Montana Health Insurance: Marketplace, Private Plans & 2027 Changes
Shopping for health insurance in Montana? 2027 brings an important change: PacificSource is leaving Montana's individual health insurance market after 2026.
That leaves two insurance companies offering Marketplace coverage in Montana for 2027, making it especially important to review your doctors, hospitals, prescriptions, networks, premiums, and out-of-pocket costs before renewing.
We help self-employed workers, individuals, families, early retirees, and small business owners compare Marketplace and other available health coverage throughout Montana.
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Montana Health Insurance at a Glance
| Topic | What Montana Residents Should Know |
|---|---|
| Marketplace | Montana uses the federal Marketplace at HealthCare.gov. |
| 2027 Open Enrollment | November 1, 2026 through January 15, 2027. |
| January 1 Coverage | Select a Marketplace plan by December 15, 2026. |
| 2027 Marketplace Insurers | Blue Cross and Blue Shield of Montana and Mountain Health CO-OP. |
| PacificSource | Individual and family plans will no longer be offered after December 31, 2026. |
| Marketplace Financial Help | Premium Tax Credits may be available to eligible households, generally within the applicable 100%–400% federal poverty level range. |
| Medicaid | Montana expanded Medicaid. Income and other eligibility requirements apply. |
| Children's Coverage | Healthy Montana Kids provides Medicaid and CHIP-related coverage options for eligible children. |
| Tribal Members | Members of federally recognized Tribes have special Marketplace enrollment and cost-sharing protections. |
PacificSource Is Leaving Montana's Individual Market
PacificSource has announced that it is exiting the individual health insurance market and will no longer offer Individual and Family plans after December 31, 2026.
If you currently have an individual PacificSource plan, your current coverage does not automatically continue as a PacificSource individual plan for 2027.
This makes the 2027 Open Enrollment period especially important for PacificSource members.
Have a PacificSource Plan? Here's What to Check
If your individual or family coverage is currently with PacificSource, use Open Enrollment to compare the 2027 options available for your ZIP code.
1. Check Your Doctors
Write down your primary doctor, specialists, preferred hospital, and any facilities you regularly use.
Don't assume a provider who accepted PacificSource will automatically be in your new plan's network.
2. Check Your Prescriptions
Compare your medications using the exact drug name and dosage.
Look at the drug tier, deductible, prior authorization requirements, and pharmacy network.
3. Compare Total Costs
Look beyond the monthly premium. Compare deductibles, copays, coinsurance, prescriptions, hospital costs, and annual out-of-pocket limits.
4. Act Before December 15
To have your new Marketplace coverage begin January 1, select your 2027 plan by December 15, 2026 and complete any required first-premium payment.
Montana Marketplace Insurance Companies for 2027
After PacificSource's individual-market exit, two insurance companies are expected to offer Marketplace individual coverage in Montana for 2027.
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Montana has a long-standing presence in Montana's individual health insurance market.
Plan designs, networks, premiums, and availability should still be reviewed for your specific ZIP code and household.
Mountain Health CO-OP
Mountain Health CO-OP will continue offering individual health insurance in Montana for 2027.
The CO-OP has also announced network and product changes for 2027, so existing members should review their renewal information rather than assuming their 2026 plan is unchanged.
Montana Open Enrollment for 2027
Montana uses the federal HealthCare.gov Open Enrollment schedule.
Open Enrollment for 2027 Marketplace coverage runs from November 1, 2026 through January 15, 2027.
- November 1, 2026: Open Enrollment begins.
- December 15, 2026: Select a plan by this date for coverage beginning January 1, 2027.
- January 15, 2027: Open Enrollment ends. Coverage selected after December 15 generally begins February 1.
Marketplace Financial Help for 2027
Eligible Montana households may qualify for federal Premium Tax Credits when buying coverage through HealthCare.gov.
The temporary federal rules that allowed some households above 400% of the federal poverty level to qualify for Premium Tax Credits ended after 2025.
Under the general rules now in effect, Premium Tax Credit eligibility typically requires household income between 100% and 400% of the federal poverty level, along with the other eligibility requirements.
For 2027, the federal applicable percentage table ranges from 2.15% at the lowest income band to 10.22% for households between 300% and 400% of the federal poverty level.
Self-Employed Health Insurance in Montana
Health insurance can be especially complicated when you're buying it without an employer.
We work with Montana ranchers, farmers, outfitters, guides, tradespeople, contractors, truck drivers, real estate professionals, remote workers, consultants, freelancers, and other people who work for themselves.
Estimate Your Income
Marketplace Premium Tax Credits are based on your expected annual household income, which can be difficult when self-employment income changes throughout the year.
Update Major Changes
If your projected household income changes significantly, updating your Marketplace application can help keep your estimated financial assistance closer to your actual situation.
Check the Network
Montana's size and rural geography make provider networks especially important. Check your doctors, hospitals, specialists, and out-of-area needs.
Check Prescriptions
Drug formularies vary between plans. Verify your medications, tiers, pharmacy network, deductibles, and any prior authorization.
Marketplace Plans vs. Other Private Health Coverage
Marketplace insurance and other private health products can work very differently.
HealthCare.gov Marketplace Plans
- ACA-compliant major medical insurance
- Coverage for pre-existing conditions
- ACA-required essential health benefits
- Defined annual out-of-pocket limits
- No medical underwriting for eligibility
- Premium Tax Credits for eligible households
Other Private Coverage
- May be sold outside HealthCare.gov
- Some products may use medical underwriting
- Pre-existing-condition rules can differ
- Benefits and exclusions can differ
- Network structures can differ
- Marketplace Premium Tax Credits generally cannot be used
Provider Networks Matter More in a State as Large as Montana
Montana's geography can make network access especially important. Many residents travel significant distances for specialists, surgery, hospital care, or other services.
Someone living in Billings may have different priorities from someone in Kalispell, Miles City, Havre, or a rural community several hours from a major hospital.
Before choosing a plan, consider checking:
- Your primary care provider
- Your preferred hospital
- Specialists you currently see
- Nearby urgent care options
- Specialty care available outside your community
- Your pharmacy and prescriptions
- Coverage when traveling outside Montana
Special Marketplace Rules for Tribal Members
Montana residents who are members of federally recognized Tribes have important Marketplace protections that differ from the normal Open Enrollment rules.
Members of federally recognized Tribes can generally enroll in a Marketplace plan at any time during the year. Once enrolled, eligible members can also change Marketplace plans up to once per month.
Tribal members may also qualify for special cost-sharing protections.
100%–300% of the Federal Poverty Level
Eligible members of federally recognized Tribes who enroll through the Marketplace may qualify for zero-cost-sharing plans, meaning no deductible, copayment, or coinsurance for covered care.
Indian Health Care Providers
Marketplace coverage does not prevent you from continuing to receive eligible services through Indian Health Service, Tribal programs, or urban Indian health programs.
Montana Medicaid and Medicaid Expansion
Montana expanded Medicaid for eligible low-income adults. Adults ages 19 through 64 may qualify depending on income and other eligibility requirements.
Montana also has Medicaid eligibility categories for children, pregnant women, people with disabilities, older adults, and other qualifying residents.
Montana Medicaid Expansion Rules Changed in 2026
Montana began implementing a community-engagement requirement for certain adults covered through Medicaid Expansion on July 1, 2026.
Adults ages 19 through 64 in the Medicaid Expansion population who do not qualify for an exclusion generally must complete 80 hours per month of qualifying activities.
Qualifying activities can include:
- Paid work
- Community service or volunteering
- Approved workforce or job-readiness programs
- Internships or apprenticeships
- Attending school at least half-time
- A combination of qualifying activities
More Montana Medicaid Changes Begin in 2027
Beginning January 1, 2027, Montana Medicaid Expansion eligibility will generally be rechecked every six months instead of annually.
Montana DPHHS says this six-month redetermination requirement does not apply to American Indian and Alaska Native individuals.
DPHHS is also adjusting some 2027 renewal dates as the new schedule is implemented.
Healthy Montana Kids
Healthy Montana Kids (HMK) is Montana's Children's Health Insurance Program.
It provides free or low-cost coverage for eligible Montana children under age 19 whose families meet the program requirements.
Covered benefits can include medical care, dental services, eyeglasses, and other eligible health services.
Leaving a Job or Losing Employer Health Insurance?
Losing qualifying employer health coverage can create a Special Enrollment Period for Marketplace insurance, so you may not need to wait for annual Open Enrollment.
Depending on your circumstances, compare:
- COBRA continuation coverage
- A spouse's employer-sponsored health plan
- HealthCare.gov Marketplace insurance
- Montana Medicaid if eligible
- Other available individual coverage
COBRA can allow you to temporarily keep the same employer coverage, but your monthly cost may increase significantly if the employer is no longer paying part of the premium.
Montana Health Insurance for Early Retirees
Retiring before age 65 can leave a gap between your employer plan and Medicare eligibility.
Possible options may include Marketplace coverage, COBRA, a spouse's employer plan, or other available private coverage.
Marketplace financial assistance can make income planning especially important for early retirees because household income can include pensions, taxable investment income, retirement-account distributions, self-employment income, and other taxable income.
Small Business Health Insurance in Montana
Montana small businesses may have several approaches to employee health benefits.
Depending on the company, options may include:
- Traditional group health insurance
- Level-funded arrangements where available
- Individual Coverage HRAs (ICHRA)
- Qualified Small Employer HRAs (QSEHRA)
- Dental and vision benefits
- Life and supplemental benefits
The right structure can depend on employee count, ages, ZIP codes, participation, employer contribution, and the type of benefits the company wants to provide.
Have PacificSource Employer Coverage?
PacificSource has announced a broader exit from Montana that includes employer plans.
However, PacificSource says transition timelines can vary by line of business and contract. Employers should review the notice they receive from PacificSource and confirm the actual end date for their group.
How We Help Montana Residents
Self-Employed & 1099 Workers
Ranchers, farmers, outfitters, guides, contractors, tradespeople, truckers, real estate professionals, remote workers, consultants, and freelancers.
PacificSource Members
We can help you compare replacement options for 2027 and recheck your doctors, hospitals, prescriptions, deductible, and total costs.
Individuals & Families
We compare Marketplace and other available coverage based on your family, doctors, prescriptions, budget, and eligibility.
People Paying Full Price
If you don't qualify for Marketplace Premium Tax Credits, we can help compare full-price Marketplace coverage with other available options.
Early Retirees
We help people who need coverage before Medicare compare Marketplace, COBRA, spouse coverage, and other options.
Small Business Owners
We can discuss group coverage, level-funded arrangements, ICHRAs, QSEHRAs, and additional employee benefits.
Serving Clients Across Montana
We work with Montana residents by phone and video, so you don't need to live near a local insurance office.
Billings, Laurel, Red Lodge and surrounding communities
Missoula, Hamilton and surrounding communities
Bozeman, Belgrade, Livingston and surrounding communities
Helena, Butte and surrounding communities
Kalispell, Whitefish, Columbia Falls and surrounding communities
Great Falls, Havre, Miles City and surrounding communities
Official Montana Health Insurance Resources
HealthCare.gov
Marketplace enrollment, Premium Tax Credits, plan comparison,
and Special Enrollment Periods.
Visit HealthCare.gov →
Montana Commissioner of Securities & Insurance
Montana insurance information, rate filings,
consumer resources, and insurance complaints.
Visit Montana Health Answers →
Montana DPHHS
Medicaid, Healthy Montana Kids, eligibility,
applications, and current Medicaid program changes.
Visit Montana DPHHS →
PacificSource Coverage Update
Current information for members affected by PacificSource's
individual-market and Montana changes.
View PacificSource Update →
Common Questions About Montana Health Insurance
Does Montana use HealthCare.gov?
Yes. Montana uses the federal Health Insurance Marketplace at HealthCare.gov for Marketplace individual and family coverage.
Is PacificSource leaving Montana?
Yes. PacificSource has announced that it is exiting the individual health insurance market and its Individual and Family plans will no longer be offered after December 31, 2026.
PacificSource has also announced a broader Montana exit affecting employer business, although transition timing can vary by contract and line of business.
What happens to my PacificSource individual plan after 2026?
PacificSource will no longer offer Individual and Family coverage after December 31, 2026.
You should actively select replacement coverage for 2027 and compare provider networks, medications, benefits, deductibles, and premiums before enrolling.
How many Marketplace insurance companies will Montana have in 2027?
Two: Blue Cross and Blue Shield of Montana and Mountain Health CO-OP.
When is Montana Open Enrollment for 2027?
Open Enrollment runs from November 1, 2026 through January 15, 2027.
Select a plan by December 15, 2026 for coverage beginning January 1, 2027.
Can tribal members enroll in Marketplace coverage outside Open Enrollment?
Yes. Members of federally recognized Tribes can generally enroll in Marketplace coverage throughout the year.
Once enrolled, eligible tribal members can also change Marketplace plans up to once per month.
Do tribal members get additional Marketplace benefits?
Eligible members of federally recognized Tribes may qualify for special cost-sharing protections in addition to any Premium Tax Credit for which they qualify.
For eligible Marketplace enrollees with income between 100% and 300% of the federal poverty level, zero-cost-sharing plan options may be available.
Did Montana expand Medicaid?
Yes. Montana provides Medicaid Expansion coverage for qualifying low-income adults ages 19 through 64, subject to income and other eligibility requirements.
Does Montana Medicaid have a work requirement?
Montana began implementing a community-engagement requirement for certain Medicaid Expansion adults in July 2026.
Affected adults who do not qualify for an exclusion generally must complete 80 hours per month of qualifying work, education, training, volunteering, or other approved activities.
What changes for Montana Medicaid in 2027?
Beginning in 2027, Medicaid Expansion eligibility is generally rechecked every six months rather than annually.
Montana DPHHS states that this six-month redetermination requirement does not apply to American Indian and Alaska Native individuals.
What is Healthy Montana Kids?
Healthy Montana Kids is Montana's Children's Health Insurance Program, providing free or low-cost coverage to eligible children under age 19.
Can self-employed people get Marketplace insurance in Montana?
Yes. Self-employed Montana residents can purchase individual coverage through HealthCare.gov and may qualify for Premium Tax Credits if they meet the applicable eligibility requirements.
Can I get health insurance outside Open Enrollment?
Possibly. Marketplace coverage outside Open Enrollment generally requires a Special Enrollment Period after a qualifying event such as losing coverage, marriage, having a baby, or certain moves.
Medicaid and Healthy Montana Kids applications are available throughout the year for eligible residents, and federally recognized Tribal members have special year-round Marketplace enrollment rights.
Is private health insurance cheaper than HealthCare.gov?
It depends on the person and the type of coverage.
Some non-Marketplace products may have lower premiums for certain applicants, but underwriting, benefits, exclusions, provider networks, and pre-existing-condition rules can differ.
Compare the actual coverage rather than assuming the lowest monthly premium is automatically the best value.
Can you check whether my doctors are in network?
Yes. Bring the names of your doctors, specialists, hospitals, and prescriptions when we compare your options.
Can you help me if your office is in Arizona?
Yes. We are licensed in Montana and work with Montana clients remotely by phone and video.
Compare Your Montana Health Insurance Options for 2027
With PacificSource leaving the individual market and only two Marketplace insurers remaining for 2027, this is an important year to review your coverage. We'll help you compare available options, check your doctors and prescriptions, and understand the costs and coverage before you choose.
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