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Montana health insurance

Three insurers offer 2019 coverage through the marketplace; short-term plans are now available with plan terms up to 364 days.

Health insurance in Montana

Montana’s marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Montana is one of the states that has done the least to preserve the Affordable Care Act’s provisions.

The federal government operates the Montana’s marketplace, which means residents enroll  at Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for Montana residents who have qualifying events.

Three insurers are offering ACA-compliant plans for 2019, including the Montana Health CO-OP – one of four remaining ACA-created CO-OPs in the country — which has taken over the top spot in terms of market share.

ACA enrollment analyst Charles Gaba estimates that the weighted average rate increase for 2019 is 5.7 percent. That increase, he says, is almost entirely due to the elimination of the individual mandate penalty and the expansion of short-term health plans and association health plans.

Montana enrollment in qualified health plans

In 2017, 47,699 people enrolled in 2018 plans through Montana’s exchange during the open enrollment period. That was about 9 percent lower than the 52,473 people who had enrolled for 2017, and down about 18 percent from Montana’s peak enrollment in 2016, when more than 58,000 people signed up for coverage through the exchange.

Montana Medicaid expansion

Initially, Montana did not move forward with Medicaid expansion, which meant there was not financial assistance available for people with incomes below the poverty level who did not qualify for Medicaid under the state’s existing guidelines. But in 2015, Gov. Steve Bullock signed an expansion bill into law, and on November 2, 2015, CMS approved Montana’s Medicaid expansion waiver.

Montana Medicaid enrollment surged in 2016. The state’s average monthly Medicaid enrollment grew 66 percent from before the ACA to January 2017, from 148,974 to 246,548. The number of Montanans covered by Medicaid/CHIP as of July 2018 at reached 278,662.

Read more about Medicaid expansion in Montana.

Short-term health insurance in Montana


Montana defers to new federal rules for short-term health plans, with plans now allowed to have initial terms of up to 364 days, and total duration, including renewals, of up to 36 months.

Read more about short-term health insurance in Montana.

The Affordable Care Act and Montana

In 2010, Montana’s U.S. Senators, Max Baucus and Jon Tester, voted to approve the health reform law. But Denny Rehberg, Montana’s sole Representative in the U.S. House, voted against the ACA. Baucus and Rehberg are no longer in Congress.

Senator Steve Daines, who replaced Baucus, has voted to repeal Obamacare. After Montana Rep. Ryan Zinke became Secretary of the Interior in the Trump Administration, Montana’s lone House of Representatives seat was vacant. Republican Greg Gianforte ultimately won the election to replace Zinke in the House. Gianforte opposes the ACA and wants to repeal it. [His opponent, Democrat Rob Quist, supported the ACA, but wanted to take it a step further, to a single-payer health care system.]

At the state level, former Gov. Brian Schweitzer and former Insurance Commissioner Monica Lindeen were supportive of the ACA, but the state legislature was not. Two bills that would have created a state-run exchange failed in Montana in 2011, while a bill banning the creation of a state-run exchange passed. That bill (SB 228) was ultimately vetoed by Schweitzer, but in late 2012 Montana officially announced that it would default to a federally-facilitated exchange run by HHS.

Gov. Steve Bullock took office in 2013 and has supported Obamacare and worked to improve access. On April 29, 2015, he signed Senate Bill 405 into law, which made Montana the 29th state to expand Medicaid. CMS approved a waiver that included deviations from standard Medicare expansion.

Lindeen was term limited in 2016, and was replaced as Insurance Commissioner by Matt Rosendale, who opposes the ACA and wants a more conservative, “free-market,” Montana-based approach to health care reform. In a letter to U.S. Senator Lamar Alexander (R, Tennessee) in March 2017, Rosendale details his proposals (which include the sale of non-ACA-compliant plans in Montana), and noted that his letter supersedes Lindeen’s letter from late 2016.

Other ACA provisions in Montana

The Affordable Care Act established a federal loan program to encourage the creation of nonprofit, consumer-run health insurance issuers – called Consumer Operated and Oriented Plans (CO-OPs). By January of 2013, 23 CO-Ops had received loans totaling $1.98 billion, including more than $85 million for the Montana Health CO-OP, which offers coverage in both Montana and Idaho.

By the end of 2016, the majority of ACA CO-OPs had closed; only five remain operational in 2017. Montana Health CO-OP is among them, but ceased enrollment for 2017 as of December 22, 2016. They planned to reopen enrollment on November 1, 2017, when open enrollment begins for 2018 coverage.

Medicare in Montana

Montana Medicare enrollment has typically been higher than the national average – 20 percent of its total population, compared with 17 percent nationwide. However, the state’s Medicare spending is among the lowest in the country at $6,737 per-beneficiary. Nationally, per-beneficiary spending is $8,970.

Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare. It is an option for consumers who seek additional benefits, and 19 percent of all Montana Medicare recipients selected a Medicare Advantage plan instead of Original Medicare in 2016. Of all Montana Medicare enrollees, 45 percent have a stand-alone prescription drug plan.

Montana health insurance resources

  • Forward Montana

Montana’s state-based health reform legislation

Here’s a summary of recent state-level bills related to health reform: