Medicare Advantage Plans In Montana

Fact Checked
Published: 5/23/2021

Medicare Advantage Plans, or Medicare Part C, are offered by private health insurance companies approved by the federal government. All Medicare Advantage Plans must offer the same services covered by Original Medicare Part A and Part B. Most Medicare Advantage Plans offer additional benefits, such as prescription drug coverage, known as Medicare Part D, vision and dental care, and access to fitness and hearing aid programs.





  • In 2019, there were 14 Medicare Advantage Plans available in Montana.
  • 18% of the total Medicare population in Montana was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,044 per beneficiary in Montana, which is 20% lower than the national average.
  • Available Medicare Advantage Plans range from one to nine across Montana’s 56 counties.

You can only select a Medicare Advantage Plan that’s available in your county in Montana. This is true even if only one or two plans are available, as is the case in some Montana counties. The fee structures for copays, premiums, and out-of-pocket expenses can differ between Medicare Advantage Plans.

Medicare Advantage Plans in Montana

Types of Medicare Advantage Plans

You can choose from one of four types of plans in Montana’s Medicare Advantage program, provided all options are available in your locale. Each type offers specific in-network and out-of-network coverage, benefits, and restrictions, and you can select the one that best suits your financial situation and health care needs.

Health Maintenance Organizations (HMO)

Regular HMO plans are popular among health care consumers — a Medicare Advantage HMO is very similar. It can be the least-expensive Medicare Advantage Plan type, but often has the most restrictions. You can only use the plan’s in-network providers, you must select a primary care physician, and you need to obtain referrals to see specialists. Many HMO plans include benefits such as vision, hearing, and dental coverage. Some plans provide prescription drug coverage, but not all do.

Preferred Provider Organizations (PPO)

Medicare Advantage PPOs allow you to seek out-of-network coverage when desired. You won’t need to choose a primary care physician or obtain a referral to see a specialist. You can use the plan’s in-network providers to reduce your health care costs, seeing an out-of-network provider when necessary. Many PPO plans offer prescription drug coverage, vision and dental care, and access to fitness and hearing programs.

Private Fee-For-Service Plans (PFFS)

PFFS plans offer flexibility with some limitations. With a PFFS, the insurance company decides how much it will pay doctors, hospitals, and other providers and how much you will pay. You don’t need to select a primary care doctor or obtain referrals for specialists. You can use any health care provider who accepts your plan’s terms and conditions. Most PFFS plans offer prescription drug coverage, but if yours doesn’t, you can sign up for a Medicare Part D plan.

Special Needs Plans (SNP)

SNPs cover specific groups and individuals, such as those living in nursing facilities, those eligible for both Medicare and Medicaid, or those suffering from an illness or chronic condition, such as cancer, AIDS or end stage renal disease (ESRD). In most cases, you must use the SNP’s in-network providers, select a primary care physician, and obtain a referral to see a specialist. All SNPs are legally required to provide prescription drug coverage.

Enrollment and eligibility for Medicare Advantage Plans in Montana

Eligibility

To join a Medicare Advantage Plan in Montana, you must be at least 65 years old or suffer from a disability. You must be a U.S. citizen or a permanent resident for the past five years. You must be enrolled in Original Medicare Parts A and B but not in a Medicare Supplement Insurance (Medigap) plan.

Enrollment Periods

You can join a Medicare Advantage Plan during the following specific enrollment periods:

  • Initial enrollment, which begins three months before you turn 65, your birth month, and three months after you turn 65.
  • Open enrollment, which occurs between October 15th and December 7th each year. You can move from Original Medicare to a Medicare Advantage Plan or return to Original Medicare. You also can switch Medicare Advantage Plans available in your county.
  • Medicare Advantage open enrollment, which takes place annually between January 1st and March 31st. You can switch between available Medicare Advantage Plans or return to Original Medicare. You can’t select a Medicare Advantage Plan for the first time. However, if you haven’t previously signed up for Medicare Part B, you can do so during this period and then select a Medicare Advantage Plan between April 1st and June 30th, with coverage starting on July 1st.
  • If you move out of your coverage area or experience certain other life events, you may be eligible for a special enrollment period.

If you’re covered by your employer’s or spouse’s health care, you don’t need to enroll in Original Medicare or a Medicare Advantage Plan when you turn 65. You have eight months after that insurance ends to select Original Medicare or a Medicare Advantage Plan.

Prescription drug coverage

Many HMO and PPO plans include prescription drug coverage in your premiums, while others charge a separate premium. If your HMO or PPO plan doesn’t include prescription drug coverage, you can’t sign up for a Medicare Part D plan; if you do, your HMO or PPO will expel you and return you to Original Medicare. Most PFFS plans include prescription drug coverage, but if not, you can purchase a Medicare Part D plan with no penalties. SNPs must provide prescription drug coverage.

Medicare Advantage Resources in Montana

Deciding between Original Medicare and a Medicare Advantage Plan isn’t always easy. Neither is choosing the right Medicare Advantage Plan, depending on how many are available in your county. Your health care needs and financial situation affect your choice. Fortunately, there are numerous resources available in Montana that provide free counseling to help you make your decision.

Montana Area Agencies on Aging

The 10 Montana Area Agencies on Aging work together to provide important resources for seniors across the state. Each office offers services for aging Montanans in its region, as well as providing connections to resources that help seniors live as independently as possible in their communities. This includes running numerous senior centers across the state where older adults can receive options counseling on Medicare and Medicare Advantage.

Contact Information: Website | 800-551-3191

Montana Aging and Disability Resource Centers (ARDC)

Montana’s ARDCs helps seniors with applications for public programs such as Medicare, Medicare Part D, Medicaid and Social Security. Trained and certified counselors work with seniors aged 60 and older and their families or caregivers to provide assistance, referrals, and information on these important topics. The ARDCs work with Montana’s Area Agencies on Aging across the state.

Contact Information: Website | 800-551-3191

Montana State Health Insurance Assistance Program (SHIP)

The Montana SHIP program provides free health care counseling to anyone eligible for Medicare, their families, or caregivers. The goal of the SHIP program is to help seniors make informed choices about their benefits. When you call a SHIP office, you’ll be put in touch with a trained counselor who can help you with decisions regarding Medicare, Medicare Supplement Insurance, Medicare Advantage, and the enrollment and eligibility requirements for each program.

Contact Information: Website | 800-551-3191

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