Montana Health Insurance Consumer Guide

To enroll in private health coverage through Montana’s Marketplace (HealthCare.gov), you must:⁶

• Live in Montana and be lawfully present in the United States
• Not be incarcerated
• Not have Medicare coverage 

So most people are eligible to enroll in Marketplace coverage. But qualifying for financial assistance (premium subsidies and cost-sharing reductions) is a bit more complex. Eligibility for financial assistance depends on your income, and you must also:

• Not have access to affordable health coverage offered by an employer. If you’re eligible to enroll in an employer-sponsored plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.

You can sign up for an ACA-compliant individual or family health plan in Montana during the annual open enrollment period, which runs from November 1 through January 15. 

For coverage to take effect on January 1, you must complete your enrollment by December 15. If your application is submitted between December 16 and January 15, your coverage will take effect on February 1.⁶

Once the open enrollment window ends, you may still be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. Some people can enroll year-round even without a specific qualifying event.⁷

Enrollment in Montana Medicaid and Healthy Montana Kids (CHIP) is available year-round.⁸ If you’re eligible for either program, you can enroll anytime.

To enroll in an ACA Marketplace (exchange) plan in Montana, you can: 

• Visit HealthCare.gov, which is Montana’s Marketplace (exchange). This platform lets Montana residents comparison shop for health coverage, determine subsidy eligibility, and select the plan that best meets their needs.. 
• Enroll in Marketplace coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁹

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except for holidays.

You may find affordable health insurance coverage in Montana by enrolling through HealthCare.gov. This is especially true if you qualify for subsidies, and most enrollees in Montana are subsidy-eligible. 

The Affordable Care Act created income-based premium subsidies called Advance Premium Tax Credits (APTC).¹⁰ If you’re eligible for APTC, it will reduce the amount you owe in premiums each month – sometimes even to $0, depending on your income and the plan you select.

Eighty-six percent of the Montana residents who selected a Marketplace plan during the 2023 open enrollment were eligible for premium subsidies. These subsidies paid an average of $491/month, reducing the average enrollee’s premium to about $133/month.¹¹

In addition to premium subsidies, you may also qualify for cost-sharing reductions (CSR) if your household income isn’t more than 250% of the federal poverty level. CSR subsidies will make the deductible and other out-of-pocket expenses (for a Silver-level plan) smaller than they would otherwise be. Twenty-six percent of Montana’s Marketplace enrollees were receiving CSR benefits in 2023.¹²

You can combine APTC and CSR benefits if you’re eligible for both, as long as you select a Silver-level plan (APTC can be used with plans at any metal level, but CSR benefits are only available on Silver plans). 

Depending on your income and circumstances, you may find that you’re eligible for free or low cost health coverage through Montana Medicaid or Healthy Montana Kids (CHIP). Check to see if you meet the criteria for these programs in Montana.

Source: CMS.gov¹³

Three private insurers offer exchange plans in Montana:

• Blue Cross Blue Shield of Montana
• Montana Health CO-OP (an ACA-created CO-OP)
• PacificSource

All three insurers offer coverage statewide.¹⁴ And all three will continue to offer coverage in 2024.

In Montana’s individual/family insurance market, the overall weighted average rate increase for 2023 was about 9.6%, which was slightly higher than the insurers initially proposed.¹⁵

Montana’s individual/family health insurers have proposed the following average rate changes for 2024:¹⁶

The rates are under review by state regulators and will be finalized before open enrollment starts in November 2023.

Average rate increases are for full-price plans. But 87% of Marketplace enrollees in Montana receive premium tax credits that cover some or all of their monthly premium costs.¹²

These subsidies are adjusted each year to match changes in the benchmark plan (the second-lowest-cost Silver plan) in each area. As a result of the American Rescue Plan and the Inflation Reduction Act, subsidies are larger and more widely available than they were in the past, and that will continue to be true at least through 2025.¹⁷

If the cost of your current plan will be going up next year, you’ll want to comparison shop in the exchange to see if there are other options that might be a better fit for your needs and budget. Open enrollment (November 1 through January 15) is your opportunity to switch to a different plan.

Nearly 54,000 people enrolled in private plans through the Marketplace in Montana during the open enrollment period for 2023 coverage.¹⁷

Effectuated enrollment is always a little lower than the number of people who initially select plans. As of early 2023, nearly 52,000 people were enrolled in coverage through Montana’s Marketplace.¹⁸

Source: 2014,¹⁹ 2015,²⁰ 2016,²¹ 2017,²² 2018,²³ 2019,²⁴ 2020,²⁵ 2021,²⁶ 2022,²⁷ 2023,¹⁷ 2024²⁸

HealthCare.gov: The Marketplace in Montana, where residents can enroll in individual/family health coverage and receive income-based subsidies. You can reach HealthCare.gov at 800-318-2596.

Montana Commissioner of Securities and Insurance: Licenses and regulates health insurance companies, agents, and brokers; can provide assistance to consumers who have questions or complaints about entities the Commissioner regulates.

Montana Primary Care Association: Montana’s federally funded Navigator organization

Montana State Health Insurance Assistance Program: A local service that provides assistance and enrollment counseling for Medicare beneficiaries and their caregivers. 

Montana Medicaid and Healthy Montana Kids (Montana’s Children’s Health Insurance Program)