Key threshold: If your income is below $22,025 (individual) or $45,540 (family of 4), you likely qualify for Montana Medicaid with free or very low-cost coverage. No premiums, no deductibles.
Montana Medicaid Income Limits 2026
The following table shows the key income thresholds for Montana in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | $22,025 | $63,840 |
| 2 | $21,640 | $29,863 | $86,560 |
| 3 | $27,320 | $37,702 | $109,280 |
| 4 | $33,000 | $45,540 | $132,000 |
| 5 | $38,680 | $53,378 | $154,720 |
| 6 | $44,360 | $61,217 | $177,440 |
If your household income falls below the 138% FPL column, you qualify for Montana Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
About Montana Medicaid
Who Qualifies for Montana Medicaid
Montana Medicaid provides crucial health coverage for many residents. You generally qualify if you're an adult with a household income up to 138% of the Federal Poverty Level (FPL). For a single adult in 2025, that's approximately $21,597 annually, or about $1,735 per month. For a household of two, the monthly income limit is around $2,344, and for a family of four, it's about $3,563 per month. Children can qualify with higher income limits, up to 148% FPL, and pregnant women up to 162% FPL. Additionally, seniors and individuals with disabilities may also be eligible, often with specific income and asset limits. As of 2024, approximately 232,400 Montanans were covered by Medicaid, demonstrating it's a significant and active program.
If You're Near the Income Line
If your income is near the Medicaid cutoff, your eligibility could shift between Montana Medicaid and marketplace subsidies on HealthCare.gov. For example, if your income is slightly above 138% FPL, you might qualify for substantial subsidies to help you afford a plan on the marketplace. With Montana's benchmark Silver plan at $536/month, subsidies can significantly reduce your actual monthly payment. It's important to remember that income changes, even small ones, can impact your eligibility, potentially moving you from one program to the other. If you lost Medicaid coverage during the recent "unwinding" period, you can reapply at any time. Many people were disenrolled due to administrative reasons, such as not returning requested information, so reapplying is always an option if your circumstances change or you believe there was an error.
What Montana Medicaid Covers
Montana Medicaid offers comprehensive benefits, including doctor visits, hospital stays, prescription drugs, and mental health services. Generally, there are no premiums for those below 100% FPL, and cost-sharing (like copayments) is limited to ensure affordability, not exceeding 5% of your quarterly household income. Montana also has specific waiver programs, such as the Big Sky Waiver, which helps seniors and individuals with physical disabilities receive home and community-based services to avoid nursing home care. Another is the Comprehensive Waiver (0208) for individuals with intellectual or developmental disabilities. These waivers allow for services like personal care, homemaker services, and even environmental modifications to your home.
Tips for Applying
When navigating Montana Medicaid, be aware that processing delays for applications have been an issue, with some applications taking longer than the federal 45-day guideline. Accurate and complete documentation is crucial for a smooth application process. You'll need information like pay stubs, bank account details, and social security numbers for household members. During the recent unwinding of continuous Medicaid coverage, many Montanans lost coverage, sometimes due to administrative errors or not responding to renewal requests. If you're applying or reapplying, make sure your contact information is up to date with the Department of Public Health and Human Services. Your concrete action step is to visit apply.mt.gov or HealthCare.gov to start an application and see what you qualify for.
Marketplace Insurance in Montana
Montana residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Montana costs approximately $536/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Montana might pay for a Silver plan after subsidies, based on the $536/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $456/mo |
| 200% FPL | $31,920 | ~$173/mo | $363/mo |
| 250% FPL | $39,900 | ~$277/mo | $259/mo |
| 300% FPL | $47,880 | ~$392/mo | $144/mo |
| 400% FPL | $63,840 | ~$523/mo | $13/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in Montana. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. Montana uses the federal marketplace at HealthCare.gov.
How to Apply for Montana Medicaid
Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:
- Online: Apply through HealthCare.gov — the system automatically checks your Montana Medicaid eligibility when you enter your income. Or apply directly through Montana Medicaid.
- Phone: Call Montana's Medicaid helpline for guided help with your application.
- In person: Visit your local human services office or a certified application counselor.
You'll need proof of income (pay stubs or tax returns), proof of Montana residency, and Social Security numbers for household members.
Calculate Your Subsidy in Montana
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Montana.
Frequently Asked Questions
What is the income limit for Medicaid in Montana?
In 2026, the Medicaid income limit in Montana is 138% of the federal poverty level: $22,025 per year for an individual, $29,863 for a household of 2, $37,702 for 3, and $45,540 for a family of 4.
Is Medicaid expanded in Montana?
Yes, Montana has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Montana Medicaid.
Am I eligible for health insurance subsidies in Montana?
Montana residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the Montana Medicaid program called?
Montana's Medicaid program is known as Montana Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my Montana Medicaid coverage is ending?
If your Montana Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Montana?
Yes. Medicaid eligibility in Montana is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($22,025 for an individual), you qualify for Montana Medicaid even if you work full-time. Many Montana Medicaid enrollees are working adults.
Should I choose Medicaid or a marketplace plan in Montana?
Medicaid (Montana Medicaid) is free or near-free with no premiums or deductibles. Marketplace plans in Montana average $536/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.