Private Health Insurance in Montana
Private health insurance in Montana is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Montana Marketplace premiums rising 22.6% to 23.3% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Montana and when the Marketplace is the better call.
Who buys their own coverage in Montana
Montana's 73,255 HealthCare.gov plan selections for 2026 were about 5 percent below the 77,221 recorded for 2025, the CMS state-level public use file shows. Roughly 77.7 percent of enrollees, or 56,892 people, received an advance premium tax credit. The other 22 percent or so, about 16,400 people, paid full price, close to double the roughly 8,500 who did so a year earlier, when the enhanced credits still applied. That full-price share is higher than in Nebraska, South Dakota or Wyoming. About 44 percent of Montana enrollees used an agent or broker, and new sign-ups fell to 10,443 from 15,404.
How Montana regulates private plans
Under MCA 33-1-102(16), Montana's insurance code does not apply to a health care sharing ministry that meets MCA 50-4-111, which bars paying commissioned agents to enroll members and requires a 12-point notice that membership guarantees no protection. That exemption list contains no carve-out for agricultural organization plans. Individual disability policies, the category that includes fixed indemnity coverage, need a commissioner-approved form and an outline of coverage handed over at application, under MCA 33-1-501 and 33-22-244. A self-funded association plan needs a certificate of authority and a sponsoring association at least five years old under MCA 33-35-103.
Protecting yourself when you buy in Montana
MCA 33-15-415 gives you 10 days after an individual disability policy is delivered, or longer if the policy allows, to return it for a direct premium refund. Montana's State Auditor, who serves as Commissioner of Securities and Insurance, tells shoppers to get an agent's full name and National Producer Number and check it with the Montana Insurance License Search on csimt.gov. The Insurance Consumer Service Bureau answers at 800-332-6148. In 2026 the office ordered an unlicensed seller of so-called limited partner plans to stop operating in Montana and warned that such plans often cover little beyond preventive care.
The Montana Marketplace you would be comparing against
Montana buyers use HealthCare.gov, and open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027, with coverage starting January 1 for plans picked by December 15. Montana runs a state reinsurance program under a federal waiver approved for 2025 through 2029, which reimburses insurers for some high-cost claims and is designed to keep individual premiums lower than they would otherwise be. Montana has no general continuation law for small employers, so a tradesperson leaving a shop too small for federal COBRA usually needs new coverage right away; losing job-based coverage opens a special enrollment period on the Marketplace. Montana sets no short-term duration limit of its own, so federal rules apply, and short-term plans are not ACA coverage. Because Montana's building season is short, self-employed tradespeople should base their Marketplace income estimate on the full year, not a busy summer month.
Other Montana rules to know
- Leaving a small employer: Montana has no general continuation law for people who leave a small employer; its law only lets a worker whose hours drop below the plan's minimum keep group coverage for up to one year, with the employer's consent and at the group rate.
- Short-term plans: Montana does not limit the duration of short-term plans in its own law, so federal rules govern, and federal agencies are not prioritizing enforcement of the four-month federal limit.
- Where to enroll: Montana uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 22.6% to 23.3% on average, small-group plans about 18%. See the Montana 2027 rate page.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
Compare Montana plans
Licensed in Montana. Private plans priced first, Marketplace alongside when it fits. No fee.
Montana questions
Where do Montana residents enroll in 2027 coverage?
Montana uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027.
What continuation rights does Montana give after leaving a small employer?
Montana has no general continuation law for people who leave a small employer; its law only lets a worker whose hours drop below the plan's minimum keep group coverage for up to one year, with the employer's consent and at the group rate.
How much are Montana premiums rising for 2027?
Individual-market premiums are set to rise 22.6% to 23.3% on average, and small-group plans about 18%.
What is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, mca.legmt.gov, mca.legmt.gov, mca.legmt.gov, csimt.gov. Facts checked October 2026. See all Montana health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Montana and 30 other states, NPN 21032307.