The Treasure State has three Marketplace insurance carriers for 2020. All three insurers have lower premiums than the year before.
Montana Health Insurance Overview
Montana is a state with roughly 1 million residents. Approximately half of the population has health insurance through Medicaid and Medicare. These are government-funded programs.
A small percentage get private coverage through the Health Insurance Marketplace. Most Marketplace enrollees in Montana get financial help with monthly premiums.
How Has the Affordable Care Act Affected Montana?
Montana’s uninsured population declined drastically since Obamacare took effect in 2013. Nearly 165,000 residents (17% of the population) lacked health insurance at that time. Roughly half gained coverage by 2018 when the number of uninsured dropped to about 84,000 or 8% of the population
The biggest change to the uninsured rate occurred in 2016. The rate fell to 8% when Montana adopted full Medicaid expansion under the ACA. The ACA allowed the state to extend eligibility to parents and childless adults who earn up to 138% of the federal poverty level ($17,609 for a single redisent).1
Where Can You Buy Health Insurance for Individuals or Families in Montana?
Montanans can get affordable private health insurance through Obamacare. Plans are available to individuals, families, and self-employed professionals with no employees. You can choose from bronze, silver, gold, and platinum plans. Policies pay from 60% (bronze) to 90% (platinum) of your covered medical expenses.
All ACA policies provide guaranteed coverage regardless of your health or preexisting condition. Policies provide major medical benefits, such as hospitalization, maternity care, and rehabilitative services. Any enrolled children must also get dental and vision coverage.
When Is the 2021 Open Enrollment Period in Montana?
Montana residents enroll in Obamacare plans through the federal Marketplace at healthcare.gov. The 2021 Open Enrollment Period (OEP) starts on November 1, 2020 and ends on December 15, 2020. Coverage kicks in on January 1, 2021.
Special Enrollment Period
Montana residents who missed open enrollment can still sign up. Due to the coronavirus, the federal government reopened enrollment on the federal Marketplace from February 15, 2021 through August 15, 2021.
Who Sells Health Insurance in Montana?
All three Montana health insurers offering Marketplace plans decreased their rates for 2021.4 These companies are:
How Much Does Health Insurance Cost in Montana?
The benchmark premium for Marketplace health insurance is the second-lowest priced silver plan that applies to you. For 2020, the benchmark rate in Montana is $483 a month compared to $462 for the U.S. average. Health insurance premiums in Montana have decreased in 2020. Here are the average monthly rates from 2019 to 2020:
- Average lowest-cost bronze premium: $379 in 2019; $328 in 2020
- Average lowest-cost silver premium: $528 in 2019; $455 in 2020
- Average lowest-cost gold premium: $590 in 2019; $502 in 2020
For 2021, the state approved rate changes averaging about 1.4% for individual plans (about $100 more for the average unsubsidized individual policy). 5
Can You Get Help Paying for Health Insurance in Montana?
The federal government provides premium tax credits (or subsidies) based on your income and household size. Subsidies reduce your monthly payment on any Marketplace metal plan.
Normally, you qualify if your income is between 100% and 400% of the federal poverty level (FPL). This range goes from $12,760 to $51,040 for a single Montana resident.6
The federal government changed the formula in 2021. For two years, it got rid of the maximum income or “subsidy cliff” (400% of FPL). Instead, families are expected to contribute no more than 8.5% of their annual income toward health insurance costs.
Medicaid Coverage for Low-Income Montanans
Medicaid in Montana enrolls about 234,000 low-income residents.8 This number include families with dependent children, pregnant women, seniors, and people with disabilities. Children under 19 get Medicaid through Healthy Montana Kids (HMK) Plus. Benefits for adults and children include dental and vision care, prescription drug coverage, and doctor visits.
Income requirements vary. For example, families who qualify for HMK Plus can earn up to 143% of the federal poverty level, or $3,069 for a family of four.9
As of January 1, 2020, Montana Medicaid enrolees no longer have a copayment for covered services. The charge was usually $4 each time you visit a provider.
Montana’s Medicaid Expansion Program
Montana has a separate Medicaid expansion program called the HELP Medicaid Plan. Those who qualify are parents who earn from 50% to 138% of the federal poverty level as well as childless adults who make from 0% to 138% of the FPL.10 This represents a maximum annual income of $17,609 for a single adult in 2020.11
The Affordable Care Act allowed Montana to expand eligibility to these groups effective January 1, 2016. About 85,000 Montanans gained Medicaid coverage under the expansion as of October 2019.
Montana Children’s Health Insurance Program
Montana’s Children’s Health Insurance Program is called Healthy Montana Kids (HMK). This program is separate from HMK Plus, which is specifically for children enrolled in Medicaid.
HMK CHIP enrolls nearly 28,000 children up to age 19.12 It’s available for a low or no monthly cost. But children must reside in households that meet income requirements. For example, the maximum income for a family of two is $3,678 a month as of 2019. This figure represents 261% of the FPL.13
The program provides medical, dental, vision, and prescription drug coverage. Enrollees also get financial help with transportation, meals, and lodging when traveling for medically-necessary treatment. Care is provided through the Blue Cross Blue Shield of Montana provider network.
Medicare for Montana Seniors and People With Disabilities
Most people qualify for Medicare upon turning 65. But people under 65 also qualify if they have a disability or chronic condition, such as ALS, also called Lou Gehrig’s disease.
More than 277,000 Montanans have Medicare as of 2018.14 About five in six beneficiaries get coverage through Original Medicare from the federal government. It provides hospital (Part A) and medical benefits (Part B), such as doctor visits, emergency care, and limited drug coverage. Enrollees who want more comprehensive prescription drug benefits typically buy a separate Medicare Part D drug plan. About 110,000 Montana beneficiaries bought an individual Part D plan in 2018.15
An alternative to Original Medicare is Medicare Advantage or Part C. It’s a private health plan that includes Part A and Part B plus extra benefits, such as Part D drug coverage. Roughly 39,000 Montanans are enrolled in Medicare Advantage.16
Another private option is Medicare Supplement, also called Medigap. This plan only works with Original Medicare. It’s designed to help pay your covered out-of-pocket expenses, such as your Part A and Part B coinsurance and deductibles. Many policies also pay for qualifying emergency care you receive in a foreign country.
Montana Short-Term Health Insurance
Short-term health insurance provides temporary coverage for a specific amount of time. You can get a policy in Montana that lasts as long as 364 days. Policy renewals are allowed for up to 36 months.17 These terms are the maximum coverage limit set by the federal government. But states can offer shorter coverage or prohibit the sale of plans altogether.
Short-term insurance can be helpful in many situations, such as when:
- You’re in between jobs
- You’re waiting for coverage to start at a new job
- You missed the annual open enrollment for Obamacare health insurance
- You aged off your parent’s health plan when you turned 26
If you choose to enroll, keep in mind that short-term plans don’t provide comprehensive health insurance. They are not required to offer all 10 essential health benefits or cover preexisting conditions. You can also be denied a policy based on your health.
Other coverage limitations apply. So make sure you understand how your policy works. You should also compare the costs (premiums, deductibles, coinsurance) and benefits with major medical coverage to decide which is right for you. Whatever you decide, Montana has several health insurance options to meet your needs.