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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.
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.
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:
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:
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:
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.
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 premium in Montana||2020||2021||2022||2023|
|Most affordable Bronze plan||$380||$358||$343||$343|
|Most affordable Silver plan||$506||$470||$445||$471|
|Most affordable Gold plan||$510||$464||$435||$521|
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).
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:
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.
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.
Beyond Medicaid and HMK, Montana provides a range of low-cost or free health programs. These include:
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.
Medicare Supplement Insurance (Medigap) plans can cover health costs Original Medicare doesn’t, including copays. Individual insurers in Montana sell Medigap plans.
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).
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.