Three carriers offer plans on Montana's federally facilitated health insurance exchange, and overall commercial enrollment has seen an increase in recent cycles. Health Care Service Corp., which operates as Blue Cross and Blue Shield of Montana, continues to dominate the commercial sector, followed by Cigna. PPO plans remain the plan of choice in Montana, and self-insured plans are gaining momentum. Beginning in 2020, Montana enacted a reinsurance program in hopes to stabilize the market and reduce the premiums significantly which is slated to expire in December 2024. Along with the enactment of the reinsurance bill, Montana also secured a 1332 waiver of federal pass-through funding which will enable the state to keep the savings generated as a result of smaller premium subsidies instead of returning it back to federal government. The insurers were approved higher premium rates for 2023 for plans marketed on health insurance exchange platform. A five-year extension has been requested for Montana's 1115 demonstration waiver focusing on individuals with disabling mental illness not otherwise eligible for Medicaid, which got preliminary approval in July 2022 from CMS.