Insights / For employers
Self-Employed in Montana: Your Healthcare Options
Subsidies, the self-employed deduction, HSAs and the 2026 rule change. What each path costs when nobody is doing the paperwork for you.
Montana runs on people who work for themselves. Contractors, outfitters, ranchers, consultants, tradespeople, seasonal operators. None of them have an HR department, and all of them have to solve healthcare alone.
Here is the landscape, laid out so you can compare options against each other rather than against nothing.
Start by checking your subsidy, honestly
Almost every self-employed person we talk to has either never run this calculation or ran it years ago on a different income.
Marketplace tax credits are based on your projected household income for the coming year, not last year's. For self-employed people that number is an estimate you make, and it is worth making it carefully rather than pessimistically.
In Montana in 2026, the average full-price marketplace plan runs about $750 a month after a weighted average rate increase of 29.1%. But roughly eight out of ten Montana enrollees qualify for an advance tax credit, and the average subsidised enrollee pays about $107 a month.
If you land in that group, a marketplace plan is very hard to beat, and we would rather you knew that than bought something from us. Run the numbers before anything else.
The self-employed health insurance deduction
If you are paying full price, this matters and it is regularly missed.
Self-employed people can generally deduct health insurance premiums for themselves, a spouse and dependants, as an adjustment to income rather than an itemised deduction. That means it reduces your adjusted gross income whether or not you itemise.
It interacts with marketplace subsidies in ways that get genuinely circular, because the deduction changes your income, which changes your subsidy, which changes your deduction. This is a conversation to have with a CPA rather than a blog post. Have it before you file, not after.
An HSA is the most under-used tool you have
If you carry a qualifying high-deductible plan, a health savings account is the best tax-advantaged account most self-employed people are not using. Contributions reduce taxable income, growth is untaxed, and withdrawals for medical costs are untaxed. Nothing else in the tax code does all three.
Two things changed on 1 January 2026 that matter here:
- HSA money can now pay direct primary care membership fees, up to $150 a month for an individual or $300 for a family
- Joining a direct primary care practice no longer disqualifies you from contributing to an HSA
That combination is well suited to how self-employment actually works: a high-deductible plan for the catastrophe, a membership for the everyday, and the everyday paid with pre-tax money. Details in Your HSA Just Changed.
Your realistic options
A marketplace plan. Real contractual protection, and cheap if you qualify for a subsidy. Tied to open enrollment unless you have a qualifying life event.
A high-deductible plan plus a membership. The plan handles the hospital, the membership handles primary care at a fixed monthly number, and the HSA makes part of it pre-tax. Popular with people who are healthy but do not want to be one bad day from a five-figure bill.
A membership on its own. Predictable and inexpensive for everyday care. It is not insurance, it does not cover surgery or hospital stays, and you are carrying the large-bill risk yourself. Know that going in.
A spouse's employer plan. Often the cheapest answer available and worth pricing properly before assuming otherwise.
Medicaid. Self-employment income fluctuates, and a lean year may qualify you. Montana expanded Medicaid and you can apply any time at apply.mt.gov, not only during open enrollment.
The thing that catches people out
Income changes. That is the defining feature of working for yourself, and it has consequences most people discover at tax time.
Marketplace subsidies are advanced based on your estimate. If you earn more than you projected, you may have to repay part of the credit when you file. If you earn less, you may be owed money back.
Update your marketplace application when your income changes materially. Do not wait until filing season to find out.
If you have employees
Once you are hiring, the picture changes and there are more options than most owners realise, including QSEHRA, ICHRA and level-funded arrangements. Our guide for Montana employers compares all six realistic paths side by side, including the ones that are not us.
Where CoreMed fits
We are a Montana membership healthcare company covering Eureka, the Flathead Valley, Helena, Bozeman and Billings, with Missoula opening next. A membership is a fixed monthly number for everyday care, paired with cost sharing for large bills.
It is not insurance and cost sharing is not guaranteed payment. For a lot of self-employed Montanans it pairs well with a high-deductible plan. For a lot of others, a subsidised marketplace plan on its own is the better answer.
Price it against your alternatives on the quote calculator, or email info@coremedhealth.com.
This article is general information, not tax, legal or financial advice. Talk to a CPA about your own situation. Montana marketplace figures are for 2026 and reset annually.
