With open enrollment underway, it’s important for Montanans to understand their healthcare options, enrollment deadlines, and alternative approaches like health-sharing plans and membership-based healthcare. This guide offers insights into what’s new for 2025 and highlights key choices, including traditional insurance plans, Medicare changes, health-sharing, and direct care memberships, such as CoreMed, that provide innovative paths to affordable, quality care.
1. Open Enrollment for Health Insurance
For most Montanans, open enrollment through the Affordable Care Act (ACA) allows individuals and families to sign up or renew their health plans for the next calendar year. The enrollment window for 2025 stretches from November 1, 2024, to January 15, 2025. Those enrolling by December 15 will start coverage on January 1, 2025, with later enrollees beginning on February 1. Montana residents can access plans through the federal exchange at HealthCare.gov, which offers ACA-compliant options as well as Medicaid and CHIP for qualifying individuals.
Employer-Sponsored Coverage Options
Employers can offer Qualified Small Employer Health Reimbursement Arrangements (QSEHRA) or Individual Coverage Health Reimbursement Arrangements (ICHRA) to support employees with individual health insurance premiums and out-of-pocket costs. These arrangements often help employers manage rising premiums by offering employees more tailored coverage options that they can control.
2. Health Insurance Choices in Montana
Montana’s healthcare market is dominated by a few key players:
- Blue Cross and Blue Shield of Montana
- Montana Health Cooperative
- PacificSource Health Plans
The average monthly premium in 2025 is expected to rise to $654, marking an 8.27% increase from 2024. Subsidies under the Inflation Reduction Act will help offset these increases, as there’s now no upper-income limit on premium tax credits for those paying over 8.5% of household income on insurance premiums. As of 2024, about 86% of Montanans receiving ACA coverage benefited from these subsidies.
Medicaid and CHIP
Medicaid and CHIP provide vital coverage for low-income families and children across the state. As of May 2024, around 230,222 Montanans were enrolled in Medicaid or CHIP. These programs play a critical role in bridging healthcare gaps for families and ensuring that children have access to essential health services.
Medicare
With 260,496 Medicare beneficiaries statewide, Montana’s Medicare program will see notable updates for 2025. Open enrollment for Medicare runs from October 15 to December 7, with a secondary period from January 1 to March 31 for limited changes.
3. CoreMed: Direct Primary Care and Beyond
For those seeking a more personal, membership-based approach, CoreMed is a unique option in Montana offering affordable access to primary care without traditional insurance complexities. Through CoreMed’s membership model, members choose from:
- Direct Primary Care (DPC) for unlimited primary care visits and preventative care.
- Catastrophic Coverage via health-sharing for emergencies and unexpected expenses.
- Comprehensive Coverage that combines DPC with catastrophic protection.
CoreMed’s local focus offers Montanans a familiar, flexible care alternative that works well alongside high-deductible plans, especially for those looking to minimize out-of-pocket expenses while receiving continuous care. This option can be especially useful for those who prefer to manage predictable primary care costs with a fixed monthly fee while staying covered in case of unexpected health events.
4. 2025 Healthcare Costs and Trends
In 2025, healthcare costs are expected to increase by 8%, the largest jump since 2012, affecting both employer-sponsored and individual market plans. Small employers in Montana may see average per-employee costs reach $16,464, while larger companies benefit from economies of scale with an average cost of $15,640 per employee.
Factors contributing to these rising costs include:
- Prescription Drug Prices: Expected to rise by 7% per employee.
- Provider Contract Inflation: Higher provider fees, driven by inflation, affect premium rates.
Employer Response to Rising Costs
With rising premiums, over half of Montana’s employers plan to manage costs by:
- Implementing high-deductible health plans to reduce premiums.
- Encouraging the use of health-sharing programs as supplemental or alternative solutions.
- Considering membership models like CoreMed for predictable primary care costs and reduced out-of-pocket expenses.
5. Health-Sharing Programs
Health-sharing ministries, such as Liberty HealthShare, offer cost-sharing models that work as an alternative to traditional insurance, especially for those seeking community-based support. Liberty HealthShare’s offerings include:
- Liberty Unite, Connect, and Essential for singles, couples, and families.
- Liberty Freedom for young adults needing basic, catastrophic support.
These programs differ from insurance; members voluntarily share medical costs, and while enrollment is year-round, coverage depends on community contributions rather than government regulations. CoreMed’s catastrophic option aligns with health-sharing’s community model, providing an affordable alternative for major, unexpected healthcare needs.
6. Medicare Changes in 2025
For Montana’s Medicare enrollees, 2025 introduces significant improvements under the Inflation Reduction Act:
- Annual Out-of-Pocket Drug Cap: Medicare Part D members will see a new $2,000 out-of-pocket maximum for drug costs, eliminating the “donut hole.”
- Monthly Drug Cost Payment Options: Beneficiaries can now opt to spread out their drug costs throughout the year, helping to avoid financial strain.
Beneficiaries should review their Annual Notice of Change and update their Medicare Part D plans as needed. For those who may struggle with drug costs, Medicare’s Extra Help program provides additional assistance.
Medicare Extra Help
Medicare’s Extra Help program helps low-income seniors reduce drug costs. Montanans needing support can reach out to the State Health Insurance Assistance Program (SHIP) for counseling and guidance on available benefits and resources.
7. Navigating Healthcare Resources in Montana
Several resources provide support and information for Montanans navigating healthcare options:
- First Choice Services: A Navigator resource for ACA enrollment assistance.
- Medicaid and CHIP: Accessible for low-income families and children.
- SHIP (State Health Insurance Assistance Program): Offers free Medicare counseling across Montana.
For Montanans looking for alternatives to traditional insurance, CoreMed and health-sharing programs like Liberty HealthShare offer flexible paths to affordable healthcare and emergency coverage.
8. Getting the Most Out of 2025 Healthcare Options
Making healthcare choices for 2025 requires balancing cost, coverage, and convenience. Here are some tips to get the best value from your healthcare plan:
- Review the Full Cost: Compare premiums with copays and deductibles to get a full picture of potential costs. Choosing the plan with the lowest monthly premium may lead to higher out-of-pocket costs, so consider what best suits your needs.
- Consider CoreMed or Health-Sharing: For those wanting predictable primary care costs or community-based coverage, CoreMed’s direct care model or a health-sharing program may provide the support needed without the restrictions of traditional insurance.
- Optimize Medicare Coverage: Medicare beneficiaries should review Part D plans during open enrollment, ensuring that their medications are covered and costs are manageable.
- Use Counseling Services: Take advantage of free SHIP counseling for Medicare, and look to Navigators for ACA guidance.
2025 brings Montana a blend of traditional insurance options, innovative alternatives like CoreMed, and enhanced Medicare benefits. With healthcare costs on the rise, making informed choices during open enrollment will help ensure that Montanans can manage their healthcare costs effectively while receiving the coverage that best meets their needs. Whether through direct primary care models, health-sharing ministries, or employer-sponsored plans, there’s a growing range of choices for Montanans seeking affordable and flexible healthcare solutions.