2026 Rate Changes - Montana: +21.2%; ~85,000 enrollees facing MASSIVE rate hikes starting in January

Overall preliminary rate changes via the SERFF database, Montana Insurance Dept. website and/or the federal Rate Review database.

Blue Cross Blue Shield of Montana:

Blue Cross and Blue Shield of Montana (BCBSMT) filed rates to be effective January 1, 2026, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 0.9% to an increase of 42.5%.

Product Blue Preferred Blue Focus Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage.

There are currently 44,116 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.

Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2024 were $252,957,302 and total claims incurred were $235,192,937. The proposed rates effective January 1, 2026, are expected to achieve the loss ratio assumed in the rate development.

Montana Health Co-Op:

As of April 2025, Montana Health Cooperative (MHC) has 23,974 insureds enrolled who will be affected by 2026 Individual Market rate changes if they continue their coverage. Before federal subsidies, the average change in premium for these individuals will be 21.7%. The requested rate change varies by product with the smallest average change of 15.2% for Connected Care Silver Option 2 and the largest average change of 29.2% for Co-op Plus Gold Standard.

PacificSource:

This rate change request impacts all ACA compliant benefit plans offered by PacificSource in the Montana Individual Market. PacificSource does not have any grandfathered or transitional business in this market.

Medical inflation and a decrease in expected reinsurance impact, offset by the impact of eliminating out of network benefits, are the primary sources of PacificSource's 11.3% rate increase. Rate changes will vary by plan due to plan specific adjustments as well as pricing model changes.

...The membership projection in Worksheet 2 of the Unified Rate Review Template was developed based on PacificSource's membership levels as of 4/30/2025. It is approximately equal to the size of our current individual block. For renewing silver plans, the portion of projected enrollment eligible for cost-sharing reduction (CSR) subsidies is estimated to be the same as the percentage of silver membership eligible for each CSR variant in the experience period. New plans are projected to have non-zero enrollment.

Unfortunately, I don't know what PacificSource's enrollment total is, but I'm estimating it to be roughly ~17,000 people based on 2024 liability risk score data from CMS, which would put total Montana individual market enrollment at around 85,000 people.

Overall, this gives a semi-weighted average rate hike being requested by Montana individual market carriers of 21.2%.

It's important to remember that this is for unsubsidized enrollees only; for subsidized enrollees, ACTUAL net rate hikes will likely be MUCH HIGHER for most enrollees due to the expiration of the improved ACA subsidies & the Trump CMS "Affordability & Integrity" rule changes.

Meanwhile, I have no enrollment data at all for some of the small group carriers; the unweighted average 2026 rate hike there is around 11.7%