Your Guide to Montana’s 2026 Health Insurance Marketplace Plans

Montana’s Big Sky country attracts people for its rugged beauty and relaxed pace of life, but finding health coverage can feel daunting. The Affordable Care Act (ACA) created a marketplace where individuals and families can purchase comprehensive health insurance. Since Montana uses the federally‑facilitated marketplace (HealthCare.gov) and not a state exchange, all Marketplace enrollments occur on the federal platform.
Three carriers — Blue Cross Blue Shield of Montana (BCBS MT), Montana Health Co‑op and PacificSource — offer statewide individual and family plans, and income‑based subsidies help most enrollees afford coverage.

This post answers the most‑searched questions about Montana Marketplace coverage for the 2026 plan year. It focuses on the 2025 open‑enrollment period (Nov 1 2025 – Jan 15 2026) and explains expected premium increases, subsidy changes, enrollment deadlines and tips for picking the right plan. Whether you’re a first‑time buyer or a returning enrollee, use this guide to make informed decisions when choosing health insurance in Montana.

Key Open‑Enrollment Dates and Deadlines

When can I sign up for 2026 coverage?

Montana uses HealthCare.gov’s enrollment calendar. For 2026 plans, open enrollment runs from November 1 2025 through January 15 2026, with a December 15 deadline for coverage that starts January 1. Applications submitted between December 16 and January 15 take effect on February 1. Missing the January 15 deadline means you’ll need a special enrollment period (see below) or you will wait for the next open‑enrollment cycle.

What happens if I miss open enrollment?

Outside of the open‑enrollment window, you can only enroll if you qualify for a special enrollment period (SEP) due to a qualifying life event (QLE). Qualifying events include losing other coverage, getting married or divorced, having a baby, adopting a child, moving to a new ZIP code or experiencing a major change in income. You generally have 60 days from the event to enroll. People who are members of federally recognized Native American tribes or who earn below 150 % of the federal poverty level can enroll year‑round.

When does coverage start?

If you enroll by December 15, your plan will usually start January 1. If you enroll between December 16 and January 15, coverage begins February 1. Pay your first month’s premium promptly or set up automatic payments to avoid lapses.

Expected Premium Increases and Why Rates Are Rising

How much will premiums increase in 2026?

Health insurers propose rates every summer based on projected medical costs and policy changes. For 2026, Montana insurers are requesting double‑digit increases. Blue Cross Blue Shield of Montana’s rate filings show a range of 0.9 % to 42.5 % increases across its individual plans. Mountain Health Co‑op proposes a 15.2 % to 29.2 % increase, with an average 21.7 % jump for its members. PacificSource seeks an average 11.3 % increase due largely to rising medical costs and the elimination of out‑of‑network benefits. Collectively, these requests translate to an overall semi‑weighted increase of roughly 21.2 %.

Nationwide, 2026 filings reflect the largest premium jump since 2018. The median proposed increase across 312 insurers in the ACA marketplaces is about 18 %, with most requests between 12 % and 27 %. Several factors drive these increases:

• Medical inflation: Rising costs for hospital services, physician fees and prescription drugs mean insurers pay more for claims.

• Expiration of enhanced subsidies: Pandemic‑era premium tax credits, created by the American Rescue Plan, expire at the end of 2025. Without congressional action, subsidies will shrink and some people will lose assistance, causing net premiums to rise.

• Marketplace “affordability & integrity” rule changes: New federal rules will reduce auto‑renewal and limit cross‑metal plan switches, which insurers fear will decrease enrollment and increase costs.

• Uncertainty and insurer exits: Some insurers are leaving the Marketplace and others are entering, creating volatility that may influence pricing.

Will premiums increase for everyone?

The proposed increases apply to the full price of plans. More than 89 % of Montana Marketplace enrollees receive premium subsidies, so many people won’t pay the full increase. However, the expiration of enhanced subsidies at the end of 2025 means that net premiums for 2026 could still rise. The Peterson–KFF Health System Tracker estimates that the end of enhanced subsidies could increase enrollees’ out‑of‑pocket premiums by more than 75 % on average. This makes it crucial to budget for higher premiums and explore all available plans.

Who Can Buy a Marketplace Plan in Montana?

To purchase an ACA‑compliant individual plan in Montana, you must:

• Live in Montana and be lawfully present in the United States.

• Not be incarcerated.

• Not have Medicare coverage.

You can still qualify for subsidies even if you have employer‑sponsored coverage, but only if that employer plan is unaffordable. Use an employer plan affordability calculator to check eligibility. If you qualify for Medicaid or Healthy Montana Kids (CHIP), you won’t be eligible for Marketplace premium subsidies.

Does Montana still have Medicaid expansion?

Yes. Montana expanded Medicaid in 2016, and the program serves over 75,000 low‑income adults. In March 2025, Governor Greg Gianforte signed House Bill 245 removing the June 2025 sunset and making the expansion permanent. The federal government pays 90 % of the expansion cost and the state funds the remaining 10 %. Medicaid expansion remains a vital safety net for adults with incomes up to 138 % of the federal poverty level (FPL). Those who qualify for Medicaid should enroll any time; Medicaid enrollment is open year‑round.

Open Enrollment vs. Special Enrollment: Know Your Windows

During open enrollment (Nov 1 – Jan 15), anyone can enroll or switch plans. Outside this window, you must experience a qualifying life event (QLE) to trigger a special enrollment period (SEP). Examples include marriage, divorce, birth/adoption of a child, loss of employer coverage, moving to a new county or a significant change in income. SEPs generally last 60 days from the event. Certain groups — including members of federally recognized tribes and people with income up to 150 % FPL — can enroll any time.

Marketplace Carriers and Plan Options in 2026

Which insurers sell Marketplace plans in Montana?

As of 2025, three insurers offer statewide Marketplace plans:

1. Blue Cross Blue Shield of Montana (Health Care Service Corporation) – Montana’s largest insurer; proposals for 2026 show rate changes between 0.9 % and 42.5 %.

2. Montana Health Co‑op – A consumer‑operated health plan; requested 2026 increases average 21.7 %, ranging from 15.2 % to 29.2 %.

3. PacificSource – A regional carrier; seeking an 11.3 % average increase due to medical inflation and the elimination of out‑of‑network benefits.

All three carriers have statewide networks. Plan availability may vary slightly by ZIP code, but there are no counties with only one insurer.

What do “metal tiers” mean?

Marketplace plans come in four metal tiers: Bronze, Silver, Gold and Platinum. These tiers indicate how costs are split between you and the insurer — not plan quality.

• Bronze: Lowest premiums, highest deductibles. Insurers pay about 60 % of medical costs; you pay about 40 %.

• Silver: Moderate premiums and deductibles. Insurers pay ~70 %, you pay ~30 %. Silver plans are the only tier eligible for cost‑sharing reductions (CSR) that lower deductibles and co‑pays for people with incomes up to 250 % FPL.

• Gold: Higher premiums but lower out‑of‑pocket costs. Insurers pay ~80 %, you pay ~20 %. Good for people who anticipate regular medical care.

• Platinum (rarely available): Highest premiums, lowest out‑of‑pocket costs (insurer pays ~90 %).

How much do plans cost?

The average monthly premium after subsidies in Montana was about $151 in 2025. Around 37 % of enrollees pay less than $10 per month. Full‑price premiums vary by tier and county. A national analysis of 2025 data shows that Montana’s lowest‑cost Bronze plan averaged $343 per month, the lowest‑cost Silver plan averaged $471 and the benchmark (second‑lowest‑cost) Silver plan averaged $477. The lowest‑cost Gold plan averaged $521. Premiums rise with age; a 60‑year‑old might pay almost twice as much as a 30‑year‑old for the same plan, before subsidies.

How do subsidies work?

Most Montana enrollees qualify for the advance premium tax credit (APTC). In 2024, these subsidies averaged $505 per month and reduced the net premium to around $156. Some families even pay $0 because the subsidy covers their entire premium. You can qualify for APTC if your household income is at least 100 % FPL (or 138 % FPL if you’re ineligible for Medicaid) and not more than 400 % FPL. Enhanced subsidies under the American Rescue Plan temporarily removed the 400 % cap and lowered household contribution percentages, but those enhancements expire after 2025. If Congress does not extend them, APTCs will shrink.

In addition to premium subsidies, people with incomes up to 250 % FPL can receive cost‑sharing reductions (CSR). CSR benefits are only available on Silver plans and reduce deductibles, copayments and out‑of‑pocket maximums.

Montana’s reinsurance program

Montana implemented a state reinsurance program in 2020. Reinsurance pays a portion of insurers’ high‑cost claims, which helps moderate premiums. When the program started, average rates decreased by 13.1 % and remained mostly flat the following year. Although rates are now rising due to other factors, the reinsurance program still prevents even sharper increases and lowers premiums for unsubsidized enrollees.

How to Enroll in a Marketplace Plan

Follow these steps to sign up for coverage:

1. Search plans and determine eligibility here.

2. Gather required information. Have Social Security numbers, birth dates, addresses, immigration documents (if applicable) and income estimates for everyone in your tax household. If you’re applying for subsidies, you’ll also need your tax filing status and information about employer‑sponsored coverage.

3. Complete the application. Provide household details, income information and current health coverage status. HealthCare.gov will determine subsidy eligibility and may refer your children to Medicaid or CHIP.

4. Select a plan and enroll. Choose the plan that fits your budget and health needs. Enroll by December 15 for coverage starting January 1, or by January 15 for a February 1 start. Pay your first month’s premium promptly.

Need help?

Certified enrollment assisters, navigators and licensed agents offer free help. Cover Montana provides local assistance and a toll‑free help line. The Montana Commissioner of Securities and Insurance also offers consumer education and can help with complaints. HealthCare.gov’s call center (1‑800‑318‑2596) operates 24/7.

Special Considerations for the 2026 Plan Year

The 2026 open‑enrollment period brings several notable changes:

• Expiration of enhanced premium tax credits. Subsidies enhanced by the American Rescue Plan end December 31 2025. Unless Congress extends them, Marketplace subsidies will shrink and net premiums will increase for many enrollees.

• Higher out‑of‑pocket maximums. The maximum an individual can pay for covered services will rise to $10,600 for individuals and $21,200 for families.

• Auto‑renewal changes. Starting with 2026 plans, the Marketplace will no longer automatically move Bronze enrollees to Silver plans when cost‑sharing reductions are available. Enrollees who qualified for $0 premiums in 2025 will owe at least $5 per month if they rely on auto‑renewal. To continue receiving full subsidies, you must log in and update your information.

• End of DACA eligibility. DACA recipients briefly gained Marketplace eligibility in 2024, but a court ruling and subsequent federal regulation ended this eligibility nationwide in August 2025.

• Health Savings Accounts (HSAs) on Bronze and catastrophic plans. For 2026, Marketplace enrollees who select Bronze or catastrophic plans may contribute to HSAs. HSAs allow you to save pre‑tax money for qualified medical expenses.

Choosing the Right Plan: Tips and Strategies

Picking the right health plan involves more than finding the lowest premium. Consider these factors:

1. Estimate your healthcare needs. If you rarely see doctors and want the lowest possible premium, a Bronze plan might work. If you expect frequent doctor visits, prescriptions or chronic care, a Silver or Gold plan may save you money in the long run because of lower deductibles and cost‑sharing.

2. Check provider networks. Make sure your doctors, hospitals and specialists are in‑network. Out‑of‑network care can be expensive, and some plans (like PacificSource’s 2026 proposals) may eliminate out‑of‑network benefits.

3. Understand drug coverage. Review each plan’s formulary to see how it covers your medications. Some drugs may require prior authorization or higher copays.

4. Compare total annual costs. Don’t focus solely on the premium. Add up the deductible, copayments, coinsurance and out‑of‑pocket maximum to estimate what you might pay if you need care.

5. Consider subsidies and cost‑sharing reductions. If your income qualifies, picking a Silver plan may unlock CSR benefits that significantly reduce your out‑of‑pocket costs.

6. Review automatic renewals. Because auto‑renewal rules have changed, plan options may not align with your current benefits. Always log into HealthCare.gov during open enrollment to review new premiums and adjust your plan accordingly.

Is there a penalty for not having health insurance?

There is no federal penalty for going without health coverage. Five states — California, Massachusetts, New Jersey, Rhode Island and the District of Columbia — impose their own penalties. Montana does not have a state‑level mandate, so you won’t face a tax penalty if you forego insurance. However, going uninsured leaves you responsible for 100 % of your medical bills and can jeopardize your financial security. Without coverage, you also miss preventive care that could catch issues early.

Final Thoughts and Next Steps

The 2026 plan year will be a turning point for Montana’s Marketplace. Premiums are poised to rise sharply as insurers anticipate higher medical costs and the possible end of enhanced subsidies. At the same time, Medicaid expansion continues thanks to a 2025 law that removed the program’s sunset. Montana’s reinsurance program will help cushion premium increases, and most residents remain eligible for generous subsidies and cost‑sharing reductions.

To prepare:

1. Mark your calendar for the 2025 open‑enrollment period (Nov 1 2025 – Jan 15 2026) and plan to enroll by Dec 15 for January 1 coverage.

2. Review your current plan, premiums and provider networks; don’t rely on auto‑renewal.

3. Update your income information to maximize subsidies and avoid repayment at tax time.

4. Compare all available plans using our link here.

5. Seek help if needed — free assistance is available from Cover Montana, the Montana Insurance Commissioner and HealthCare.gov.

Choosing the right health plan can protect your health and financial well‑being. Use this guide to navigate the 2025 open‑enrollment period confidently and secure the coverage that fits your needs in 2026.

-Klinton Jones
Principal Insurance Broker