Health insurance in Montana
72,900 Montana residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 52 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Montana uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in Montana
Montana expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
97,158 under-65 Montana residents are uninsured all the same, 11.1% of them — 14th of the 51 states and DC, and 1.1× the 26-state median of 9.9%.
Competition is uniform across Montana
Every county in Montana has the same number of insurers selling on the exchange: 3. That is unusual, and it means the question of where you live inside Montana does not change how much competition you get.
No county in Montana is down to a single insurer. Since the previous plan year, 52 counties in Montana gained an insurer and none lost one.
How many Montana residents buy on the marketplace
72,900 Montana residents selected a marketplace plan for 2026. Against the state's under-65 population that is 83 per thousand, close to the 26-state median of 79, and 10th highest of the 26 states on this site.
Of those, 10,422 — 14% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (14th of 26).
The spread inside Montana
Yellowstone County is the largest county we publish here, with 136,958 under-65 residents; Flathead County is the smallest, with 90,206. Yellowstone County has 3 insurers offering 42 plans, and Flathead County has 3 offering 39.
The widest choice in Montana is in Yellowstone County — 3 insurers, 42 plans. The narrowest is Gallatin County, with 3 insurers and 39 plans. Same state, same rules, 3 more plans to choose from.
Uninsured rates range from 8.9% in Gallatin County to 12.1% in Flathead County — 1.4 times as high, within one state.
The 4 largest counties in Montana
By under-65 population, covering 50% of the state's under-65 residents. Montana has 52 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Yellowstone County | 136,958 | 10.4% | 3 | 42 | 60 |
| Gallatin County | 106,997 | 8.9% | 3 | 39 | 104 |
| Missoula County | 99,693 | 9.2% | 3 | 39 | 82 |
| Flathead County | 90,206 | 12.1% | 3 | 39 | 104 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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