North Dakotans Could See Significant Health Insurance Premium Increases in 2026 if Federal Subsidies End

BISMARCK, N.D. – North Dakotans who purchase their own health insurance could face substantial premium increases in 2026 if enhanced federal subsidies are not renewed beyond next year. Insurance Commissioner Jon Godfread has approved 2026 rates for Affordable Care Act (ACA) plans, but the potential expiration of these subsidies could mean some consumers pay significantly more each month—changes that would come in addition to, and separate from, state-approved rate adjustments.

“This year, we asked companies to submit rates based on the assumption that enhanced subsidies would continue,” Insurance Commissioner Godfread said. “They also filed supplemental documentation outlining the potential market impacts if those subsidies were to end. Our approved rates reflect the state’s review and adjustments, but the larger variable for 2026 will be determined at the federal level.”

A large change will also be seen this year for “catastrophic plans” in the individual market. Previously, these plans were only available to younger individuals who met certain requirements. This year, these plans will be made available to those who meet the new eligibility requirements for 2026, regardless of age. These changes resulted in much higher rate increases for 2026 than was originally anticipated for those plans.

While North Dakota’s approved 2026 rates are in place, many consumers who currently receive subsidies could face additional costs due to a reduction in federal subsidy amounts—costs not determined or approved by the state. In some cases, the financial impact could be significant.

“We can and should debate the long-term future of these federal subsidies” Godfread said. “But that debate has to include an honest conversation about health care costs. Hospitals, pharmaceutical companies, and insurers all pla a role in affordability. Until those costs come down, or at least stabilize, simply removing the subsidies just leaves consumers exposed.”

To help visualize the potential impact on consumers, KFF (Kaiser Family Foundation) developed graphics showing how out-of-pocket premium costs could rise if enhanced ACA premium tax credits are not extended.

For the 2026 plan year, Godfread approved the following average base rate changes for the small group market:

• UnitedHealthcare Insurance Company: 8.29%
• Blue Cross Blue Shield of North Dakota: 6.30%
• Sanford Health Plan: 3.91%
• Medica Insurance Company: 7.89%

The following average base rate changes were approved for individual health plans for 2026:

• Blue Cross Blue Shield of North Dakota: 8.30%
• Sanford Health Plan: 5.12%
• Medica Health Plan: 23.09%

In order to offset the effects of changing subsidies, consumers can consider other plan options (such as lower premium silver plans, bronze plans, or catastrophic plans) which may help offset the reduction in advanced tax credits.

These changes may affect deductibles, coinsurance, and provider networks. The Department strongly encourages consumers to review their options carefully and contact their insurance company or a licensed agent to understand how any changes could affect their coverage and out-of-pocket costs, as well as potential impact on network coverage.

“Our goal is transparency,” Godfread added, “North Dakotans deserve to know what’s driving these potential changes. The discussion in Washington is complex and isn’t just about numbers – it’s about real people who have come to rely on these subsidies to find affordable coverage to protect their families. We want North Dakotans to understand what’s driving potential premium changes and to know they have options to help manage costs.”

For more information, see the approved rates and subsidy impact graphic.