Originally posted 8/10/23; updated 11/07/23

The good news about the Montana Insurance Dept. is that once the final, approved annual rate changes for the individual and small group markets are released, they're pretty good about posting them in a clear, transparent manner.

The bad news is that they only do so for the final rates, not the preliminary/requested rate filings.

For that, I have to yet again rely on an unweighted average of the rate filings from the federal Rate Review website.

Montana only has three carriers on the indy market and four on the small group market. Of these, Montana Health Co-Op is providing their actual enrollment numbers for both, although one is in a roundabout way. For their individual market filing they state that:

via the Centers for Medicare & Medicaid Services (CMS):

October 16th: CMS approved a state plan amendment for Montana to extend postpartum coverage for a full year for individuals enrolled in Medicaid. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Montana’s approval marks 38 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. This approval supports the CMS Maternity Care Action Plan and Biden-Harris Maternal Health Blueprint.

via KFF, the 12 states which haven't expanded postpartum Medicaid coverage to a full year include:


Over on Twitter, political commentator Krystal Ball made an interesting claim:

A provision in Obamacare allows residents in areas deemed a public health disaster to be covered by Medicare for life. At the very least, East Palestine residents deserve this universal coverage after being exposed to a known carcinogen.

— Krystal Ball (@krystalball) February 21, 2023

What she's referring to is an obscure & fascinating nugget buried in the Patient Protection & Affordable Care Act: Section 10323, which states:


(a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1881 the following new section:


I didn't write about the Kansas abortion ban amendment vote back in August, but I should have:

Voters in Kansas rejected a proposed state constitutional amendment Tuesday that would have said there was no right to an abortion in the state, according to The Associated Press.

Kansas was the first state to vote on abortion rights since the U.S. Supreme Court handed down its ruling in Dobbs v. Jackson's Women's Health Organization.

President Joe Biden hailed Tuesday's vote and called on Congress to pass a law to restore nationwide abortion rights that were provided by Roe.

"This vote makes clear what we know: the majority of Americans agree that women should have access to abortion and should have the right to make their own health care decisions," Biden said in a statement.

The statewide abortion ban ballot proposal, in a fairly solidly red state, ended up failing by a massive 18 points, with 544,000 voting against it and only 378,00 in favor of it.


The Montana Insurance Dept. has published the final/approved (unsubsidized) premium rate changes for 2023 in both the individual and small group markets:

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Montana State Auditor’s Department of Insurance for review and before plans can be sold to consumers.

What is a rate review?

The rate review process, established by the Montana Legislature in 2013, does not give the Commissioner the authority to disapprove rates or prevent them from taking effect. It does give the commissioner the chance to review the factors insurance companies use in setting rates.

If the commissioner finds a rate increase to be excessive or unjustified, the insurer can voluntarily lower the rate increase. If the insurer decides to use the rate anyway, the commissioner will issue a public finding announcing that the rate is unjustified.

What does the department consider?


Going forward, it looks like I'm going to have to do some educated guesses for a lot of carrier enrollment numbers for the states which haven't made their full 2023 rate filing data publicly available either on their own insurance dept. sites or even via the SERFF database.

The federal Rate Review site includes the average rate increases for each individual carrier, but most of the enrollment data is still redacted.

In Montana, there are only 3 carriers offering individual market coverage next year. I have hard enrollment numbers for one of them; for the other two, I'm assuming equal enrollment for each based on a rough assumption of ~52,000 total indy market enrollees statewide.

Assuming this is fairly close, that would put the weighted average rate increases at roughly 8.8%. If not...well, the unweighted average would be 9.3%.

For the small group market, I don't even have a decent total market size to base an estimate off of, so I have to go with the unweighted average of 4.9%.


See how simple that was, other state health insurance carriers?

Seriously, if every state displayed their annual rate filing data in as simple and clear-cut a fashion as Montana does, I'd be a much happier man. Admittedly, several others do, but the trickiest issue is usually getting the estimated enrollment numbers.

In any event, not much to say about Montana's ACA markets in 2022: No new carriers are jumping in, no current ones are dropping out, and the rate changes are pretty straightforward: +0.5% on the individual market, +5.2% on the small group market.

UPDATE 10/22/21: Well, it looks like the Montana Insurance Dept. has signed off on all 7 rate filing requests without making any changes, so I guess these are the approved rate changes as well:


I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.

Today I'm presenting Montana.

For enrollment data from January 2021 on, I'm relying on adjusted estimates based on raw data from the Montana Dept. of Public Health & Human Services.

ACA expansion in Montana didn't launch until 2016. It gradually ramped up over the next year or two and peaked at around 260,000 in 2018 before gradually dropping off to around 240,000 in early 2020...right before the COVID pandemic hit.


 Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.

Here's Montana:

Note: The CDC lists ~19,000 Montana residents (4.9% of the total fully vaccinated) whose county of residence is unknown.

Gold Bars

NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.