Understand Medicare in Montana

Medicare, the United States federal medical insurance program, provides coverage for almost 200,000 people in Montana who qualify for Medicare.  You can get Medicare if you’re 65 or older or have a qualifying disability.

Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income.  There are 14 Medicare Advantage Plans in the state that are an alternative to Original Medicare.  Learn more about your Medicare options in Montana.

Medicare Plans in Montana

Compare ratings of Montana’s Medicare plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars 5 out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of ten
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Medicare Plan Options in Montana

Residents of Montana have multiple Medicare plans to choose from. Many are tiered to help Montana seniors find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Montana’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.

Original Medicare (Parts A and B) Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:

  • Original Medicare is a good choice if you want flexibility in choosing and accessing providers that accept Medicare anywhere in the U.S.
  • There is no cap on what you could spend for out-of-pocket expenses, and you must purchase drug coverage separately, so it’s a better choice for you if you don’t need much in the way of health care or prescription drugs.
  • If you don’t purchase a Medigap policy to supplement Original Medicare when you are first eligible, you may not be able to purchase one or may have to pay higher premiums, depending on your health status.
Medicare Advantage Plans (Part C) Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:

  • Medicare Advantage is a good choice if you want to have all of your health care and drug benefits bundled together in one plan and if you don’t mind being restricted in your choice of providers to save on costs.
  • There is a cap on what you can spend for out-of-pocket Medicare-covered expenses.
  • You also have access to services that Medicare doesn’t cover, like routine dental and vision exams.
Medicare Prescription Drug Coverage Plans (Part D) Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:

  • Part D is a good choice if you have Original Medicare, or if you have a Medicare Advantage Plan ― not a health maintenance organization (HMO) or preferred provider organization (PPO) ― that doesn’t have prescription drug coverage.
  • You pay a penalty if you wait to enroll in a Part D plan, unless you have creditable coverage from an employer-sponsored group plan.
  • If you don’t require medications now, you can enroll in a low-premium Part D plan to avoid late enrollment penalties later.
Medicare Supplement Insurance Plans (Medigap) Some Montana seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.

  • Medigap is a good choice if you have Original Medicare and want help paying for out-of-pocket expenses you incur when you access your Part A and Part B benefits.
  • You pay a monthly premium, and most copays and coinsurance costs are covered.
  • If you have significant health care needs, want the freedom to see any Medicare provider without network restrictions, a Medigap plan offers predictable coverage and costs for Medicare-covered care.
  • Medigap doesn’t cover prescription drugs or other benefits like dental and vision.

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 $499 per month*

Plan B: $170.10 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

Getting support can help when you’re making Medicare decisions. Montana has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP). SHIP has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.

Montana Area Agencies on Aging

There are 10 Area Agencies on Aging located throughout Montana. Each Agency offers services to seniors living within their respective counties and can connection you to resources. The Agencies also support senior centers throughout the state where you can find individualized counseling on your Medicare and Medicare Advantage options.

Contact information: Website |  800-551-3191

Montana State Health Insurance Assistance Program (SHIP)

Montana Medicare beneficiaries and their families and caregivers can get free healthcare cousneling through Montana’s official State Health Insurance Assistance Program (SHIP).  Local SHIP offices provide connections to counselors who are trained to answer questions about Medicare, Medicare Advantage and Medicare Supplemental Insurance, including questions about each program’s eligibility and enrollment requirements.

Contact information: Website | 1-800-551-3191

Montana Aging and Disability Resource Centers (ARDC)

The Montana Aging and Disability Resource Centers (ARDC) employes trained counselors to help answer your Medicare and Medicare Advantage questions. Counselors are also able to walk you through your Medicare applications and provide referrals to other resources when necessary.

Contact information: Website | 800-551-3191

Montana Department of Public Health and Human Services – Senior and Long-term Care Division

The Montana Department of Public Health and Human Services’s mission is to improve and protect the health, well-being and independence of Montana residents. It’s Senior and Long-term Care division provides information, education and assistance to Montana’s seniors.

Contact information: Website |  888-515-6565

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