Health insurance in Montana
- The Montana health insurance marketplace uses the federally run exchange at HealthCare.gov.
- The open enrollment period for 2021 coverage in Montana ended on December 15, 2020. Residents with qualifying events can enroll or make changes to their plan outside that window. Losing employment and health benefits due to coronavirus-related business shutdowns is considered a qualifying event.
- Short-term health insurance can be sold in Montana with initial plan terms up to 364 days.
- Three health insurance companies are offering 2021 coverage through the Montana health insurance marketplace.
- Montana’s insurers lowered premiums by an average of 13% for 2020, due in large part to new reinsurance program (but subsidies are smaller too). For 2021, insurers have proposed an average rate increase of about 3%.
- About 45,000 enrolled in 2019 coverage through the Montana exchange.
- Montana implemented the ACA’s Medicaid expansion in 2016. The state is now seeking federal approval to add a work requirement.
This page is a resource to help consumers quickly find health insurance options in Montana. Here, you’ll find information about the types of health insurance coverage available for families and individuals. You can find the basics of the Montana health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Montana; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of Montana health insurance resources for residents.
Montana’s health insurance marketplace overview
The health insurance marketplace, or health insurance exchange, was created by the Affordable Care Act (Obamacare). The marketplace is an avenue to get coverage for people who are self-employed or work for an organization that doesn’t provide health benefits. The federal government operates Montana’s marketplace, which means individuals can enroll themselves or their families enroll at Healthcare.gov.
The ACA mandates essential benefits that must be covered through marketplace plans. Enrollment may not automatically carry over from one year to the next. The available health plan options and premium costs offered on the marketplace vary from one year to the next, and if you had a change in income change, you may qualify for a different level of subsidies or cost-sharing reductions.
Montana open enrollment period and dates
Open enrollment in Montana for 2021 coverage ran from November 1 through December 15, 2020. Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan. Loss of an employer-sponsored plan is a qualifying event, so people losing coverage amid the COVID-19 pandemic can obtain replacement coverage in the exchange.
Three insurers are offering ACA-compliant medical plans in Montana for 2020, 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.
43,822 people enrolled in private plans through the Montana health insurance marketplace for 2020. As is the case in most states that use HealthCare.gov, enrollment peaked in Montana’s exchange in 2016 — with more than 58,000 enrollees — and has declined each year since then.
Premiums in Montana’s individual market are an average of 13 percent lower for 2020 than they were for 2019, due in large part to the new reinsurance program the state implemented. (That applies to full-price premiums; changes in after-subsidy premiums for people who are subsidy-eligible can be much different.)
For 2021, the state’s individual market insurers have proposed an overall average rate increase of about 3 percent. Although that’s fairly modest, Insurance Commissioner Matt Rosendale has said that he doesn’t believe insurers should raise prices at all for 2021, due to the significant reduction in elective medical procedures during the COVID-19 pandemic.
Read our guide to the Montana health insurance marketplace for more details.
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 superseded a letter Lindeen wrote in late 2016, which took an opposing perspective.
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, and only four remain operational as of 2020. Montana Health CO-OP is among the four surviving CO-OPs, and it has a larger share of Montana’s individual market than either of the other two insurers.
Medicaid is a health insurance option for people who have little or very low income or who have a disability. Medicaid is run jointly by state and federal government; Medicaid is primarily funded by the federal government. Each state determines specific eligibility rules and operates the program within the overall guidance and requirements established by the federal government. Income limitations for eligibility vary by state and for adults, children, pregnant women, and people with disabilities. Some people qualify for both Medicaid and Medicare.
Medicaid expansion in Montana
Initially, Montana did not move forward with Medicaid expansion, which meant there was no financial assistance available for people with incomes below the poverty level who did not qualify for Medicaid coverage 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.
The state renewed funding for Medicaid expansion in 2019, but included a work requirement provision. The work requirement proposal is still pending federal approval as of mid-2020 (and Medicaid work requirements are essentially on hold as a result of the COVID-19 pandemic and the widespread unemployment that it has caused).
The state’s average monthly Medicaid enrollment grew 66 percent from before the ACA to March, from 148,974 to 247,058. But it had been even higher as of mid-2018, when the number of Montanans covered by Medicaid/CHIP reached 278,662.
Read more about Medicaid expansion in Montana.
Short-term health insurance in Montana
Read more about short-term health insurance in Montana.
Medicare covers people who are age 65 or older, certain people with disabilities, and people with end stage renal disease (ESRD). Medicare terminology can be confusing. Here are simple definitions of Medicare options you may have heard about, and visit the Medicare Resources website for detailed information.
- Medicare Part A covers inpatient hospital care.
- Medicare Part B covers medical services.
- Medicare Part D covers prescription drugs.
- Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for services you receive. You can also buy a Medicare supplemental (Medigap) policy and/or a standalone Prescription Drug Plan.
- Medicare Part C, also called Medicare Advantage, covers parts A, B, and, D. Through Medicare Advantage, you can chose from one of several private health plans in your state, and the federal government pays the plan for the services you receive.
Medicare coverage and enrollment in Montana
As of May 2020, 234,867 Montana residents were enrolled in Medicare plans. Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare, and 18 percent did so in 2018 (quite a bit lower than the national average of 34 percent). Of all Montana Medicare enrollees, about 51 percent have a stand-alone prescription drug plan.
Read more about Medicare enrollment in Montana, including the state’s rules for Medigap plans.
Montana health insurance resources
- The Healthcare.gov website provides information on how renew, change, update, or cancel the exchange plan in which you are currently enrolled
- First Choice Services (2019 Navigator grant recipient in Montana)
- Montana Medicaid and Health Montana Kids (HMK) Plus
- Montana Medicare 101
Montana’s state-based health reform legislation
Scroll to the bottom of this page for a summary of recent state-level bills related to health reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.