Frequently asked questions about health insurance
coverage options in Montana
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 at Healthcare.gov.
The ACA mandates essential benefits that must be covered on marketplace plans. 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.
Read our overview of the Montana health insurance marketplace – including news updates and exchange history.
The open enrollment period for individual/family coverage runs from November 1, to January 15. Outside of open enrollment, a qualifying event (that triggers a special enrollment period) is necessary to enroll or make changes to your coverage.
Learn more in our comprehensive enrollment guides:
For 2022 coverage, there are three insurers that offer exchange plans in Montana:
- Blue Cross Blue Shield of Montana
- Montana Health CO-OP
All three insurers offer coverage statewide. And all three will continue to offer coverage in 2023.
For 2023, Montana’s individual market insurers have proposed average rate increases that vary from about 2% (Montana Health CO-OP) to nearly 16% (PacificSource). The proposed rates are under review and will be finalized before open enrollment begins on November 1, 2022.
For 2022, Montana’s individual market insurers implemented an average rate increase of about half a percent, although two of the three insurers reduced their average rates.
The year before, for 2021 coverage, average rates increased by about 1.4%, which was very much in line with the overall average rate increase in the individual market nationwide.
During the open enrollment period for 2022 coverage, 51,134 people enrolled in private individual/family plans through Montana’s exchange. That was the highest enrollment had been since 2017.
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.
By the end of 2016, the majority of ACA CO-OPs had closed, and only three remain operational as of 2022. Montana Health CO-OP is among the three surviving CO-OPs, and it had about 36% of Montana’s individual market share in 2021.
Montana Health CO-OP has also expanded over the years (as Mountain Health CO-OP), selling plans in Idaho, and as of 2021, also in Wyoming.
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.)
In the 2020 election, Gianforte successfully ran for governor of Montana, and Insurance Commissioner Matt Rosendale successfully ran to replace Gianforte in the House of Representatives. Rosendale has long been an outspoken critic of the ACA, as described below.
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. He was supportive Obamacare and worked to improve access to health care. 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 detailed 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.
As of 2022, Rosendale is the US House Rep. for Montana, and Troy Downing has taken his place as the state’s insurance commissioner. Downing is also opposed to the ACA.
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. By 2022, there were more than 116,000 people enrolled in Medicaid expansion in Montana. And the state’s average monthly Medicaid enrollment grew by 107% from late 2013 to April 2022.
The state renewed funding for Medicaid expansion in 2019, but included a work requirement provision. The work requirement proposal was still pending when the Biden administration took office, and the new administration notified Montana officials (as well as officials in other states with pending or approved Medicaid work requirements) that they would be reviewing work requirement proposals. Ultimately, the Biden administration rescinded all of the work requirement waivers that had been approved in other states, and will not approve those that were still pending, including Montana’s. Medicaid work requirements were already essentially on hold as a result of the COVID-19 pandemic, and none were in effect in 2021 even before HHS began rescinding approvals that had been previously granted in other states.
Read more about Medicaid expansion in Montana.
Montana defers to the 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.
But all of the short-term plans available in Montana as of 2022 have six-month terms (insurers can choose to offer coverage with shorter durations than the maximum allowed under state/federal rules).
Read more about short-term health insurance in Montana.
As of April 2022, 247,020 Montana residents were enrolled in Medicare plans. Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare, and about a quarter of the state’s Medicare beneficiaries had Medicare Advantage plans as of early 2022. This was quite a bit lower than the national average of 46% at that point.
Read more about Medicare enrollment in Montana, including the state’s rules for Medigap plans.
- The Healthcare.gov website provides information on how renew, change, update, or cancel the exchange plan in which you are currently enrolled
- Montana Primary Care Association (2021 Navigator grant recipient in Montana)
- Montana Medicaid and Health Montana Kids (HMK) Plus
- Montana’s Medicare SHIP (State Health Insurance Assistance Program)