In the Big Sky state of Montana, you have a wide variety of affordable health coverage options. Individual, family, or self-employed health plans are available through the Health Insurance Marketplace. State and federally funded programs including Medicare and Medicaid address low-income health needs.

This guide explains your Montana affordable health insurance options in detail.

What to know about insurance in Montana

  • Marketplace plans: Individual health insurance plans are available to individuals, families, and self-employed people with no employees. You can buy individual health insurance as long as you’re a legal Montana resident.
  • Open enrollment: Open enrollment dates in Montana are through November until January 15 each year. New health plans can be signed up for or amendments to existing plans made during this period.
  • Special enrollment: Outside of the open enrollment period, special enrollments are available when you experience milestone life events such as moving to a new address, marriage, or having a baby are eligible for Special Enrollment Periods. You have 60 days from the actual event to make health insurance changes.
  • Health Insurance Marketplace: Montana does not have a state exchange and uses the federal exchange. Individual health insurance plans in Montana can be bought through Healthcare.gov. During the open enrollment period for 2021 coverage, 44,711 people enrolled in individual/family plans through Montana’s exchange. All Affordable Care  Act health plans guarantee coverage for defined essential benefits.
  • Coverage types: According to 2019 insurance data, Montana employers covered 43% of insured residents. Federal and state funded programs – Medicaid and Medicare-had enrollees of 20.8% and 18.1%. Non-group insured made up 8%, while the military only covered 1.8%. Uninsured Montanans were at 8.3%.

How do I enroll in the Montana Health Insurance Marketplace?

You can purchase Affordable Care Act (ACA) health insurance plans through the federal Health Insurance Marketplace. Enrollment is done through Healthcare.gov. You can enroll via the website, by phone, in person, or through the mail.

Selecting a plan via the Healthcare.gov website is a simple process.

  • First, choose Montana as your state at the Get Coverage page
  • Click the “Apply Now” button
  • Log in (if you already have an account) or create a new account
  • Register your name and email address
  • Create a password and three security questions
  • Click “Create Account”

The next step is applying for health insurance. Make sure you have the full name, birth date, and Social Security number of every person in your family who needs coverage. Healthcare.gov provides a handy checklist of the data for this step.

The affordable health insurance plans you are eligible for in Montana, including Medicare and Medicaid, will be listed. Details of plans can be compared side-by-side to quickly scan features, benefits, premiums, deductible costs, and coinsurance payment levels. Each plan must cover the same essential health benefits, and preexisting health conditions cannot be excluded.

To finish the process, all you need to do is choose a plan.

If you need help, Montana has experienced and trained individuals who can guide you. Healthcare.gov also has a call center and live web chat if you have questions.

Three insurers provide plans on the Health Insurance Marketplace for Montana:

  • Blue Cross Blue Shield of Montana
  • Montana Health CO-OP, and
  • PacificSource

How do I enroll in Montana individual and family insurance?

For individuals, it’s a relatively straightforward process to compare plan costs and decide the best value plan. However, getting the best family health plan requires more foresight in planning for future health issues. There are some important considerations when shopping for coverage, whether for yourself or for multiple people. These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Montana

Before deciding on a specific health plan, consider two types of costs: monthly premiums and out-of-pocket expenses. Annual deductible, copay, and coinsurance costs collectively make up the out-of-pocket side of the equation.

If you’re in good health and don’t plan to use your insurance often, you may save the most money by enrolling in the plan with the lowest premium. You’ll be covered in the event of a sudden illness or injury, but you won’t have to worry about paying a high premium each month.

If you have a chronic health condition, however, you need to weigh the low premium against other out-of-pocket costs. A plan that costs $350 per month and has a $500 deductible may be a better fit for your financial needs than a plan that costs $250 per month and has a $5,000 deductible if you require regular medical care. A more expensive plan may also give you access to more specialists or better coverage for your prescriptions.

There are several different plans from which you can choose:

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Montana

If you need coverage for multiple people, you need to think about how each person might use the plan. A spouse may need maternity care or fertility services, while a child might need to be covered for a tonsillectomy or other common childhood procedure. Review plan details carefully to make sure the services you need are covered. If someone in your family receives specialty care, you should also check to make sure the specialist participates in the plan’s network.

Another consideration for family plans is that many plans have an individual deductible and a family deductible. An individual deductible applies to each person covered by the plan, while the family deductible applies to the entire family. If one of your family members is hospitalized or undergoes an expensive surgery, it’s possible to meet the family deductible before every person on the plan has met their individual deductible.

How much does health insurance cost in Montana?

The cost of health insurance plans in Montana dropped quite dramatically in 2020 by roughly 13%. Lower premiums were due to reinsurance legislation coming into effect that year.  Reinsurance helped keep average monthly premiums down in 2021 as well.

Montana’s Health Insurance Marketplace uses a metal tier system for their plans: Bronze, Silver, Gold, and Platinum. For cheap health insurance seekers, the Bronze level is the least expensive and the most costly is Platinum. However, the higher the monthly premium, the lower your out-of-pocket costs could be.

Tax credits can help lower the cost of monthly premiums across all metal tier plans, but you must buy your health plans via Healthcare.gov to qualify. In 2021, the American Rescue Plan provides subsidies if health plan costs are more than 8.5% of your household income.

Average premiums in Montana 2018 2019 2020 2021 2022
Most affordable Bronze plan $347 $379 $328 $330 $331
Most affordable Silver plan $495 $528 $455 $445 $449
Most affordable Gold plan $582 $590 $502 $483 $487

  • Bronze plans may work well for you if you’re fit and healthy and rarely need medical services. In 2021, the average monthly premium for Bronze-level plans in Montana was $331. A high deductible and 40% coinsurance apply.
  • Silver plans have a higher monthly payment than Bronze plans. In 2022, the most affordable Silver premium was $449. A lower deductible and 30% coinsurance apply.
  • Gold and platinum plans have higher monthly payments than Bronze and Silver, but have the lowest deductibles. Gold plans have a 20% coinsurance payment while Platinum is only 10%. These plans are best suited to people with chronic or severe health conditions, where lower out-of-pocket costs may end up saving you money. The lowest average premium for Gold plans in 2022 was $487.

What kind of low-income health insurance is available in Montana?

State and federal health programs, including Healthy Montana Kids (HMK) and Medicaid, provide low-income citizens with health coverage. HMK and Medicaid are administered by the Montana Department of Public Health and Human Services (DPHHS).

Medicaid in Montana

The federal and state governments jointly fund Medicaid. This program delivers free or low-cost health services to eligible low-income residents of all ages. Benefits for adults and children include dental care, vision services, prescription medications, and visits to doctors.

Medicaid defines specific groups of people who can receive assistance though eligibility conditions differ for each group. Designated groups include:

  • Pregnant people
  • Disability-affected people
  • Families with dependent children 18 and younger
  • Seniors
  • Those who are blind

You can check for Medicaid eligibility at benefits.gov. In addition, you can apply for Medicaid through the DPHHS site or request a PDF application form.

Healthy Montana Kids (HMK)

Jointly funded by the federal government and Montana state government, the HMK program provides health services for children under 19. Aside from age, additional eligibility rules require that applicants be ineligible for Medicaid and uninsured. Household income limits also apply.

Health services include physician visits and examinations, dental care, and eyeglasses. Services must be considered medically necessary.

You can check for HMK eligibility on the website. To apply, use the DPHHS website or request a PDF application form via email.

Special State Programs in Montana

Beyond Medicaid and HMK, Montana provides a range of low-cost or free health programs. These include:

What are Montana’s Medicare options for seniors and people with disabilities?

The federally funded Medicare program is generally aimed at 65s and over. However, people under 65 with disabilities may also be covered by Medicare. You can qualify if you have end-stage renal disease, ALS, or have received disability benefits for 24 months.

In Montana, people eligible for Medicare have two choices – to sign up with Original Medicare or Medicare Advantage.

  • Original Medicare has been around since 1965. It consists of two parts – hospital insurance (Part A) and medical insurance (Part B). However, prescription medications are not covered, and neither are dental or vision health services. You can purchase a Part D plan for prescription medication.
  • Medicare Advantage (known as Part C) is an Individual health insurance alternative to Original Medicare. Medicare Advantage plans cover hospital and medical services, prescription medications, and often, the choice of dental and vision care all rolled into one health plan package.

Medicare Supplement Insurance (Medigap) plans can cover health costs Original Medicare doesn’t, including copays. Individual insurers in Montana sell Medigap plans.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program or the Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

The Medicare Resource Center provides extensive information to help make decisions on the best Medicare options for you.

Montana also runs the State Health Insurance Assistance Program (SHIP) to help with Medicare decision-making. In addition, SHIP provides counselling and advocacy services, and education on Medicare at no cost.

Are there short-term health insurance plan options in Montana?

Short-term health insurance provides temporary coverage for a limited timeframe. Holding short-term insurance can provide some peace of mind in the case of accidents or unexpected sickness during a gap in coverage.

In Montana, short-term plans can cover up to 364 days of initial coverage. Renewals are allowed for up to 36 months in total. However, insurers aren’t compelled to offer plans that meet the maximum permitted number of days. These plans also don’t provide all the essential benefits that Affordable Care Act metal tier plans are required to, such as pre-existing conditions.

Montana Insurance FAQs

Does Montana require health insurance?

The Affordable Care Act (ACA) mandates health insurance plans at a federal level. However, there are currently no penalties for not having insurance federally or in Montana.

Do I have to use the Health Insurance Marketplace in Montana?

It’s not compulsory to buy health insurance plans through the Health Insurance Marketplace. You are free to purchase plans on or off the exchange. But you have to use the marketplace if you want to lower your premiums with tax credits.

What types of alternative health insurance plans (like cost-sharing plans) are available in Montana?

The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.

Do I need health insurance if I have HSA/FSA?

Tax-advantaged flexible spending accounts (FSA) and health saving accounts (HSA) can be valuable tools to help with meeting medical expenses. However, given the high cost of many medical services, uninsured health care expenses can easily outweigh your savings. Paying a regular premium may save you money in the long run.

Do I need short-term disability coverage in Montana if I have health insurance?

Short-term disability insurance coverage will generally only pay a certain percentage of your regular income if you’re sick or injured. You’ll need to use this to cover your everyday bills and expenses. Having a suitable health insurance plan means you can keep your disability benefits to use as intended, not cover your out-of-pocket medical expenses.

Do I need long-term disability coverage in Montana if I have health insurance?

If you’re unable to earn a living while suffering from a long-term illness or injury, disability insurance bridges your income gap. It’s intended to help you pay for everyday living expenses. You still need health insurance to pay for medical costs.

What do Montana’s Special State Programs cover?

The Healthy Montana Kids (HMK) program provides health services for children under 19 in low-income households. Health services include physician visits and examinations, dental care, and eyeglasses. Services must be considered medically necessary.

Montana has additional low-cost or free health programs. These include; AIDS drug assistance, services for special needs children, early intervention for developmentally delayed children, and provision of specialized aids to assist disabled persons.

author-img
Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

Sources