The news: North Dakota Insurance Commissioner Jon Godfread announced the approved 2027 premium rates for Affordable Care Act plans on October 12, 2026 — individual marketplace premiums are going up as much as 19% on average, and small-group employer plans up to 18.3%, according to the North Dakota Insurance Department. In several cases the commissioner reduced what insurers asked for. Here is what the hike means, who it hits, and what to do before open enrollment closes January 15.
North Dakota is the latest state to confirm what is shaping up to be one of the steepest ACA rate years on record: rate filings across the country for 2027 average in the high teens, and open enrollment for January 1 coverage starts in just weeks. The playbook below applies in every state, but the numbers here are North Dakota's.
In this guide
The announcement, in brief
- Individual market: approved average increases range from 7.03% (Sanford Health Plan) to 19.00% (Blue Cross Blue Shield of North Dakota), with Medica at 13.27%.
- Small-group market: approved average increases range from 9.50% (Blue Cross Blue Shield of North Dakota) to 18.34% (Sanford Health Plan), with UnitedHealthcare at 11.28% and Medica at 17.49%.
- The regulator pushed back: Godfread cut several carriers' requested increases — for example, BCBS North Dakota's individual request of 21.40% was approved at 19.00%, and Medica's individual request of 17.01% was approved at 13.27%.
- When it matters: open enrollment for ACA plans runs November 1 through January 15, and you must enroll by December 15 for coverage starting January 1.
Individual market: who's up, and by how much
Three carriers sell ACA individual plans in North Dakota, and the approved increases are not even close to uniform:
- Blue Cross Blue Shield of North Dakota: requested 21.40% on average, approved at 19.00% — the largest increase in the state.
- Medica Health Plan: requested 17.01% on average, approved at 13.27% — the commissioner's review shaved nearly 4 points off.
- Sanford Health Plan: requested 7.03%, approved at 7.03% — the mildest increase, and the same number the carrier asked for.
Averages hide the spread within each carrier too. BCBS North Dakota's approved increase ranges roughly from 14% to 23% depending on the specific plan, so two households with the same carrier can see very different bills. Your actual rate depends on your plan, your age, and your county.
Small-group market: what employers face
Small businesses buying group coverage for their teams are also in for a significant jump. Four carriers serve North Dakota's small-group market:
- Sanford Health Plan: 18.34% average increase (approved as requested).
- Medica Insurance Company: requested 18.96%, approved at 17.49%.
- UnitedHealthcare Insurance Company: 11.28% (approved as requested).
- Blue Cross Blue Shield of North Dakota: 9.50% (approved as requested).
For an employer with a small team, a double-digit premium increase can be the difference between keeping coverage generous and shifting costs to employees. If you own a small business, expect your broker or renewal letter to arrive with these numbers baked in — and start the comparison shopping early, since the open-enrollment deadline applies to your group plan cycle too.
Why rates are jumping
Commissioner Godfread put the blame squarely on the cost of receiving care: "When hospital care, medical services and prescription drugs become more expensive, the cost of insuring that care rises, too." That driver is national — hospital prices, drug costs, and higher utilization of expensive treatments are pushing premiums up in nearly every state for 2027.
There is also a subtler pressure this year: the enhanced federal premium tax credits that cushioned ACA costs in recent years have expired, and Congress declined to extend them. That raises what enrollees actually pay out of pocket and pushes some healthier people out of the market, which concentrates costs on those who remain.
It could have been worse. State law gives the North Dakota commissioner authority to approve or adjust requested rates, and this year that review shaved several percentage points off what insurers asked for — including a cut from 21.40% to 19.00% on BCBS North Dakota's individual book and from 17.01% to 13.27% on Medica's. Rate review doesn't erase the increase, but it does hold back the worst of it.
Who gets hit hardest
Middle-income buyers who no longer get enhanced subsidies. With the enhanced premium tax credits gone, people earning above 400% of the federal poverty level — roughly $62,160 for a single person or $127,000 for a family of four — absorb the full approved increase with no cushion.
Small businesses and their employees. A small-group increase of 18% can force an employer to raise deductibles, shift more premium share to workers, or shop to a cheaper carrier. Employees may see less generous benefits on the other side.
BCBS North Dakota individual customers who don't shop around. At 19% average — the steepest in the state — auto-renewing without comparing plans is the most expensive option. The Sanford individual book rose only 7.03%, so the market now has real price spread to shop against.
What to do before January 15
- Do not auto-renew without comparing. Averages mask a 12-point spread between carriers. Running a fresh comparison on Healthcare.gov takes about 15 minutes and could save hundreds of dollars a month.
- Recheck your subsidy eligibility. Even with the enhanced credits expired, standard ACA premium tax credits are still available based on your income. If your income changed in 2026, your eligibility may have shifted — check again even if you checked last year.
- Self-employed? Update your income estimate carefully. Subsidies are based on projected net income, not gross revenue. Getting that number right avoids a surprise bill at tax time. Our guide to health insurance for the self-employed walks through how marketplace plans work when your income isn't a salary.
- Mind the December 15 deadline. Open enrollment runs November 1 to January 15, but if you want coverage starting January 1, you must enroll by December 15. Waiting into January risks a coverage gap at the start of the year.
- Compare against the broader picture. Similar 2027 rate stories are playing out across the country — our coverage of Oregon's 22% increase and two carrier exits shows the national pattern and an extra playbook for when your carrier leaves the market.
Frequently asked questions
I'm not in North Dakota. Should I care about this?
Directly, no — these are North Dakota-approved rates. Indirectly, yes: the drivers (medical inflation, expired enhanced subsidies, utilization) are national, and most states are approving 2027 increases in the high teens. The same playbook — compare plans, recheck subsidies, beat the deadline — applies wherever you live.
Why did some carriers get cut more than others?
The North Dakota commissioner reviews each carrier's filings — financial condition, claims costs, administrative expenses, and profit margins — and can approve a lower increase than requested. This year Medica's individual request was cut from 17.01% to 13.27% and BCBS North Dakota's from 21.40% to 19.00%, while Sanford's was approved as filed.
Does this affect Medicare?
No. This story is about ACA individual and small-group plans for working-age people and families — the Healthcare.gov market. Medicare is a separate system with its own annual cycle. Our CMS 2027 Medicare Advantage star ratings guide covers what's new there.
Where can I verify the approved rates?
The underlying story is the North Dakota Insurance Department announcement (October 12, 2026), which publishes the requested and approved rate tables by carrier.