community-Based Services (HCBS) waivers designed to help elderly and disabled residents receive care in their homes or communities rather than in nursing facilities. A unique benefit under some waivers is "family personal care," which allows a family member, such as a spouse or adult child, to be paid for providing care. Additionally, North Dakota has specific Medicaid programs for children with disabilities, including a buy-in program, and waivers for medically fragile children and those with intellectual or developmental disabilities.
Tips for Applying
When navigating ND Medicaid, be aware that while there's no limited enrollment window, eligibility rules are updated annually on April 1st. For certain coverage groups, particularly for the aged, blind, and disabled, there are asset limits of $3,000 for an individual and $6,000 for a couple. If you're applying for long-term care, a 60-month "look-back" period for asset transfers is in effect, and transfers for less than fair market value could result in a penalty period. It's always a good idea to provide thorough documentation of your income and assets when applying to avoid processing delays. Your concrete action step is to visit HealthCare.gov or the North Dakota Department of Health and Human Services website to use their eligibility tools or apply.
Marketplace Insurance in North Dakota
North Dakota residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in North Dakota costs approximately $554/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in North Dakota might pay for a Silver plan after subsidies, based on the $554/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $474/mo |
| 200% FPL | $31,920 | ~$173/mo | $381/mo |
| 250% FPL | $39,900 | ~$277/mo | $277/mo |
| 300% FPL | $47,880 | ~$392/mo | $162/mo |
| 400% FPL | $63,840 | ~$523/mo | $31/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in North Dakota. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. North Dakota uses the federal marketplace at HealthCare.gov.
How to Apply for ND Medicaid
Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:
- Online: Apply through HealthCare.gov — the system automatically checks your ND Medicaid eligibility when you enter your income. Or apply directly through ND Medicaid.
- Phone: Call North Dakota's Medicaid helpline for guided help with your application.
- In person: Visit your local human services office or a certified application counselor.
You'll need proof of income (pay stubs or tax returns), proof of North Dakota residency, and Social Security numbers for household members.
Calculate Your Subsidy in North Dakota
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in North Dakota.
Frequently Asked Questions
What is the income limit for Medicaid in North Dakota?
In 2026, the Medicaid income limit in North Dakota is 138% of the federal poverty level: $22,025 per year for an individual, $29,863 for a household of 2, $37,702 for 3, and $45,540 for a family of 4.
Is Medicaid expanded in North Dakota?
Yes, North Dakota has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for ND Medicaid.
How do I get help paying for health insurance in North Dakota?
North Dakota residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of North Dakota's Medicaid program?
North Dakota's Medicaid program is known as ND Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
How do I keep my health insurance if I lose Medicaid in North Dakota?
If your ND Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Am I eligible for ND Medicaid if I'm employed?
Yes. Medicaid eligibility in North Dakota is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($22,025 for an individual), you qualify for ND Medicaid even if you work full-time. Many ND Medicaid enrollees are working adults.
What's the difference between Medicaid and marketplace insurance in North Dakota?
Medicaid (ND Medicaid) is free or near-free with no premiums or deductibles. Marketplace plans in North Dakota average $554/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.