Montana Health Insurance Exchange Options and Enrollment

If you're a Montana resident looking for health insurance options, you're in the right place. Montana's Health Insurance Exchange offers a range of plans to fit different needs and budgets.

There are two main types of plans to choose from: on-exchange and off-exchange. On-exchange plans are available through the Health Insurance Exchange and may offer subsidies to help lower costs.

The Health Insurance Exchange offers a variety of insurance companies to choose from, including Blue Cross and Blue Shield of Montana, PacificSource Health Plans, and Mutual of Omaha.

You can 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.

Eighty-nine percent of Montana's Marketplace enrollees were receiving premium subsidies as of early 2024, with an average subsidy of $505/month.

You can combine Advance Premium Tax Credits (APTC) and Cost-Sharing Reduction (CSR) benefits if you're eligible for both, as long as you select a Silver-level plan.

Three private insurance companies offer Marketplace health insurance coverage in Montana, and all three have statewide coverage areas.

Here are the options for those losing Montana Medicaid or Healthy Montana Kids coverage:

A record-high 66,336 people enrolled in private plans through the Marketplace in Montana during the open enrollment period for 2024 coverage.

To enroll in a Marketplace 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.

You can also enroll with the help of an insurance agent or broker, or a Navigator or certified application counselor. Alternatively, you can enroll via an approved enhanced direct enrollment entity (EDE). Keep in mind that EDEs can also offer off-exchange plans and non-ACA-compliant plans, so be sure to specify that you want to enroll in Marketplace/exchange coverage to obtain any subsidies for which you might be eligible.

To enroll in your selected plan, you'll need to follow these steps: apply, enter information about you and your family, and then enroll. You can also call HealthCare.gov's contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325) for assistance.

Here's a summary of the steps to enroll:

* Apply on HealthCare.govEnter information about you and your familyEnroll in your selected plan

Note: Internet/Wi-Fi connection is needed for computer access, and data charges may apply.

You can enroll in Medicare during your initial enrollment period, which starts three months before your 65th birthday and ends three months after.

Medicare has several enrollment periods throughout the year, including the annual enrollment period from October 15 to December 7.

In Montana, you can also enroll in Medicare Advantage plans, which combine Medicare Part A and Part B, and often include additional benefits like dental and vision coverage.

You can also enroll in Medigap plans, which supplement your Medicare coverage and help pay for out-of-pocket costs like deductibles and copays.

Medicare Advantage plans and Medigap plans have different enrollment periods and rules, so it's essential to understand the specifics for Montana.

The initial enrollment period is the best time to enroll in Medicare, as it ensures you don't have to pay late enrollment penalties.

In Montana, you can purchase Medigap plans from private insurance companies, and the state regulates the plans to ensure they meet certain standards.

Medicare Advantage plans, on the other hand, are offered by private insurance companies, but are regulated by Medicare.

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.

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

You can enroll in an ACA-compliant plan through HealthCare.gov, Montana's Marketplace (exchange), or with the help of an insurance agent or broker, or a Navigator or certified application counselor.

To enroll in an ACA-compliant plan, you can visit HealthCare.gov, HealthCare.gov's contact center (1-800-318-2596), or an approved enhanced direct enrollment entity (EDE).

You can also enroll in Medicaid and Healthy Montana Kids (CHIP) year-round, if you're eligible.

Here are the key enrollment periods to keep in mind:

To enroll in a Marketplace plan in Montana, you can visit HealthCare.gov, which is Montana's Marketplace (exchange), or work with an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity (EDE).

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

To find the right plan for you, you can shop through the HealthCare.gov platform, which will show you the plans you're eligible for, along with their price and benefits.

Short-term health plans are a temporary solution for consumers who may find themselves without comprehensive coverage. They provide a safety net until a more permanent solution can be found.

In Montana, short-term health plans are available for those who need temporary health insurance. These plans offer a way to bridge the gap between losing coverage and getting a new plan.

Short-term plans can be a good option for people who are between jobs or waiting for their new employer's health insurance to kick in. They can also be a stopgap for those who are waiting for their new plan to start.

Short-term plans are typically less expensive than comprehensive health insurance, but they often come with higher deductibles and limited coverage.

To be eligible to buy Marketplace health insurance, you must live in Montana and be lawfully present in the United States. You also can't be incarcerated.

Most people are eligible to enroll in Marketplace coverage, but qualifying for financial assistance is a bit more complex. To qualify for financial assistance, your income plays a big role.

You won't qualify for financial assistance if you 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 a calculator to see if you might qualify for premium subsidies in the Marketplace.

Eligibility for financial assistance also depends on whether you're eligible for Medicaid or CHIP (Montana Healthy Kids), or premium-free Medicare Part A. If you're married, you must file a joint tax return with your spouse. And, you can't be claimed by someone else as a tax dependent.

Here are the key requirements to keep in mind:

Three private insurance companies offer Marketplace health insurance coverage in Montana, and all three have statewide coverage areas.

Montana is one of the states with a relatively small number of insurers offering Marketplace plans, which means consumers have fewer options to choose from.

One of Montana’s insurers, Montana/Mountain Health CO-OP, is among just three ACA-created CO-OPs still in operation nationwide, showing that it's been able to adapt and thrive in a competitive market.

This limited number of insurers can make it harder for consumers to find the best plan for their needs and budget.

The fact that all three insurers have statewide coverage areas is a positive aspect, as it ensures that people can get coverage no matter where they live in Montana.

In Montana, some health insurance premiums are increasing in 2025, but not all plans are affected equally. BCBS of Montana's premium will rise by 5.03%, while PacificSource's will increase by 8.16%.

However, most people won't feel the full brunt of these increases, as 89% of Marketplace enrollees in Montana receive premium tax credits that cover some or all of their monthly premium costs.

The average rate increases are for full-price plans, which are the plans that don't qualify for these subsidies. Despite the increases, these subsidies will continue to be larger and more widely available than they were in the past, thanks to the American Rescue Plan and the Inflation Reduction Act.

Here's a brief look at how average full-price premiums have changed in Montana's individual/family health insurance market over the years:

You can find the plans you're eligible for, along with their price and benefits, when you start shopping through the Blue Cross Blue Shield of Montana shopping platforms.

The plans you can enroll in might differ in their deductible, coinsurance or copay costs.

Start by learning more about your plan options to find coverage that fits your needs.

To enroll in an ACA Marketplace plan in Montana, you can visit HealthCare.gov, which is Montana's Marketplace. This platform lets Montana residents comparison shop for health coverage, determine subsidy eligibility, and select the plan that best meets their needs.

You can also enroll with the help of an insurance agent or broker, or a Navigator or certified application counselor. Enrolling via an approved enhanced direct enrollment entity (EDE) is another option, but be sure to specify that you want to enroll in Marketplace/exchange coverage to obtain any subsidies for which you might be eligible.

If you have questions or need help with the enrollment process, you can call HealthCare.gov's contact center at 1-800-318-2596 (TTY: 1-855-889-4325), which is available 24 hours a day, seven days a week, except for holidays.

Dental coverage is a smart addition to your health coverage, especially if you're hoping to improve your smile.

Some states, like Montana, offer specific options for dental insurance.

Dental insurance may be a good idea if you want to save money on dental care.

In Montana, for example, dental insurance can help you cover expenses for regular check-ups, fillings, and other procedures.

Regular dental care can help prevent more costly problems down the line.

Dental insurance can also help you budget for unexpected dental expenses.

You can check which doctors and hospitals are covered by a plan's network using the Provider Findertool. This tool lets you search in-network doctors, hospitals, and specialists.

To get started, simply visit HealthCare.gov or BCBSMT's website and use their Provider Findertool. You can filter by ZIP code, plan name, and type of care needed to explore covered doctors.

If you're already a BCBSMT member, you can log in to get search results personalized to you and your plan. This can be a big help if you're trying to find a specialist or a hospital that's close to your home.

You can also search as a guest, which is a good option if you're just starting to research plans and want to get a sense of which providers are covered.

You can enroll in a Blue Cross Blue Shield of Montana (BCBSMT) plan during the annual open enrollment period, which runs from November 1 through January 15.

If you miss the December 15 deadline, your coverage will take effect on February 1, not January 1.

To enroll in a BCBSMT plan, you can visit HealthCare.gov, which is Montana's Marketplace (exchange), and comparison shop for health coverage.

You can also enroll with the help of an insurance agent or broker, a Navigator, or a certified application counselor.

If you prefer, you can enroll via an approved enhanced direct enrollment entity (EDE), but be sure to specify that you want to enroll in Marketplace/exchange coverage to obtain any subsidies for which you might be eligible.

You can also call HealthCare.gov's contact center at 1-800-318-2596 (TTY: 1-855-889-4325) to enroll or get help with the process.

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

If you experience a qualifying life event, such as giving birth or losing other health coverage, you may still be eligible to enroll or make a plan change.

You can enroll in a Montana Health Insurance Exchange plan during the annual open enrollment period, which typically runs from November to December.

Open enrollment is the only time outside of special enrollment periods when you can enroll in a new plan or make changes to your existing plan.

You can also enroll in a Montana Health Insurance Exchange plan if you've experienced a qualifying life event, such as losing your job, getting married, or having a baby.

Qualifying life events can trigger a special enrollment period, allowing you to enroll in a new plan or make changes to your existing plan.

The Montana Health Insurance Exchange offers four levels of coverage: Bronze, Silver, Gold, and Platinum.

Bronze plans have the lowest premiums but also have higher out-of-pocket costs.

Silver plans have moderate premiums and out-of-pocket costs.

Gold plans have higher premiums but lower out-of-pocket costs.

Platinum plans have the highest premiums but also the lowest out-of-pocket costs.

You can also choose a catastrophic plan, which has lower premiums but only covers essential health benefits.

Catastrophic plans are only available to people under the age of 30 or those who qualify for a hardship exemption.

All Montana Health Insurance Exchange plans must cover essential health benefits, including doctor visits, hospital stays, and prescription medications.

Essential health benefits also include maternity care, mental health services, and substance abuse treatment.

You can also add a dental or vision plan to your Montana Health Insurance Exchange plan, if you choose.

Adding a dental or vision plan can help you save money on out-of-pocket costs for these services.