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.
Open enrollment in Montana for 2021 coverage ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021. This enrollment window is a good opportunity for both uninsured residents and current marketplace enrollees to take advantage of the newly enhanced premium subsidies created by the American Rescue Plan.
The open enrollment period for 2022 coverage will run from November 1 through December 15, 2021. Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan.
Three insurers offer plans for sale in the exchange and all three offer coverage statewide.
For 2021, the state’s individual-market insurers proposed an overall average rate increase of about 3%, but the approved rate increase averaged about 1.4%.
Although the proposed rate increases were fairly modest, Matt Rosendale, who was the insurance commissioner at the time, said that he didn’t believe insurers should raise prices at all for 2021, due to the significant reduction in elective medical procedures during the COVID-19 pandemic.
The 1.4% average rate increase ended up being very much in line with the overall average rate increase in the individual market nationwide.
During the open enrollment period for 2021 coverage, 44,711 people enrolled in private individual/family plans through Montana’s exchange. That was an increase of about 2% over the year before, but it was still down about 23% from peak enrollment in 2016.
During the first several weeks of the COVID-related enrollment window in 2021 (and before the American Rescue Plan’s new subsidy amounts were available on HealthCare.gov), 1,767 people enrolled in health plans through the Montana marketplace. That was higher than the 2020 enrollment pace during the same time of year, but the increased enrollment pace was not as significant as it was in most other states.
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 three remain operational as of 2021. Montana Health CO-OP is among the three surviving CO-OPs, and it has about a third of Montana’s individual marketshare.
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 2021, 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.
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 and likely to rescind those that had already been approved. (Medicaid work requirements were already 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.
As of February 2021, 239,951 Montana residents were enrolled in Medicare plans. Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare, and 18% did so in 2018 (quite a bit lower than the national average of 34% at that point). Of all Montana Medicare enrollees, about 51% have a stand-alone prescription drug plan.
Read more about Medicare enrollment in Montana, including the state’s rules for Medigap plans.