New data released by the Centers for Medicare & Medicaid Services show that fewer Montanans — and Americans overall — have signed up for health plans through the Affordable Care Act Marketplace.
According to Commissioner of Securities and Insurance James Brown, 77,221 Montanans signed up for Marketplace coverage for the 2025 plan year. But the latest CMS data shows that 73,255 Montanans had signed up for the current plan year, a roughly 5% decline.
“This preliminary report indicates that Marketplace plan selections in Montana are down by about 5% compared to last year,” Brown said in a press release. “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.”
Nationally, CMS reports roughly 23 million consumers signed up for health insurance coverage through the Marketplace for 2026, or were automatically reenrolled, representing a drop of around 1.2 million signups compared to the same period last year.
According to Brown’s office, enrollment on the federally facilitated exchange – healthcare.gov — fell by 7.93% while state-based exchanges saw an increase due to the addition of Illinois opening a state-based marketplace.
Without Illinois’ addition, state-based signups dropped by nearly 4%, according to Brown’s office.
KFF, a large nonprofit, nonpartisan healthcare research organization, notes that the data is considered preliminary and represents how many people have signed up or been automatically renewed into 2026 coverage, but does “not necessarily translate into effectuated enrollments.”
“As returning consumers receive their first bills from their insurance carriers and see how much they have to pay, they may not pay their premium and eventually lose their coverage or they may actively disenroll,” KFF reports.
Effectuated, or actual, enrollment data is typically released over the summer.
Rising costs across the board
A major contributor to decreased Marketplace enrollment is the expiration of the enhanced premium tax credits, which were put into place during the COVID-19 pandemic.
The tax credits’ expected sunset became a flashpoint in Congress last fall and led to the record-breaking government shutdown when Democrats blocked a funding bill that didn’t address sharply rising healthcare costs.
During the shutdown, Brown signed onto a letter submitted by the National Association of Insurance Commissioners urging Congressional leaders to continue the tax credits.
But Brown has been vocal about the flaws with the ACA in interviews with news outlets.
“Until Congress repeals and replaces the failed law that has driven rates higher for years on the American people, we are calling on the federal government to restore the ACA subsidies that help keep insurance within reach for Montana families,” Brown said in a statement to the Montana State News Bureau.
After the shutdown ended, the U.S. Senate failed to pass two pieces of health care legislation in December, leaving the subsidies to expire at the end of the year.
According to KFF, only 42,822 Montanans selected insurance through the ACAS Marketplace in 2020, prior to the expanded credits taking effect.
In 2024, more than 58,000 Montanans received more than $63.5 million in expanded ACA subsidies, which were extended from the 2022 Inflation Reduction Act.
A KFF state-by-state analysis shows that Montanans with the tax credits pay an average monthly premium of $112, compared to $203 without the credit — an 81% difference. Nationally, KFF said a roughly 113% increase in premiums could be expected.
Among Montana’s major insurance providers, expected average cost increases for individual marketplace plans range from nearly 12% for PacificSource Health Plans to more than 25% for Blue Cross/Blue Shield individual marketplace plans, with maximum increases exceeding 40%.
In addition to the expired subsidies, rising costs for medical care, hospital services and prescription drugs have contributed to increased insurance costs.
Fraud in the health care space is also a contributing factor, according to Brown.
Brown’s office announced last month that his office had helped stop a multimillion-dollar billing scheme by agents preying on Native Americans on reservations.
The investigation secured more than $23.3 million of fraudulently incurred claims through the ACA, with another $27 million pending.
The Commissioner of Securities and Insurance is Montana’s official consumer advocate, which includes helping Montanans understand their rights and coverage options under federal and state law.
The office does not have a role in approving or denying rates in the ACA marketplace.
“At the end of the day, what matters most is that Montana families can get the coverage and care they need when they need it,” Commissioner Brown said. “Whether someone is shopping for a Marketplace plan, trying to understand their benefits, or fighting an unfair denial, our office is here to stand up for them.”
For more information or assistance with health insurance questions, Montanans can contact the Office of
The Montana State Auditor, Commissioner of Securities and Insurance, by calling 406-444-2040, visiting csimt.gov, or using the consumer resources and contact forms available on the agency’s website.
Daily Montanan is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Daily Montanan maintains editorial independence. Contact Editor Darrell Ehrlick for questions: info@dailymontanan.com.
