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 $20,783 for a single person in 2026). 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.

What plans cost in 2026

Montana marketplace premiums are among the higher in the country, driven by low population density, geographic distances, limited provider competition, and high per-capita healthcare costs. A 40-year-old in Billings or Missoula can expect a benchmark Silver plan around $500 to $650 per month before subsidies.

The higher premiums mean larger subsidies for those who qualify. Many Montana marketplace enrollees pay relatively little after premium tax credits. Montana had approximately 50,000 marketplace enrollees for 2025.

With enhanced subsidies expiring for 2026, people above 400% FPL ($63,440 for an individual) will face the full premium without assistance. In a state where median household income is about $60,000, this threshold catches a substantial portion of the working population.

Carriers in Montana (2026)

Two carriers offer individual marketplace plans in Montana for 2026:

• 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. For many Montanans, particularly those in rural areas, BCBS is the only realistic option due to its network breadth.
• PacificSource Health Plans offers marketplace plans in select Montana counties, primarily in the western part of the state (Missoula, Flathead, and surrounding areas). PacificSource is an Oregon-based nonprofit insurer that expanded into Montana. Their plans can be price-competitive in the counties where they operate, providing an alternative to BCBS.

In western Montana (Missoula, Kalispell), residents may have both carriers to choose from. In central and eastern Montana, BCBS is typically the only marketplace option.

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. The marketplace typically offers BCBS as the primary option in the Billings area.

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. Both BCBS and PacificSource typically offer plans in the Missoula area, giving residents more choice than most 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 but fewer carrier options than Missoula. 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. BCBS is the only marketplace carrier in most rural counties.

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