Medicare in Montana

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Montana Medicare Plans

Medicare is the federal health insurance program designed especially for people 65 years and older and for people with disability.

In order to qualify for the Medicare plans people must have 10 years of full-time employment on record or they should be disabled based on Social Security Administration criteria.

Nearly 21 % of the state’s population, around 225,000 Montana residents are enrolled in Medicare. Out of the 21%, thirteen percent of enrollees are under 65 years of age and qualify due to a disability. Medicare beneficiaries in Montana receive benefits under Original Medicare that includes Medicare Part A and Medicare Part B.

Generally enrollment in Medicare Part A is premium free, though some individuals in Montana may have to pay a monthly premium based on their income. Medicare Part A benefits in Montana like any other state include hospital care, skilled nursing facility, nursing home care, hospice care and home health services. Medicare Prat B plan has a monthly premium and beneficiaries above a certain limit annual income may have to pay a higher monthly premium. Medicare Part B coverage for preventive health care services and medically necessary services include outpatient doctor’s office visit, outpatient laboratory services and x-rays, ambulance services, durable medical equipment, mental health services and getting a second opinion before surgery. Residents of Montana can apply for medicare through the Social Security website.

Medicare Part C or Medicare Advantage Plan in Montana

Medicare Advantage Health Plan in Montana works the same way as of other states and is offered by the private insurance companies having contract with Medicare. Around 18% of Medicare beneficiaries in Montana are enrolled in Medicare Advantage plans. Beneficiaries of Medicare Advantage plan receive both Medicare Part A and Part B benefits and most of the Advantage plans in Montana also offer prescription drug coverage. Some of the plans also include additional benefits like routine dental or hearing services. There are several types of Medicare Advantage plans in Montana, some of the common plans include, HMO, PPO and Private Fee-for-Service plans.

Irrespective of the type of Advantage plan the residents enrolled in they need to keep paying the premium of Medicare Part B along with their premium of Advantage plan if any. Residents looking for Advantage plan can sign up during their Medicare Initial Enrollment Period. This is a seven-month period that starts three months before one 65th birthday month, includes the birthday month, and continues for three more months. In order to qualify for Medicare Advantage plan, residents should have both Medicare Part A and Part B and they should live in the plan’s service area and should not have End Stage Renal Disease.

Medicare Part D or Prescription Drug Plan

Medicare Part D is also known as prescription drug plans help cover the cost of prescription medications, though these plans do not include medical coverage. Since Original Medicare offers limited prescription drug coverage, residents of Montana need to enroll in Medicare Part D for coverage of most of the prescription medications. Original Medicare beneficiaries can enroll in a Medicare Prescription Drug Plan for stand-alone coverage. These plans are offered by private insurance companies approved by Medicare. To have this coverage residents of Montana need to manually enroll in a separate Medicare Prescription Drug Plan that works with Original Medicare benefits. Medicare part D plans cover a portion of all covered prescription drug costs after the members have paid their annual drug deductible. However, the actual drug cost for the members will depend on plan’s cost sharing requirements for every drug tier, whether they visited pharmacy that is included in the plan’s network, whether their drugs are listed in the plan’s formulary and whether the members are eligible for income-based subsidies.

Medigap or Medicare Supplement Plans in Montana

Medicare beneficiaries in Montana enrolled in Original Medicare have the opportunity to enroll in a Medicare Supplement plan or Medigap plan that allow them pay for certain costs that is not covered under Original Medicare. Medicare Supplement plans are offered through private insurance companies and work along with the Original Medicare coverage. Montana offers ten standardized Medicare Supplement plan and benefits are standardized across each plat type. Therefore, irrespective of the insurance company, members will get the same level of coverage for Medicare Supplement Insurance plans of same category. These plans generally provide coverage for Original Medicare expenses like copayments, deductibles and coinsurance, which members usually pay from their own pocket. Beside this, the Medicare Supplement plans may also offer coverage for benefits that are not included in Original Medicare like the first three pints of blood, excess charges of Part B, as well as the emergency health coverage outside the country. In order to be eligible for Medicare Supplement plans, members must be enrolled in Original Medicare.

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