Montana Health Care Enrollment Down After ACA Subsidies Expire

Thom Bridge | Bozeman Daily Chronicle

Fewer Montanans have chosen to enroll in marketplace health plans this year, an outcome foreshadowed by health policy experts who warned that letting subsidies lapse would lead people to gamble on foregoing insurance coverage rather than pay sky high premiums.

Last year’s federal government shutdown — the longest ever-recorded — was driven by disagreements over whether to extend pandemic-era subsidies that made more people eligible for financial help when purchasing health care on the marketplace. The government ultimately reopened without a deal being struck, and the subsidies expired at year’s end.

Of the nearly 78,000 Montana ranchers, small business owners, gig workers and others who purchased health care in 2025 from the marketplace, a majority received some sort of benefit from the federal government that has since been reduced or slashed altogether. The average monthly subsidy was $545, and many households have seen their premium costs balloon by that or more.

The marketplace sign-up window closed last month. Preliminary data puts enrollment in Montana down by about 5% as compared to last year, the first time enrollment has dropped since before the Covid-19 pandemic.

That figure is consistent with the national average but somewhat incomplete because it doesn’t capture customers who have opted for cheaper plans that provide less comprehensive coverage and, therefore, may delay vital care.

“Our office will continue monitoring enrollment as final numbers are confirmed, and we remain focused on making sure Montanans understand their coverage options and know where to get help,” Montana State Auditor James Brown said in a statement on Monday.

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