Medicare Plan Options

While the Original Medicare base coverage and cost-sharing responsibilities are the same for everyone, you can tailor your health insurance to better fit your needs. Private insurance companies, which must follow the rules set by Montana’s Medicare Advantage program, sell policies as well.  Medicare Advantage Plans may cover prescription drug fees and out-of-country care and offer benefits, such as vision, dental, and hearing services, providing you with flexibility and cost-saving options.

Original Medicare

Original Medicare is the program run by the federal government that provides health insurance coverage to those aged 65 and over. Most people qualify for free Part A coverage, which includes hospital stays, nursing home care, and hospice. You have to pay a monthly premium to enroll in Medicare Part B, which pays for outpatient services and preventive and routine medical care. In addition to the monthly premium, you pay a medical deductible and a percentage of the cost of the medical services you get. The deductible resets every year, and there’s no out-of-pocket maximum. For that reason, this coverage may be an economical option if you’re in good health. If you’re managing a chronic condition, annual out-of-pocket costs can be high.

Medicare Advantage Plans

Medicare Advantage Plans offer comparatively robust coverage, which may appeal to you if you need more than routine preventative care. These plans, which are offered by private health insurance companies, feature the same hospital and medical benefits as Original Medicare. They also typically offer prescription drug coverage and may include coverage for vision, dental, and hearing services and discounts for fitness and wellness programs. You still pay the Part B premium, and you may have an additional monthly premium for the policy you choose. Different plans have different rules regarding seeing in-network providers and getting referrals to see specialists. Plans have copays and annual out-of-pocket maximums, and some plans deductibles that must be met before coverage kicks in.

Medicare Prescription Drug Coverage Plans

Prescription drug costs can be a significant expense. According to one study, if you take five brand name medications on a regular basis, you could spend $26,000 or more annually. While Original Medicare doesn’t cover prescription drugs, private companies sell prescription drug coverage plans that can be added to your policy. It’s recommended that you add this coverage, called Part D, when you first sign up for Medicare to avoid late enrollment penalties, even if you don’t take any medications at that time. Before signing up for a plan, make sure it covers the medications you want, and watch for rules, such as restrictions on what health providers you can use.

Medicare Supplement Insurance Plans

Medicare Supplement Insurance, or Medigap, are special policies that private health insurance companies sell to help you control out-of-pocket costs. Instead of adding additional benefits, these policies reduce health care costs, such as copays, coinsurance, and deductibles. Policies are standardized, making it easy to compare them. If you enroll in a Medigap plan, you pay a premium that’s separate from the Original Medicare premium. A Medigap policy only covers one person, so if you and your spouse both want Medigap, you must buy two policies.

Medicare in Montana by the Numbers

People enrolled in Original Medicare Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
189,852 Plan A: $0 to $471 per month*
 
Plan B: $148.50 per month**
$8,044 -20.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Montana

Montana is home to several departments and agencies that can help you research your options and make informed decisions regarding your health insurance coverage. Through the following resources, you can find out what Medicare options are available in your region; compare Medigap, Medicare Advantage, and prescription drug plans; and get answers to questions regarding your benefits and cost-sharing responsibilities.

Office of the Montana State Auditor, Securities and Insurance Commissioner

The Office of the Montana State Auditor, Securities and Insurance Commissioner is the state regulator for insurance. This office protects Montanans by making sure insurance companies treat their policyholders fairly and provide high-quality insurance. Through its Montana Health Answers website, it provides you with a detailed overview of health insurance plans in the state, including prescription drug plans, tips for finding in-person help, and how to pay for coverage. The office also helps with the appeals process if a health insurance claim is denied.

Contact Information: Website | 406-444-2040

State Health Insurance Assistance Program

Montana SHIP is an independent agency that provides you with free, unbiased advice on health insurance. It’s administered by the state’s Office on Aging and staffed with counselors who can give you information about Original Medicare benefits, Medicare plans provided by private insurance companies, and how to recognize Medicare fraud or abuse. SHIP counselors provide this information in public presentations and one-on-one over the phone, at various community locations, and in your home.

Contact Information: Website | 800-551-3191

Area Agencies on Aging

Montana has 10 Area Agencies on Aging, each of which serves a designated region of the state. Through your local agency, you can connect with a SHIP counselor to obtain free Medicare options counseling. The agencies also provide free legal aid, which can help you address issues, such as denied coverage and canceled policies.

Contact Information: Website | 800-551-3191

Montana Senior Medicare Patrol

SMP is a statewide volunteer-run program that gives you the information you need to be proactive in addressing issues, such as billing mistakes and fraud. Through this program, you can learn how to compare your health care bills to spot any discrepancies. Assistance is available on a one-on-one basis and via group presentations in the community.

Contact Information: Website | 800-551-3191

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