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Montana health insurance

Three insurers offer 2020 coverage through the marketplace; short-term plans can now be sold 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 Montana’s marketplace, which means residents enroll at Healthcare.gov. Open enrollment for 2020 coverage has ended, although residents who have qualifying events can still sign up or make plan changes for 2020. The next open enrollment window, for plans effective January 2021, will begin November 1, 2020.

Three insurers are offering ACA-compliant plans 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.

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 has implemented (that applies to full-price premiums; changes in after-subsidy premiums for people who are subsidy-eligible can be much different). Read our guide to the Montana health insurance marketplace for more details.

Montana enrollment in qualified health plans

45,374 people enrolled in private plans through the Montana exchange for 2019, down from the 47,699 people who enrolled in plans for 2018. Montana’s peak exchange enrollment came in 2016 (as is the case for most states that use HealthCare.gov) 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.

The state renewed funding for Medicaid expansion in 2019, but included a work requirement provision. The work requirement proposal is pending federal approval as of late 2019.

The state’s average monthly Medicaid enrollment grew 77 percent from before the ACA to September 2019, from 148,974 to 264,220 (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

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 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; only five remain operational in 2017, and that has since dropped to four. 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.

Medicare in Montana

Montana Medicare enrollment has typically been higher than the national average – 21 percent of its total population, compared with 18 percent nationwide. However, per-beneficiary Medicare spending in Montana was among the lowest in the country in 2017, at $7,652. Nationally, per-beneficiary spending stood at $9,761.

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.

Montana health insurance resources

Montana’s state-based health reform legislation

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