Montana Health Insurance

Health insurance in Montana

● Montana's health insurance market uses federally managed exchange HealthCare.gov.

● The open enrollment period for 2021 coverage in Montana runs from November 1 to December 15, 2020. Residents with eligible events can sign up or make changes to their plan outside of that window. Losing employment and health benefits due to the closure of coronavirus-related businesses is considered a qualifying event.

● Short-term health insurance can be sold in Montana with initial plan terms of up to 364 days.

● Three health insurance companies offer 2021 coverage through montana's health insurance market.

● Montana insurers have lowered premiums by an average of 13% for 2020, largely because of the new reinsurance program (but subsidies are also smaller). For 2021, insurers have proposed an average rate increase of about 3%.

● About 45,000 subscribers to the 2019 coverage through the Montana exchange.

● Montana implemented the ACA's Medicaid expansion in 2016. The state is now seeking federal approval to add a work requirement.

This page is a resource to help consumers quickly find health insurance options in Montana. Here you will find information about the types of health insurance coverage available to families and individuals. You can find the basics of Montana's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Montana; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of Montana health insurance resources for residents.

Montana Health Insurance Marketplace

The health insurance market, or health insurance exchange, was created by the Affordable Care Act (Obamacare). The market is a way to get coverage for people who are self-employed or work for an organization that doesn't provide health benefits. The federal government manages the Montana market, which means individuals can enroll themselves or their families can Healthcare.gov.

The ACA imposes essential benefits that must be covered through market plans. Registration cannot be automatically carried over from one year to the next. The options available for the health plan and the premium costs offered on the market vary from year to year, and if you've had a change in income change, you might qualify for a different level of subsidies or cost-sharing reductions.

Montana Open enrollment period and dates

Montana's open enrollment for 2021 coverage will run out from November 1, 2020 to December 15, 2020. Outside of that open enrollment period, residents need a qualifying event to sign up for coverage or make a change to their plan. The loss of an employer-sponsored plan is a qualifying event, so people who lose coverage in the midst of the COVID-19 pandemic can get replacement coverage in the exchange.

Three insurers offer ACA-compliant medical plans in Montana for 2020, including CO-OP Montana Health - one of four remaining CO-POs created by ACA in the country - which took the top spot in terms of market share.

43,822 people have signed up for private plans through Montana's health insurance market for 2020. As in most states that use HealthCare.gov, enrollment peaked in Montana's exchange in 2016 -- with more than 58,000 enrollees -- and has declined every year since then.

Premiums in Montana's individual market are on average 13% lower for 2020 than in 2019, largely due to the new reinsurance program implemented by the state. (This applies to full-price premiums; changes in post-grant premiums for people eligible for grants can be very different.)

For 2021, individual market insurers in the state have proposed an overall average rate increase of about 3%. While modest enough, Insurance Commissioner Matt Rosendale said he doesn't believe insurers should raise prices for 2021, due to the significant reduction in elective medical procedures during the COVID-19 pandemic.

Affordable Care Act and Montana

In 2010, Montana's U.S. senators, Max Baucus and Jon Tester, voted to pass the health care reform law. But Denny Rehberg, Montana's only representative in the U.S. House, voted against the ACA. Baucus and Rehberg are no longer in Congress.

Senator Steve Daines, who replaced Baucus, voted to repeal Obamacare. After Montana Rep. Ryan Zinke became Interior Secretary of the Trump Administration, montana's lone House of Representatives seat was vacant. Republican Greg Gianforte eventually won the election to replace Zinke in the House. Gianforte opposes the ACA and wants to repeal it. [His opponent, Democrat Rob Quist, supported the ACA, but wanted to take a step forward, toward a single-payer health care system.]

At the state level, former Governor Brian Schweitzer and former insurance commissioner Monica Lindeen were in favor of the ACA, but the state legislature was not. Two bills that would create a state-run exchange folded in Montana in 2011, while passing a bill banning the creation of a state-run exchange. That bill (SB 228) was eventually vetoed by Schweitzer, but in late 2012 Montana officially announced that it would default on a federally facilitated exchange operated by HHS.

Governor Steve Bullock took over in 2013 and supported Obamacare and worked to improve access. On April 29, 2015, he signed Senate Bill 405 into law, which made Montana the 29th state to expand Medicaid. CMS approved a waiver that included deviations from medicare's standard expansion.

Lindeen was limited in 2016 and was replaced as insurance commissioner by Matt Rosendale, who opposes the ACA and wants a more conservative, "free market" approach, based on Montana to health care reform. In a letter to U.S. Senator Lamar Alexander (R, Tennessee) in March 2017, Rosendale details his proposals (which include selling non-ACA-compliant plans in Montana), and noted that his letter replaced a letter Lindeen wrote in late 2016, which took an opposite perspective.

Other ACA provisions in Montana

The Affordable Care Act established a federal loan program to encourage the creation of consumer-run nonprofit health insurance issuers called Consumer Operated and Oriented Plans (CO-OP). As of January 2013, 23 CO-PO had received loans totaling $1.98 billion, including more than $85 million for CO-OP Montana Health, which offers coverage in both Montana and Idaho.

By the end of 2016, most ACA CO-POOs had been closed and only four remain operational as of December 2020. Montana Health CO-OP is among the four surviving CO-POs and has a larger share of Montana's individual market than one of the other two insurers.

Medicaid Overview

Medicaid is a health insurance option for people who have a low or very low income or who have a disability. Medicaid is jointly managed by the state and federal government; Medicaid is primarily funded by the federal government. Each state determines specific eligibility rules and manages the program within the general guidelines and requirements set by the federal government. Income restrictions for eligibility vary by state and for adults, children, pregnant women, and people with disabilities. Some people qualify for both Medicaid and Medicare.

Medicaid expansion in Montana

Initially, Montana did not extend Medicaid, which meant there was no financial assistance available to people with incomes below the poverty level who did not qualify for Medicaid coverage under the state's existing guidelines. But in 2015, Governor Steve Bullock signed an expansion law, and on November 2, 2015, CMS approved the waiver of Montana's Medicaid expansion.

The state renewed funding for Medicaid expansion in 2019, but included a provision of work requirements. The labor requirements proposal is still awaiting federal approval starting in mid-2020 (and Medicaid work requirements are essentially on hold due to the COVID-19 pandemic and the widespread unemployment it has caused).

The state's average monthly Medicaid enrollment grew 66 percent from before the ACA in March, from 148,974 to 247,058. But it had been even higher in mid-2018, when the number of Montanans covered by Medicaid/CHIP reached 278,662.

Short-term health insurance in Montana

Montana refers to new federal rules for short-term health plans, with plans now authorized to have initial terms of up to 364 days and total duration, including renewals, up to 36 months.

Medicare Overview

Medicare covers people over the age of 65, some people with disabilities, and people with end-stage kidney disease (ESRD). Medicare terminology can be confused. Here are simple definitions of medicare options you may have heard of and visit the Medicare Resources website for detailed information.

● Medicare Part A covers hospital care.

● Medicare Part B covers medical services.

● Medicare Part D covers prescription drugs.

● Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for the services you receive. You can also purchase an additional Medicare policy (Medigap) and/or a standalone prescription drug plan.

● Medicare Part C, also called Medicare Advantage, covers parts A, B, and, D. Through Medicare Advantage, you can choose between one of the many private health plans in your state, and the federal government pays for the plan for the services you receive.

Medicare coverage and enrollment in Montana

As of May 2020, 234,867 Montana residents were enrolled in Medicare plans. Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare, and 18 percent did so in 2018 (a little below the national average of 34 percent). Of all Montana Medicare enrollees, about 51 percent have a self-prescription plan.

Montana Health Insurance Resources

● Web Healthcare.gov provides information on how to renew, modify, update, or cancel the exchange plan you are currently enrolled in

● First choice services (beneficiary of navigator 2019 grant in Montana)

● Montana Medicaid and Health Montana Kids (HMK) Plus

● Montana Medicare 101