Mountain Health CO-OP

What Mountain Health CO-OP does

Mountain Health CO-OP is a non-profit, member-owned health insurance cooperative founded in 2012 and headquartered in Helena, Montana, serving individual, family, small employer, and Medicare Supplement customers across Idaho, Montana, and Wyoming. The company offers Individual & Family Plans (ACA marketplace and off-exchange), Small Group/Employer Plans (typically 2-50 employees), and Medicare Supplement Plans (standardized Medigap A-N), with plan-year offerings extending through 2026. Its operational platform consists of multiple web portals: a Member Portal for plan management, claims, EOBs, billing, and digital ID cards; a Provider Portal for eligibility and benefits verification; a myCare Portal for prior authorizations and appeals; a RealRX Portal for pharmacy authorizations; and a Broker Portal for quoting, proposal, and enrollment workflows.

Revenue is generated primarily through recurring monthly premiums across the three product lines, with member-funded tax credits reducing some individual premiums to zero. Distribution is hybrid: licensed insurance brokers and agents handle the majority of small-group and Medicare Supplement sales via the Broker Portal; individual plans are sold through Healthcare.gov, Your Health Idaho, and HealthSherpa; and direct sales are supported via the company website and a call center (800-299-6080). The company relies on third-party partners for claims processing (Change Healthcare and Optum with Payer ID MHC01), Medicare Supplement administration (UFLIC), No Surprises Act dispute resolution (Zelis), telehealth (Doctor on Demand), mail-order pharmacy (Birdi), and in-home health assessments (Porter). Value-add "Signature Benefits" — $0 pharmacy options, 100% preventive care coverage, $0 first mental health visit, $50 health assessment reward, $60 vision exam reward, and $100 dental exam reward — are bundled into plans before the deductible is met. The organization is reported as backed by $75M in reserves and holds NCQA Audited HEDIS Compliant certification.

Name

Mountain Health CO-OP

Legal name

Mountain Health CO-OP

Website

https://mountainhealth.coop

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

101–250 employees

Short description

Mountain Health CO-OP is a non-profit, member-owned health insurance cooperative offering Individual & Family, Small Group, and Medicare Supplement plans across Idaho, Montana, and Wyoming via brokers, federal and state marketplaces, and direct sales.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

CO-OP / Nonprofit Individual Market Plans (HLAEABAH)

akta.pro secondary industry

Small Group Health Insurance (2–50/100) (FSAIAFAD)

Keywords

• Health insurance plans
• Individual family coverage
• Small group insurance
• Medicare Supplement insurance
• Member-owned cooperative

Headquarters

HQ city

Eagle

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Supply Chain, Marketing or Sales, Technology or R&D

Revenue model

1. Individual & Family Health Insurance Premiums: Monthly premium payments from individuals and families purchasing health coverage either directly or through marketplace exchanges. Plans available in Idaho, Montana, and Wyoming for 2024-2026 plan years.
2. Small Group/Employer Health Insurance Premiums: Monthly premium payments from employer groups purchasing health coverage for employees. Includes quote and enrollment through broker portal.
3. Medicare Supplement Insurance Premiums: Monthly premium payments from Medicare beneficiaries purchasing supplement plans to fill gaps in Original Medicare coverage. Administered through third-party partner UFLIC with dedicated Med Supp portals and contact center.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

Mountain Health CO-OP is a non-profit, member-owned health insurance cooperative selling individual and family health plans, small group/employer health plans, and Medicare Supplement plans across Idaho, Montana, and Wyoming. Coverage includes medical, pharmacy, telehealth, preventive care, and dental/vision reward benefits.

Product overview

Mountain Health CO-OP is a non-profit, member-owned health insurance company offering Individual & Family Plans, Small Group/Employer Plans, and Medicare Supplement Plans across Idaho, Montana, and Wyoming. The core insurance products are supported by multiple self-service platforms: the Member Portal for plan management and claims, the Provider Portal for healthcare providers, the myCare Portal for prior authorizations, the RealRX Portal for pharmacy authorizations, and the Broker Portal for agent quote and enrollment tools. Signature Benefits add-on features provide additional value including 24/7 telehealth via Doctor on Demand, pharmacy mail order via Birdi, dental and vision exam rewards, and a health risk assessment program via Porter.

Differentiator

Problem solved

Functional benefit

Products and services

• Individual & Family Health Plans Health insurance plans for individuals and families available in Idaho, Montana, and Wyoming, including plan years 2024, 2025, and 2026. Plans include Signature Benefits such as $0 pharmacy, 100% preventive care coverage, and telehealth access.
• Small Group/Employer Health Plans Employer-sponsored group health insurance plans providing coverage for employees, with options for small businesses (typically 2-50 employees) in Idaho, Montana, and Wyoming. Includes plan comparison tools for brokers.
• Medicare Supplement Plans Medicare Supplement (Medigap) insurance that fills gaps left by Original Medicare Parts A and B. Available in Idaho and Montana with standardized plan options (A-N), administered through third-party partner UFLIC.
• Signature Benefits Included benefit perks available before meeting deductible: $0 pharmacy options, 100% preventive care coverage, 24/7 telehealth, $0 mental health first visit, $100 dental exam reward, $60 vision exam reward, and $50 health assessment reward, up to $210 annual rewards.
• 24/7 Telehealth Services Round-the-clock virtual doctor access via Doctor on Demand for urgent care, behavioral health, and therapy. Records shared with the member's primary care provider.
• Pharmacy Benefits Prescription drug coverage including $0 out-of-pocket medications across categories such as anticoagulants, antidepressants, cardiovascular, cholesterol, diabetic supplies, and respiratory medications. Mail order available through Birdi.
• Health Risk Assessment Program Free in-home or telehealth health assessment provided by Porter Care Guides. Identifies health risk factors and provides personalized care plans; members earn $50 upon completion.
• Member Portal Secure online portal for members to access plan documents, view claims, check EOBs, manage billing, send secure messages, view pharmacy details, and download digital Member ID cards.
• Provider Portal Secure portal for healthcare providers to manage claims, verify eligibility, view patient benefits, submit claims electronically, and access clinical policies.
• Broker Portal Online platform for insurance brokers to generate instant quotes, manage group applications, estimate subsidies, review client information, and complete sales for Mountain Health CO-OP products.

Quantifiable outcome

• Members can earn up to $210 per year through Signature Benefits rewards program
• +2 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

Feature5 records

Partnerships

Eleven partnerships are on record, tiered core and supporting.

• Doctor on DemandcoreTechnology or IntegrationTelehealth partnership providing 24/7 virtual doctor visits for members. Doctor on Demand offers urgent care, behavioral health, and preventive care through video consultations. All records are shared with the member's primary care provider.
• Porter (Health Assessment Partner)supportingStrategic or Co-development PartnerPorter Care Guides conduct free in-home or telehealth health risk assessments for eligible members. Members earn $50 for completing assessments. Care Guides coordinate with primary care physicians and help members understand benefits.
• Change HealthcarecoreTechnology or IntegrationChange Healthcare provides electronic claims submission, eligibility verification, ERA (Electronic Remittance Advice), and EFT (Electronic Funds Transfer) services for provider payments. Payer ID: MHC01.
• UFLIC (Medicare Supplement Administration)coreImplementation/ SI/ Consulting PartnerUFLIC handles Medicare Supplement plan administration including applications, underwriting, commission inquiries, and member services for Med Supp plans. Located in Duncan, OK.
• Zelis (No Surprises Act Disputes)supportingTechnology or IntegrationZelis handles No Surprises Act dispute resolution for out-of-network claims and balance billing disagreements. Providers submit Open Negotiation Notices through Zelis.
• Optum (Electronic Claims)coreTechnology or IntegrationOptum provides electronic claims submission connections for institutional (CPID 7565) and professional (CPID 2499) claims. Effective September 1, 2024, new payer connections replaced University of Utah payer IDs.
• St. Alphonsus Health Alliance Network (Idaho)coreTechnology or IntegrationIn-network provider network for Idaho plans, offering members access to St. Alphonsus health system providers and facilities.
• St. Luke's Health Partners Network (Idaho)coreTechnology or IntegrationIn-network provider network for Idaho plans, offering members access to St. Luke's health system providers and facilities.
• HealthSherpasupportingChannel Partner/ Reseller/ DistributorHealth insurance marketplace platform for Idaho agents to quote and enroll individual policies. Effective Fall 2024, agents use HealthSherpa instead of the Agent Portal for individual policy quoting.
• Your Health IdahocoreChannel Partner/ Reseller/ DistributorIdaho's state health insurance marketplace where members can enroll in individual plans and report changes affecting eligibility and premium amounts.
• Healthcare.govcoreChannel Partner/ Reseller/ DistributorFederal health insurance marketplace for individual and family plan enrollment. Members purchasing through the federal exchange receive 1095-A forms for tax purposes.

Scale indicators2 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• PacificSource Health Plans: Non-profit, member-focused regional health plan operating across Idaho, Montana, Oregon, and Washington. Closest comparable to Mountain Health CO-OP due to overlapping geographic footprint, cooperative/mission-driven culture, and similar individual, group, and Medicare product mix.
• Community Health Options: One of the few surviving ACA-era CO-OPs, operating in Maine. Closest structural peer as a non-profit member-owned cooperative offering individual and small group marketplace plans under the same ACA CO-OP framework.
• Health Alliance: Non-profit regional health plan serving Illinois and surrounding states with HMO, POS, and Medicare plans. Comparable as a non-profit regional carrier operating across a limited multi-state footprint with similar product structure.
• SelectHealth (Intermountain Health): Non-profit health plan affiliated with Intermountain Health, operating across Idaho, Utah, and Nevada. Comparable regional non-profit model with integrated provider system partnerships similar to Mountain Health CO-OP's St. Alphonsus and St. Luke's affiliations.
• Common Ground Healthcare Cooperative: Surviving ACA-era CO-OP serving Wisconsin. A direct structural peer sharing Mountain Health CO-OP's non-profit CO-OP governance model, individual marketplace focus, and small-group product line.
• Moda Health: Non-profit-affiliated regional health plan serving Oregon, Alaska, and nearby markets. Comparable non-profit-leaning operating model with similar individual, group, and Medicare Supplement product portfolio.

Broad incumbents

• UnitedHealthcare (UnitedHealth Group): Largest U.S. health insurer with significant ACA marketplace, employer group, and Medicare Supplement presence in Idaho, Montana, and Wyoming. The dominant broad incumbent against which Mountain Health CO-OP competes for broker channel and member share.
• Premera Blue Cross: Regional BCBS licensee serving Washington and Alaska with individual, group, and Medicare Supplement plans. A relevant comparable for the scale and product breadth Mountain Health CO-OP aspires to across its Mountain West footprint.
• Blue Cross Blue Shield of Idaho: Idaho's BCBS licensee and largest carrier in the state. Direct competitor in the individual marketplace, small group, and Medicare Supplement segments where Mountain Health CO-OP also operates.
• Blue Cross Blue Shield of Montana: Montana's BCBS licensee and dominant incumbent carrier in the state. Operates individual, group, and Medicare plans with much larger scale and broader provider networks than Mountain Health CO-OP, making it the primary competitive incumbent in shared markets.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UCc3HeO9amFD9oFBLkrZgo_g
• Facebookfacebook.com/MountainHealthCoop
• Instagraminstagram.com/mountainhealthcoop/?hl=en

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Mountain Health CO-OP