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Montana Health Insurance

By Leonie Dennis

Published: August 25th, 2015

We want to make health insurance content easy to understand so that it can help you make better decisions. We adhere to strict editorial standards. This post may contain links to lead generation forms, which is how we make money. However, this will not influence our writing. The content of this page is accurate as of the posting or update date.

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.1 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. 

Montana and the Affordable Care Act (ACA or Obamacare)

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).2

Buying Montana Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs

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 free preventive services. Any enrolled children must also get dental and vision coverage.

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Montana Health Insurance Marketplace Enrollment

Montana residents enroll in Obamacare plans through the federal Marketplace at Healthcare.gov. Nearly 44,000 residents signed up during the 2020 open enrollment period (OEP), which ended on December 18, 2020.3 This is a slight decrease from the roughly 45,000 people who enrolled the year before.4

You may get a Special Enrollment Period to buy a 2020 plan at any time if you missed the OEP.   This happens if you have a qualifying life event, such as relocation or marriage. If not, you’ll have to wait until the next open enrollment season starting on November 1, 2020. 

Montana Health Insurance Companies

All three Montana health insurers offering Marketplace plans decreased their rates for 2020.5 These companies are:

  1. Blue Cross Blue Shield of Montana 
  2. Montana Health Cooperative
  3. PacificSource Health Plan

Health Insurance Costs 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

Help With Marketplace Premiums for Low-Income Montanans

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.

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 majority of Montanans (87%) with Marketplace coverage received premium tax credits in 2019.7 The average amount was $570 per month.

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 FPL, or $3,069 for a family of four.9

As of January 1, 2020, Montana Medicaid enrollees 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 FPL 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. 

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Article Sources

  1. 1 Kaiser Family Foundation. “Medicaid in Montana.” kff.org. (accessed March 1, 2020).

     

  2. 2 Kaiser Family Foundation. “Medicaid Expansion in Montana.” kff.org. (March 2, 2020).

     

  3. 3Centers for Medicare & Medicaid & Services. “2020 Federal Health Insurance Exchange Enrollment Period Final Weekly Enrollment Snapshot.” cms.gov (accessed March 2,   2020).

     

  4. 4Kaiser Family Foundation. “Marketplace Enrollment, 2014-2019.” kff.org. (accessed March 2, 2020).

     

  5. 5U.S. Government Website for the Federal Health Insurance Marketplace. “Rate Review.” ratereview.healthcare.gov. (accessed March 2, 2020).

     

  6. 6 U.S. Department of Health & Human Services. “HHS Poverty Guidelines for 2020.” aspe.hhs.gov. (accessed March 2, 2020).

     

  7. 7 Kaiser Family Foundation. “Marketplace Effectuated Enrollment and Financial Assistance.” kff.org (accessed March 2, 2020).

     

  8. 8U.S. Government Website for Medicaid. “November 2019 Medicaid & CHIP Enrollment Data Highlights.” medicaid.gov. (accessed March 1, 2020).

     

  9. 9Montana Department of Public Health and Human Services. “ACA/FAMILY MEDICAID 005 Table of Standards: Healthy Montana Kids Program-Income (HMK and HMK Plus).” dphhs.mt.gov. (accessed March 2, 2020).

     

  10. 10Kaiser Family Foundation. “Medicaid Expansion in Montana” kff.org. (March 2, 2020).

     

  11. 11U.S. Department of Health & Human Services. “HHS Poverty Guidelines for 2020.” aspe.hhs.gov. (accessed March 2, 2020).

     

  12. 12U.S. Government Website for Medicaid. “November 2019 Medicaid & CHIP Enrollment Data Highlights.” medicaid.gov. (accessed March 1, 2020).

     

  13. 13Montana Department of Public Health and Human Services. “ACA/FAMILY MEDICAID 005 Table of Standards: Healthy Montana Kids Program-Income (HMK and HMK Plus).” dphhs.mt.gov. (accessed March 2, 2020).

     

  14. 14 Kaiser Family Foundation. “Total Number of Medicare Beneficiaries.” kff.org (accessed March 2, 2020).

     

  15. 15Kaiser Family Foundation. “Medicare Prescription Drug Plans: Stand Alone PDP Enrollment.” kff.org (accessed March 2, 2020).

     

  16. 16Kaiser Family Foundation. “Total Number of Medicare Beneficiaries.” kff.org (accessed March 2, 2020).

     

  17. 17Montana Commissioner of Securities & Insurance. “New Short-Term Health Insurance Plans Can Be In Place Next Week.” csimt.gov, September 28, 2018. (accessed March 2, 2020).

Leonie Dennis

Leonie Dennis is a rising subject matter expert in the Medicare and ACA healthcare reform landscape. She holds a Bachelor of Science in Marketing from William Paterson University of New Jersey.