Health Insurance in Montana

Health insurance is an important precaution when it comes to insuring your financial future as well as your family’s physical wellness. Protecting your family against the occurrence of illness or injury is rather difficult; however a suitable health policy can relieve your financial burden caused by these situations. When it comes to purchasing health coverage, you should evaluate all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, are exposed to the consequences of not having proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.

Montana is the 23rd healthiest state to live in and obtain health coverage, according to the America’s Health 2008 Rankings. The state fell from its 18th position in 2007; it was on 22nd position on 2006. Nevertheless, Montana has a strong health care system with declining crime rate, low percentage of children under 18 in poverty and moderate public health funding. The state of Montana, with more than nine hundred thirty thousand people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Montana who meet specific eligibility requirements of age and income.

The Insurance Division of Montana State Auditor’s Office manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s strong health features, approximately 9.9% of the state population is still uninsured with the Montana government attempting to tackle the state’s the high geographical parity. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 36.1% of Montana’s uninsured residents come under the above 200% FPL category.

Buying health coverage is easier said than done, however, with the help of a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are ideal for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Montana. These regulations apply to all insurance companies offering individual or family health insurance in Montana:

Medical Underwriting
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
36 months
Look Back Standard
Mandatory Benefits
Cancer screening for women including breast cancer screening, coverage for mastectomy stay as determined by the surgeon, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, infertility coverage, maternity care
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Montana. These regulations apply to all insurance companies offering small group health insurance in Montana.

Small Group Size
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Montana. For employer groups of more than 20 employees, refer to the federal COBRA guidelines.

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
Extension of Benefits Period – Disabled
Maximum Premium Increase
State Legislation Reference
Additional Notes
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Montana to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Montana is summarized in the chart below:

Plan Name
Montana Comprehensive Health Association (5MCHA)
Phone Number
HIPPA Eligibility Required?
Available Carriers
Blue Cross Blue Shield of Montana
Pre-Existing Condition Waiting Period
12 months
Enrollment Periods
First Come, First Serve Basis
Premium Limits
No more than 200% of standard rates
Lifetime Maximum Benefit
$2 million
Special Notes
To qualify for the coverage, individuals:
Must be a resident of Montana at least 30 days
Cannot be eligible for COBRA or government programs (5except “end-stage renal disease” covered under Medicare)
Must prove denial of coverage or would be paying 150% higher premium than MCHA
May also be automatically eligible with certain health conditions as listed by MCHA
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Montana provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Montana Children’s Health Insurance Plan (5CHIP)
Phone Number
Apply Online
Age Limits
Under 19
Insurance Carrier
Blue Cross Blue Shield of Montana
Length of Coverage
12 months
Residency Requirements
Montana residents, US citizens or qualified aliens
Other Eligibility Requirements
To be eligible, the child:
Should not currently be insured and should be uninsured for one month (5some exceptions apply)
Should not be eligible for Medicaid
Parents are not employed by the State of Montana or the Montana University system.
Household meets income guidelines for household size

Pre-Existing Condition Exclusions
Some families must pay co-payments depending on income. No co-payment for well-baby or well-child care, including age-appropriate immunizations, dental services and eyeglasses. The maximum co-payment is $215 per family per benefit year

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Montana:

Governing Agency
Department of Public Health & Human Services
Phone Number
Residency Requirements
Montana resident
Federal Poverty Line Income Limits
Newborn-No Income Limit
Children (5under 6): 133% FPL
Pregnant women: 150% FPL
Children (5Ages 6-19): 100% FPL
Supplemental Security Income Recipients: 74% FPL
Medically Needy Individual: 73% FPL
Working Parents: 65% FPL
Medically Needy Couple: 54% FPL
Non-Working Parents: 38% FPL
Additional Resources

Montana Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Montana’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Montana: At-A-Glance
Provides exclusive health data of Montana. is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.