Health Insurance in Montana

Medicaid in Montana

Montana expanded Medicaid effective January 1, 2016, under the HELP Act signed by Governor Steve Bullock. The expansion was reauthorized in 2019 by the state legislature. It covers adults aged 19 to 64 earning up to 138% FPL (about $22,025 for a single person, or $45,540 for a family of four, for 2027 coverage). The Montana program includes some features like modest premiums for enrollees above 50% FPL and a community engagement component.

Over 90,000 Montanans have enrolled through the expansion, a significant number given the state's total population of about 1.1 million. Before expansion, Montana's uninsured rate was about 16%. It has dropped to roughly 7 to 8%.

Montana's Medicaid program is administered by the Department of Public Health and Human Services. About 250,000 Montanans total are covered by Medicaid, including expansion enrollees, children, pregnant women, and people with disabilities. Roughly 80,000 to 90,000 residents remain uninsured.

New federal work requirements also apply to expansion adults. States must start them by January 1, 2027 (a state making a good-faith effort can get extra time). Most expansion enrollees ages 19 to 64 will need to show 80 hours a month of work, school, job training, or community service. Parents of children under 14, pregnant people, people who are disabled or medically frail, American Indians and Alaska Natives, and some others are exempt. Watch for notices from DPHHS.

What plans cost in 2027

Montana premiums are among the higher in the country, driven by low population density, long distances, limited provider competition, and high per-capita healthcare costs. They jumped again for 2027. Here is the benchmark (second-lowest cost Silver) premium for a 40-year-old before subsidies, from HealthCare.gov plan data:

• Yellowstone County (Billings): about $731 per month, up from $561 in 2026
• Missoula County: about $871, up from $671
• Gallatin County (Bozeman): about $976, up from $748
• Cascade County (Great Falls): about $976, up from $748

That is roughly a 30% jump in each of these counties. The higher benchmark means larger tax credits for those who qualify, so many subsidized enrollees will see a much smaller change in what they pay. About 73,000 Montanans picked a marketplace plan during 2026 open enrollment, according to CMS.

The enhanced subsidies expired after 2025 and were not renewed. For 2027, people above 400% FPL ($63,840 for an individual, $132,000 for a family of four) pay the full premium without assistance. With premiums this high, that cliff is steep. The 2027 benchmark Silver plan for a 60-year-old in Billings costs about $1,553 a month at full price.

Carriers in Montana (2027)

Two insurers offer individual marketplace plans in Montana for 2027, and both sell in all 56 counties. PacificSource Health Plans, which sold marketplace plans in 2026, left the Montana market, so PacificSource enrollees need to choose a new plan:

• Blue Cross and Blue Shield of Montana (a subsidiary of Health Care Service Corporation) is the dominant insurer, offering plans in all 56 counties. BCBSMT has the broadest provider network in the state, including Billings Clinic, SCL Health (now Intermountain Health), Providence Health, and most community hospitals.
• Mountain Health CO-OP is a member-owned nonprofit insurer that sells plans statewide for 2027. It is the only alternative to Blue Cross in most of the state, so compare both, and check that your doctors and nearest hospital are in network.

With only two insurers, Montana has one of the least competitive marketplaces in the country. Every county has the same two choices for 2027.

Key regions

Billings

Yellowstone County (Billings) is the largest city in Montana and the healthcare hub for the eastern half of the state. Billings Clinic and St. Vincent Healthcare (now Intermountain Health) are the two major hospital systems. Billings serves as the referral center for a vast area stretching into eastern Montana, northern Wyoming, and western North Dakota. Billings residents choose between Blue Cross and Mountain Health CO-OP for 2027.

Missoula

Missoula County is the healthcare hub for western Montana. Providence St. Patrick Hospital and Community Medical Center are the main facilities. The University of Montana brings a younger population, some of whom use marketplace coverage. With PacificSource gone for 2027, Missoula has the same two insurers as the rest of the state.

Great Falls and Helena

Benefis Health System in Great Falls and St. Peter's Health in Helena serve central Montana. These cities have moderate healthcare infrastructure. Residents needing highly specialized care often travel to Billings or out of state to Salt Lake City or Seattle.

Rural and frontier Montana

Much of eastern and central Montana is classified as "frontier" territory with fewer than six people per square mile. Critical access hospitals and Indian Health Service facilities provide the healthcare backbone. Distances between providers can be enormous. Many rural Montanans drive one to three hours for specialist appointments. Air ambulance coverage is a real consideration when choosing a plan. Both marketplace insurers sell in rural counties, but network depth varies, so check which local hospitals and clinics each one includes.

Estimate your subsidy

Montana-specific things to know

Geography is the biggest healthcare challenge. Montana is the fourth-largest state by area with one of the smallest populations. Driving three hours to see a specialist is not unusual. When comparing plans, consider not just premiums and deductibles but also where in-network providers are located. A plan that is $50 cheaper per month but requires a 200-mile round trip for care may not be the better deal.

Tribal health matters. Montana has seven Indian reservations and a significant Native American population. American Indian and Alaska Native individuals have special ACA enrollment rights, including monthly enrollment (not limited to open enrollment), special cost-sharing reductions on Silver plans at any income level, and the option to use Indian Health Service facilities alongside marketplace coverage. If you are AI/AN, explore these benefits before enrolling.

Montana's reinsurance program helps. Montana operates a 1332 waiver reinsurance program that helps stabilize premiums by covering high-cost claims. The program is estimated to reduce marketplace premiums by about 10 to 15%. Without it, premiums in Montana would be even higher than they already are.

Resources

• HealthCare.gov for marketplace enrollment (Montana uses the federal marketplace)
• Montana DPHHS — Medicaid for Medicaid and HELP Act enrollment
• Montana Commissioner of Securities and Insurance for consumer assistance and insurance information