MONTANA HLTH COOPERATIVE Market Analysis: Market Share and Coverage by State

Payer Overview

Montana Hlth Cooperative is the #117 ranked US A&H payer by reported premium and participates across 3 states with a US premium of $442.28M, giving it a US market share of 0.03%. The organization reports an estimated total membership base of 116.6K and operates with 0 affiliated subsidiaries, positioning it as a regional player with concentrated state footprints rather than a national platform.

The Cooperative's largest presences are clustered in the Mountain West, and its operating scale — measured by premium and member counts — suggests focused contracting leverage in those states rather than broad national influence. This concentrated footprint supports targeted provider-network strategies in key states while offering limited scale for nationwide negotiations.

Premium by Scope

Montana Hlth Cooperative's premium is exclusively reported in the US States & DC scope, representing 100.00% of the payer's disclosed premium. This indicates the organization has no reported premium in US territories or foreign jurisdictions, concentrating its financial exposure and contractual relationships within the continental US.

For providers evaluating this payer, the concentrated premium footprint implies negotiation and contracting efforts should be prioritized in the states where the Cooperative operates, as there is no territorial or foreign premium exposure to influence broader network strategy.

State Market Table

Montana Hlth Cooperative's premium and membership are heavily concentrated in the Mountain West. The Cooperative writes $219M in Montana, $164M in Wyoming, and $60.1M in Idaho, totaling $442M across the three states with 116.6K members. This geographic concentration creates strong local market influence in those states but limits national negotiating power.

For provider contracting, the payer's scale in Montana and Wyoming (combined $383M) means local networks and reimbursement arrangements in those states will be most impactful. National or multi-state provider groups should prioritize Montana and Wyoming when seeking leverage with this payer; Idaho is a smaller, secondary market for the Cooperative.

State-by-State Market Position

The Cooperative's strongest presence is in the West region, specifically the Mountain West where Wyoming and Montana represent its largest state footprints. Wyoming is the top state by market share at 10.18%, followed by Montana at 7.11%, while Idaho shows a modest presence at 0.93%. There is no meaningful presence in the Northeast, Southeast, Midwest, or Southwest regions based on the available state-level data.

The Affordable Care Act (ACA) established federally-facilitated health insurance marketplaces ("exchanges") where individuals and small businesses can shop for and enroll in health plans, often with income-based subsidies. Issuers that participate in these marketplaces are required to report enrollment, claims, and denial data to CMS (Centers for Medicare & Medicaid Services) each year.

The sections below cover this payer's ACA marketplace-specific footprint — enrollment, plan portfolio, and claims/denial-rate data. This is a narrower, separate population from the NAIC-based commercial data shown earlier on this page (total premium, market share, and membership across all lines of business): ACA marketplace enrollment is typically a small fraction of a payer's total commercial book, and the two datasets should not be treated as equivalent. CMS claims-transparency reporting has also been inconsistent industry-wide since 2020 — many issuers have little or no data for 2021 onward, so a single reporting year is common and does not necessarily indicate anything about the payer's current ACA presence.

Estimated Member Demographics

Nationally, the largest age bands are 6–18 (18,982 members), 35–44 (16,614 members), and 55–64 (16,596 members), indicating a strong presence among families with children and middle-aged adults. The under 6 and 75+ bands are smaller but still represent meaningful populations for pediatric and geriatric care.

Montana and Wyoming both show a balanced age distribution, with Montana having the highest total member count (56,511), followed by Wyoming (47,151) and Idaho (12,925). Idaho's member profile is slightly younger, with a higher proportion of members in the 6–18 and under 6 bands relative to its total. Providers should note these state-level nuances when planning care delivery and outreach.

Estimated Members by State

MONTANA HLTH COOPERATIVE's estimated member distribution is concentrated in Montana () and Wyoming (), with a smaller but notable presence in Idaho (). This geographic concentration aligns with the payer's premium volume and market share, as Montana and Wyoming are the states where the cooperative holds its strongest market positions.