Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerStatesMontana
    Ask Trek AI about this page

    Montana Health Insurance Market Analysis: Market Share, Payer Mix, and Coverage Trends

    Montana's health insurance market is dominated by a small number of large payers, with Health Care Service Corporation Group and Humana Group leading the landscape. The state features a mix of national and regional insurers, but market concentration remains high.

    Customize your policy alerts

    Sign up for Montana policy alerts

    Stay informed as new and updated payer policies are released across Montana.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    State Overview

    Montana has a total population of 1.10M residents. The state comprises 56 counties. The private insurance penetration rate is 65.74%, calculated from the privately insured total of 723.3K out of the total population. The estimated members covered by the top payer, Health Care Service Corporation Group, is 301.0K.

    Insurance Market

    RankInsurerPremium WrittenEstimated Members CoveredMarket Share
    1HCSC Group$1.28B301.0K41.57%
    2Humana Group$583.0M137.1K18.95%
    3PacificSource Health Plan Group$227.0M53.6K7.39%
    4Montana Health Cooperative$219.0M51.4K7.11%
    5UnitedHealth Group

    Frequently Asked Questions

    References

    1. 1.S2703: Private Health Insurance Coverage by Type and Selected Characteristics. U.S. Census Bureau, 2024 American Community Survey 5-Year Estimates. Retrieved Aug 11, 2026.Annual estimates of private health insurance coverage rates by state, broken out by age, income, and plan type — the basis for this page's coverage-rate figures.
    2. 2.2024 Market Share Reports for the Top Accident and Health Insurance Groups and Companies by State and Countrywide. National Association of Insurance Commissioners (NAIC). Retrieved Aug 11, 2026.Ranks the largest accident and health insurance carriers by direct premiums written in each state, used to identify the dominant payers operating there.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Table of contents

    Progress1 / 2

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    $206.0M
    48.5K
    6.71%
    6CVS Group$90.6M21.5K2.95%
    7Cigna Health Group$61.7M14.5K2.01%
    8Mutual of Omaha Group$32.5M7.67K1.06%
    9Centene Corporation Group$25.6M5.99K0.83%
    10Dentegra Group$20.0M4.70K0.65%

    Health Care Service Corporation Group is the clear leader in Montana's private health insurance market, with a market share exceeding 40%. Humana Group follows as the second largest insurer, holding nearly one-fifth of the market. Together, these two payers cover a majority of Montana's privately insured residents.

    Regional insurers such as PacificSource Health Plan Group and Montana Health Cooperative also play significant roles, each covering over 50,000 members. National payers like UnitedHealth Group, CVS Group, and Cigna Health Group contribute to the competitive landscape, but their shares are notably smaller compared to the top two. The remaining insurers in the top ten collectively account for less than 10% of the market, indicating a steep drop-off in market presence beyond the leading payers.

    Overall, Montana's insurance market is highly concentrated, with the top five insurers responsible for more than 80% of all privately insured members. This concentration shapes the dynamics of reimbursement, network design, and consumer choice within the state.

    Insured Population Demographics

    Coverage TypeCountShare of Privately Insured
    Employer-Based441.7K61.07%
    Direct-Purchase87.7K12.13%
    TRICARE12.0K1.65%
    CHIP/Subsidized30.0K4.15%

    Montana's privately insured population is primarily covered through employer-based plans, which account for over 60% of all private insurance. Direct-purchase coverage is the next most common, representing just over 12% of the privately insured segment. Smaller shares are covered by TRICARE and CHIP/subsidized programs, together making up less than 6% of the total.

    The age distribution of the privately insured population is broad, with significant representation across all age bands. The largest groups are those aged 6-18 and 55-64, indicating both a strong presence of families and older working-age adults in the insured pool. Coverage for children under 6 and adults over 75 is notably lower, reflecting typical patterns in private insurance enrollment.

    Market Dynamics

    Montana's health insurance market is characterized by a high degree of concentration, with Health Care Service Corporation Group (HCSC Group) holding a dominant position. The top payer alone covers more than two-fifths of the privately insured population, and the top two payers together account for over 60% of the market. This level of concentration suggests limited competition among insurers, with a few large players shaping the landscape.

    The presence of regional payers such as PacificSource Health Plan Group and Montana Health Cooperative, alongside national giants like UnitedHealth Group and Humana Group, provides some diversity in the market. However, the cumulative market share of the top five insurers exceeds 80%, underscoring the dominance of a select few.

    Employer-based coverage remains the primary source of private insurance, reflecting Montana's employment patterns and the role of group health plans. Direct-purchase options and government-related programs such as TRICARE and CHIP contribute to the overall coverage mix but are secondary in scale.

    Demographically, the privately insured population is distributed across all age bands, with notable concentrations among school-aged children and older working adults. This distribution highlights the importance of both family coverage and pre-retirement health benefits in Montana's insurance landscape.

    Top 10 Health Insurers by Market Share in Montana
    Privately Insured Population by Age Band in Montana