Montana’s state employee health plan will triple its in-network individual deductible and double its medical out-of-pocket limits on January 1, 2027, while also raising monthly contributions for workers and their families.
The Department of Administration’s 2027 plan memo raises the individual deductible from $1,000 to $3,000. The medical out-of-pocket maximum will increase from $4,000 to $8,000 for an individual and from $8,000 to $16,000 for a family. Copays for specialist and urgent-care visits will rise from $35 to $60, while the $25 primary-care copay will remain unchanged.
Employees working at least 30 hours a week will also pay more each month. Before wellness incentives, employee-only medical coverage rises from $60 to $120; employee-and-spouse coverage from $318 to $418; employee-and-children coverage from $134 to $234; and family coverage from $397 to $497. The state’s published 2027 rate tables list a $1,107 monthly employer contribution for each eligible employee.
The increase is steeper for employees working 20 to 29 hours a week. Their employee-only contribution rises from $60 to $216, while family coverage increases from $397 to $895. The Live Life Well incentive can reduce monthly costs, but the maximum discount remains $60 for an employee and $60 for an enrolled spouse or domestic partner.
Prescription costs also rise
For prescriptions, a short-term Tier 1 copay will double from $15 to $30 and Tier 2 from $50 to $100. The copay for Tier 4 specialty brand medicines rises from $200 to $500. Annual pharmacy out-of-pocket limits increase from $1,800 to $2,500 for an individual and from $3,600 to $5,000 for a family, according to the benefit comparison. Dental, vision, life, accidental-death and long-term disability rates are unchanged.
The state says its self-funded plan is facing nearly double-digit health-cost growth for a fourth consecutive year. Claims exceeding $1 million increased nearly 74% from 2020 through 2025. In 2025, 2% of the plan’s approximately 28,000 members generated more than 30% of paid claims, primarily through treatment for serious and complex conditions.
A previously approved 2.5% increase in the state’s contribution takes effect in 2027. The administration says it will ask lawmakers for another 5%, worth about $8 million; if approved, the annual employer contribution would reach $179 million. The request will be decided in the 2027 legislative session, while the employee contribution and benefit changes are already presented as effective January 1.
What members should watch
The Montana Federation of Public Employees disputes the affordability of the package. In an August 25 response, the union said the higher payroll deductions and point-of-care costs could worsen recruitment and retention, and it made health benefits a priority for bargaining before the legislative session.
Plan members do not need to act immediately. The Health Care and Benefits Division says in its official enrollment notice that open enrollment runs October 21 through November 7. That will be the annual window to review elections, change plans or add and remove dependents before the new costs begin.
