TABLE OF CONTENTS
Once you turn 65 or have a qualifying disability, you’ll have two choices for getting Medicare coverage: You can enroll in Original Medicare Parts A and B separately, or use a bundled plan called a Medicare Advantage Plan. Medicare Advantage Plans are an alternative to Original Medicare that provide the same coverage as Parts A and B but through a single Medicare-approved private insurer.
Since Medicare Advantage Plans are provided by private insurance companies, each plan can differ on how much they charge and what additional benefits, if any, are provided. As such, it’s important to compare your plan options before enrolling.
This guide explains everything you need to know about Medicare Advantage Plans in Montana.
Compare ratings of insurance companies offering Medicare Advantage Plans in Montana:
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Blue Cross Blue Shield||3.8 stars||A – B++||A+||2.5 to 4.5 stars||Sixth and ninth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of 10|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
Through the CMS Innovation Center’s Value-Based Insurance Design (VBID) Model, 6 plans will offer Medicare Advantage enrollees eliminated Part D cost-sharing; rewards and incentives programs related to healthy behaviors; and customized, innovative benefits that address social determinants of health, such as food insecurity and social isolation, for certain underserved and/or chronically ill enrollees.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 27 Medicare Advantage Plans available in Montana, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are 27 Medicare Advantage Plans available in Montana as of 2022. These include:
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Montana, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Montana Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Montana Area Agencies on Aging||Phone: 800-551-3191||The Montana Department of Public Health and Human Services seeks to improve and protect the health, well-being and self-reliance of all Montanans|
|Montana Commissioner of Securities and Insurance||Phone: 800-332-6148||The Office of the Montana State Auditor, Commissioner of Securities and Insurance (CSI) is a criminal justice agency that protects Montana’s consumers by ensuring fairness, transparency and access for Montanans in two of Montana’s largest industries — securities and insurance|
|Montana Healthcare and Benefits Division||Phone: 800-287-8266||HCBD manages the State of Montana Benefit Plan (State Plan) which provides benefits (ie. medical, prescription, dental, vision, life) for State of Montana Employees, Retirees, Legislators, and Survivors|
|Montana Medicaid||Phone: 800-362-8312||DPHHS reimburses private and public providers for a wide range of preventive, primary, and acute care services|
|Montana Senior Medicare Portal||Phone: 800-551-3191||Through Montana SMP, senior volunteers help fellow seniors become pro-active consumers identifying potential mistakes, abuse or fraud in medical billing|
|Montana State Health Insurance Program (SHIP)||Phone: 800-551-3191||The Montana State Health Insurance Assistance Program (SHIP) is a FREE health-benefits counseling and advocacy service for Medicare beneficiaries and their families or caregivers|
|Resource||Contact||How they help|
|Butte Area Agency on Aging||Phone: 800-551-3191
email: [email protected]
|Southwest Montana Aging and Disability Services strives to be the focal point for elderly persons, adults with disabilities and their families to get educated on and connected to services within their community|
|Cascade County Aging Services||Phone: 406-454-6990||Encompassing all of Cascade County, the primary focus of Aging Services is to provide services to those 60 years of age and older|
|Eastern Montana Area Agency on Aging||Phone: 406-377-3564||Action for Eastern Montana is committed to strengthening and enhancing the quality of life within the communities we serve by promoting education, advocacy and dignity for achieving independence|
|Havre Area Agency on Aging||Phone: 406-265-5464||Area X Agency on Aging/Hill County Council on Aging, is dedicated to promoting the general welfare of senior citizens, in seeking out ways to enrich their lives. A variety of services are available to meet the needs of our aging population|
|Kalispell Area Area Agency on Aging||Phone: 406-758-5730||They help older adults with what’s important to them by providing the services, information and resources they need to live well at every age|
|Missoula Area Aging Services||Phone: 406-728-7682||Missoula Aging Services provides a wide range of programs and services for older adults and those who care for them|
|Polson Area Agency on Aging||Phone: 406-883-7284
email: [email protected]
|Polson Area Agency on Aging seeks to match seniors and their caregivers with essential services in the area|
|Roundup Area Agency on Aging||Phone: 406-323-1320
email: [email protected]
|The Roundup Area Agency on Aging is a public, non-profit organization who serves the needs and concerns of seniors and the disabled throughout an eleven-county area, including two reservations, in central Montana|
|Western Montana Agency on Aging||Phone: 800-266-4188||Western Montana Agency on Aging seeks to match seniors and their caregivers with essential services in the area|
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||N/A||Provided by the CMS, this page provides information related to dealing with Medicare managed care plan grievances and appeals|
|CMS Medicare Managed Care Eligibility and Enrollment||N/A||Provided by the Centers for Medicare & Medicaid Services (CMS), this page offers information for contacting MAP organizations plus other health plans and related aspects to Medicare health plan enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||N/A||Provided by the CMS, this page details prescription drug eligibility and enrollment as it relates to MAP|
|Medicare.gov||Phone: 800-633-4227||The homepage for the main Medicare website for the U.S|