The Montana Association of Counties Health Care Trust was established in 2005 to provide a cost-effective alternative for health insurance benefits for counties and county-related boards and districts. By pooling the risk of a severe financial loss over a larger population, premiums are generally more stable, limiting the broad fluctuations that an individual county or district might otherwise experience.

The Health Care Trust is able to combine the purchasing power of pool members when negotiating plan services, such as claim management, case management, preferred provider pricing, and reinsurance. The result is favorable coverage, terms, conditions, and plan limits that are tailored to the needs of the county, board, or district.

Plan services such as enrollment, risk control, and wellness programs are tailored to the needs of county members. Health Care Trust members have a significant voice in how the pool is operated and how claims are resolved, since the policy-making board is comprised of county commissioners. If claims controversies should arise, Health Care Trust members have the full support of MACo administration and the Health Care Trust board.