The Healthcare System in the Northern Mariana Islands: Health Insurance, Public Hospital, Emergencies and Health Risks

There is no universal health insurance fund comparable to French Sécurité sociale in the Northern Mariana Islands. The system combines three tiers. US federal programmes form the first: Medicare, for people aged 65 and over, and Medicaid, for low-income households. The second is territorial: the Commonwealth Medicaid Agency administers the CNMI’s Medicaid and Children’s Health Insurance Program (CHIP). The third consists of employer insurance and individual contracts, for which CMS refers questions to the CNMI Department of Commerce.

Funding of the CNMI’s Medicaid is mixed: according to the MACPAC commission, the 2023 appropriations act permanently set the federal contribution rate at 83% for the CNMI, as for Guam, American Samoa and the Virgin Islands. The territories are treated as states for Medicaid, unless otherwise indicated, but their programmes differ from those of the states. The CNMI Medicaid agency says it covered more than 18,000 beneficiaries, with a network of more than 1,500 providers and some sixty facilities, ranging from local providers to facilities abroad. On the provision of care, the public sector is organised around the Commonwealth Healthcare Corporation, described below.

Medicare is for people aged 65 and over. According to the CMS guide on immigrants’ coverage options, US citizens and qualified immigrants with at least 40 quarters of contributions (10 years for most people) receive Part A, hospital insurance, premium-free. Without enough quarters, Part A can be bought, with a reduced monthly premium from 30 quarters and a higher one below that. Part B (doctors and outpatient care) carries a monthly premium and an annual deductible; permanent residents must show five years of continuous residence for Part B. These amounts, like the Part A hospital deductible, are revised each year.

CNMI Medicaid: CMS explains that many qualified immigrants must wait five years after obtaining their status before accessing Medicaid and CHIP, with exceptions such as refugees. CMS also notes that the CNMI is among the territories and states that have chosen to cover lawfully residing children or pregnant women without subjecting them to this waiting period. The conditions applicable to a French national should be confirmed with the Commonwealth Medicaid Agency (+1 670 664 4880 in Saipan, +1 670 433 9263 in Tinian, +1 670 236 2080 extension 5016 in Rota; info@cnmimedicaid.org), open Monday to Friday from 7:30 a.m. to 4:30 p.m.

Employer insurance and individual contract: for insurance taken out by oneself or by an employer that operates only in the CNMI, CMS refers to the CNMI Department of Commerce (+1 670 664 8020, support@commerce.gov.mp). Lastly, CMS reminds readers that CNMI residents are not eligible for the federal Marketplace.

The official sources consulted describe no uniform organisation of the first-contact doctor in the Northern Mariana Islands, nor published consultation fees. In Tinian and Rota, the CHCC offers primary care, a pharmacy, a laboratory and radiology; its outpatient clinics generally operate Monday to Friday from 7:30 a.m. to 4:30 p.m., and specialist consultations in paediatrics, podiatry, gynaecology-obstetrics and ENT are organised in visiting clinics. The CHCC also offers telemedicine and a medical referral programme between the islands. In practice, access to practitioners depends on the insurance contract: the employer’s insurer or the individual contract specifies the care network and deductibles, which should be read before any planned consultation.

For medicines, the CHCC presents an outpatient pharmacy open Monday to Friday from 8 a.m. to 5:30 p.m., and at weekends and on public holidays from 8 a.m. to 4:30 p.m. France Diplomatie specifies that a French prescription does not allow you to buy medicines in the United States: you must bring a sufficient quantity of your treatment and keep a copy of the prescription. Chronic treatment should be prepared before departure with your regular doctor. The detail of reimbursements by situation is in the page healthcare reimbursement in the Northern Mariana Islands.

The Commonwealth Healthcare Corporation (CHCC) is a public corporation created by public law 16-51, signed on 15 January 2009: it brought together in a single entity the hospital, public health, mental health and community guidance centre of Saipan, Tinian and Rota. Its head office is at 1178 Hinemlu Street, in Garapan (Saipan), and its switchboard is +1 670 234 8950; its emergency services operate 24 hours a day. The areas of care cited on its site include public health (vaccinations, maternal and child health, family planning, prevention of non-communicable diseases), mental health, medical specialities and a directory of practitioners.

In Tinian, the Lucia “Chiang” Villagomez Arizapa Health Center (San Jose Village, +1 670 433 9337) and, in Rota, the Rota Health Center (Songsong, +1 670 532 9461) each have an emergency department open 24 hours a day, a pharmacy, a laboratory, radiology, public health and a community guidance centre. The sources consulted do not publish the number of beds or activity figures of the Saipan hospital, and do not specify the list of tests or procedures performed on each island: complex cases are referred between the islands or abroad, as the mention of facilities abroad in the Medicaid agency’s network suggests.

In an emergency, the number to dial is 911 throughout US territory. France Diplomatie indicates that the ambulance is the only transport that gives priority on arrival at hospital emergency departments, that admission depends on a financial guarantee and that, without cover, access to care may be refused, even in a life-threatening situation.

France Diplomatie describes the United States’ medical infrastructure as excellent but very costly and deems essential an assistance or insurance contract covering all medical costs, including surgery and hospitalisation, as well as medical repatriation: the embassy can under no circumstances cover the costs. The CDC for its part indicates that emergency care in the Northern Mariana Islands may be limited or may not meet US standards, that trauma centres are few outside urban areas and that medical evacuation insurance is recommended in the event of serious injury. See repatriation and assistance and expat health insurance.

The CDC (traveller page for the Northern Mariana Islands) recommends vaccines against hepatitis A for unvaccinated travellers from one year old, against hepatitis B for all ages, against typhoid for most travellers, and complete measles vaccination (MMR) for all travellers, at least two weeks before departure. The yellow fever vaccine is neither recommended nor required. Rabies is uncommon in dogs, but post-exposure treatment may be available only in large facilities. France Diplomatie reminds travellers that the vaccinations of the French schedule must be up to date, notably diphtheria, tetanus, poliomyelitis, whooping cough and measles.

Dengue is transmitted by mosquito bite and has no curative treatment, according to France Diplomatie, which asks people to avoid anti-inflammatory drugs at all costs; the CDC page on the Northern Mariana Islands associates no vaccine with it and indicates that prevention relies on protection against bites: repellent, long clothing, air-conditioned rooms or mosquito nets. The CDC also mentions leptospirosis, transmitted through contact with water, soil or food contaminated by animal urine (avoid floodwater), hantavirus and tuberculosis.

The American weather service in Guam specifies that cyclone activity peaks from September to November for many places in the region, but that cyclones can occur all year round in the Northern Mariana Islands: it invites people to stay prepared at all times. Its brochure recommends building up supplies of non-perishable food and drinking water, getting batteries, lamps and a battery-powered radio, filling up with fuel and protecting openings, then, during the storm, staying indoors and listening to local bulletins or NOAA weather radio.

For a patient on regular treatment, it is wise to agree in advance with your doctor the quantity of medicines to keep at home, and to identify the nearest CHCC facility; the guidance in force should be consulted with CNMI services and NWS Guam at the time of the stay. See the page living in the Northern Mariana Islands.