Affordable Care Act Enrollment Questions Answered

INTRODUCTION 

As the United States approaches the upcoming open enrollment period and several changes to the Affordable Care Act (ACA), this document serves as a resource to support you: The Montana consumer.  

Montana Consumers have Health Options  

Now is the time to consider health insurance coverage or 2026. The Health Insurance Marketplace will undergo changes, and premium costs may be higher for people enrolled in its plans. The Commissioner of Securities and Insurances (CSI) encourages consumers to consider all health plan options to find a plan that best fits individual needs.  

What are my options?  

• Enroll in a Health Insurance Marketplace plan. Under the Affordable Care Act (ACA), the federal government runs the Health Insurance Marketplace. You can shop and apply for coverage at HealthCare.gov. Financial help is available for most enrollees on a sliding scale based on income.  

However, changes are expected next year for Marketplace plans. A portion of its tax credits, known as enhanced subsidies, which help make insurance more affordable, are scheduled to expire at the end of 2025. The expiration could affect the cost of monthly premiums. (A premium is the amount paid to an insurer for coverage.)  

If you currently have coverage through a Marketplace plan, you are encouraged to actively shop when the open enrollment period begins on November 1.   

• Enroll in job-based coverage. If your employer offers health benefits, you may qualify to enroll in its health insurance plan, even if you declined coverage in the past. Employers usually pay a portion of premiums for enrolled employees. You may also be eligible to enroll in coverage through relatives, such as spouse’s employer-sponsored plan or, if you are under 26, through a parent or guardian’s employer-sponsored plan.  

• Enroll in a plan through a private insurer. Coverage options are available through insurance agents or brokers, or directly from a health insurance company.  

• Enroll in a student health plan. If you are enrolled in school, you may be eligible for a student health plan. Contact your school’s health services department to explore this option.  

What if my insurer leaves the ACA Marketplace?  

If your insurer leaves the Marketplace and no longer provides coverage, carefully review your options. This includes reviewing plans available both inside and outside of the Marketplace.  

If you do not actively select a new plan, you may be automatically enrolled in a different Marketplace plan. However, this plan may not meet your coverage needs.  

What should I consider when choosing a plan?  

When deciding on a plan, it’s most important to carefully evaluate your family’s health care needs. To pick the best coverage, first calculate costs from recent years and try to estimate what they might be for the coming year. Do not forget to include copays for medical visits, prescription medications, and any procedure you might need.  

Next compare the premiums, out-of-pocket expenses, and benefits under each plan. If you are buying a policy from the Marketplace, you can compare the plans offered side by side on its website.  

Finally, decide how much you can afford to pay. If you have a Marketplace plan, the Marketplace provides guidance.  

Be mindful that some products are not health insurance and do not have the same consumer protections. Health care sharing ministries (HCSMs), discount plans, and risk-sharing plans are not insurance products and are not regulated by consumer protection laws.  

Where can I go for help when choosing a plan?  

If you need help navigating your choices, contact the Commissioner of Securities and Insurances (CSI). The department can help you understand the different types of plans available.  

CSI’S ROLE IN REGULATING HEALTH INSURANCE AND ACA RATES 

The CSI regulates all insurance companies doing business in Montana. While CSI has oversight of rate transparency and compliance under both state and federal laws, the agency does not have the authority to approve or deny rates in the ACA small group and individual markets — a limitation imposed by federal law and state statute. 

THE CSI’S RESPONSIBILITIES INCLUDE: 

• Licensure and Regulation of insurance companies by enforcing compliance with all applicable state insurance laws and rules through the performance of market conduct examinations, financial reviews, and licensing oversight. 

• Review of rate filings to ensure that the rate submissions are complete, actuarially justified, and in accordance with federal and state statutes. 

• Consumer outreach and education to help Montanans understand what factors are driving premium increases. 

• Protecting policyholders through education, enforcement, and advocacy. 

WHY ARE ACA RATES INCREASING NATIONWIDE IN 2025? 

Montana is not alone. ACA rate filings across the country are reflecting increases. Several key factors are contributing to the upward trend: 

• Medical inflation and rising hospital and physician costs across the nation. 

• Prescription drug inflation, especially driven by high-demand specialty medications. 

• Post-pandemic workforce pressures and hospital consolidations, which reduce competition and increase operating costs. 

• Ongoing uncertainty about federal subsidies and reinsurance policies, which affects how insurers price future risk. Enhanced premium tax credits, made available during the COVID-19 pandemic, will expire at the end of 2025. 

• Fraud and abuse, leading to increased costs, reduced quality of care and even patient harm. 

AUDITOR BROWN ENCOURAGES CONSUMERS TO SHOP AROUND 

“The rising cost of health insurance is one of the most urgent issues facing Montana families and small businesses,” said Auditor Brown. “My agency is committed to ensuring maximum transparency and advocates strongly for consumers. The CSI’s rate review is limited to ensuring that all filings are justified, transparent, non-excessive, and not unfairly discriminatory; however, under state and federal law, the Commissioner does not have the authority to approve or deny ACA rates. Instead, the CSI serves as a reviewer—not an approver—for ACA small group and individual market rate filings. As always, I encourage every Montanan to carefully review their coverage options each year and reach out to your agent with any questions or concerns. Our mission is to protect consumers, promote competition, and ensure access to quality coverage across the state.” 

WHAT CONSUMERS AND EMPLOYERS CAN DO 

Looking ahead to open enrollment this fall, the State Auditor’s Office recommends: 

• Shop and Compare: Use Healthcare.gov or a licensed health insurance broker to compare all available plans and carriers. 

• Check for Updated Subsidies: Many Montanans still qualify for generous federal subsidies that can drastically lower monthly premiums. 

• Get Help: Talk to a certified enrollment specialist, insurance broker, or call the CSI for guidance on plan options. 

• Know the Timeline: Marketplace open enrollment begins November 1, 2025, but certain qualifying life events allow people to enroll or change coverage sooner. 

• Reach Out: Contact the CSI with questions or complaints. 

ABOUT THE COMMISSIONER OF SECURITIES AND INSURANCE 

The Office of the Montana State Auditor, Commissioner of Securities and Insurance (CSI), protects Montana consumers by ensuring a fair and competitive insurance marketplace. The agency licenses insurance companies and producers, investigates complaints, ensures compliance with insurance laws, and helps consumers make informed decisions. 

For more information or to get help with your health insurance options, contact the CSI at csimt.gov or 406-444-2040, or visit the official Montana Health Answers website at ratereview.healthcare.gov. 

The Montana State Auditor, Commissioner of Securities and Insurance, regulates the insurance and securities industries in Montana. The State Auditor is also an ex officio member of the Montana Board of Land Commissioners. James Brown was elected Montana State Auditor in 2024.