Medicare Advantage (Medicare Part C) in Montana lets you receive most of your Medicare health benefits through a private insurance plan contracted with Medicare, rather than through Original Medicare, Part A and Part B, which is administered by the federal government. Medicare Part C may be a good option if you want more extensive coverage than what’s provided under Original Medicare. The specific benefits under Medicare Advantage plans in Montana will vary depending upon where you live and which Medicare Advantage plan you choose. Not all Medicare Advantage plans may be available in every county of Montana.
How Medicare Advantage plans work in Montana
Medicare Advantage plans in Montana are required by the government to offer at least the same medical and hospitalization benefits as Original Medicare, Part A and Part B. In Montana, as in the rest of the United States, many Medicare Advantage plans offer additional benefits, like routine vision, hearing, dental, and prescription drug coverage.
You must have Original Medicare, Part A and Part B, to sign up for a Medicare Advantage plan in Montana. You can enroll in Original Medicare during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. Failure to enroll in Medicare during your Initial Enrollment Period may result in a late-enrollment penalty, which translates into higher premiums for as long as you remain enrolled in Medicare. If you miss your Initial Enrollment Period, you can still enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late-enrollment penalty. You may also be eligible for a Special Enrollment Period –for example if you had group health insurance coverage when you first become eligible for Medicare– and not be subject to a late-enrollment penalty.
If you want to switch Medicare Advantage plans, you can do so during the Annual Election Period, which runs from October 15 to December 7, in Montana and the rest of the United States. Your new coverage goes into effect on January 1 of the following year. You may also switch Medicare Advantage plans in Montana during Special Enrollment Periods, if you experience certain events including, but not limited to, moving to a new address where your old plan may not be available, losing your current coverage, or undergoing changes in your current plan that affect your health benefits. Special Enrollment Periods vary depending on the reason you want to switch plans and on the particular health plan you choose.
Medicare beneficiaries enrolled in a Medicare Advantage plan in Montana who want to switch back to Original Medicare, Part A and Part B, may do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year, During this period you also can add a stand-alone Part D Prescription Drug Plan go alongside your Original Medicare or switch to another Medicare Advantage plan.
Types of Medicare Advantage plans in Montana
Take a look at the main types of Medicare Advantage plans available in Montana in order to choose the one that suits you best:
- Health Maintenance Organization (HMO): An HMO plan may require you to visit doctors, health-care providers, and hospitals included in your plan’s network except in the case of an emergency. In addition, you may have to get a referral from your primary doctor to receive coverage for a number of health services.
- HMO Point-of-Service: A more flexible option that an HMO, an HMO-POS plan allows you to sometimes go out of network for some health services, but generally at a higher out-of-pocket cost.
- Preferred Provider Organization (PPO)*: A PPO plan offers even more flexibility than an HMO-POS plan, allowing you to choose doctors, other health-care providers, and hospitals outside of your plan’s network, but at a higher out-of-pocket cost and subject to the provider’s willingness to provide non-emergency care to you.
- Private Fee-for-Service (PFFS): A PFFS plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, as well as your share of each expense.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account, allowing you to use the savings account to pay for your health-care expenses.
- Medicare Special Needs Plan (SNP): A Medicare SNP is type of plan for people with particular health needs, offering coverage tailored to suit those specific needs. Medicare SNPs include plans for people with certain chronic conditions, those who live in institutions (like nursing homes), and people who are eligible for both Medicare and Medicaid.
- Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage (available under Medicare Part D) into a single insurance plan.
Remember: you must continue paying your Medicare Part B premium to retain your health coverage if you enroll in a Medicare Advantage plan.
Comparing Medicare Advantage plans available in Montana
As a Medicare beneficiary in Montana, you may find it useful to compare the various Medicare Advantage plans available in your area.
The availability of Medicare Advantage plans typically varies depending on where you reside in Montana and the amount of coverage provided by the Medicare Advantage plan. Also, you may find that the premiums of Medicare Advantage plans that offer the same benefit coverage vary. Some Medicare Advantage plans in Montana may offer premiums as low as $0, for example. Always keep in mind, however, that you have to continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you select, to retain your Medicare insurance coverage.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage best meets your health care and coverage needs. For instance, Medicare prescription drug coverage is one important consideration. You may be able to choose a Medicare Advantage Prescription Drug plan (MAPD) that combines health and prescription drug benefits. If you choose a Medicare Advantage plan that does not offer prescription drug benefits, however, you may be able to select a stand-alone Medicare Part D Prescription Drug Plan to provide these benefits. Medicare plans that provide prescription drug coverage typically have formularies or lists of covered medications. The formulary may change at any time, but you will receive notice from your plan when necessary.
With all these Medicare insurance options, you can understand why it may be smart to compare each Medicare Advantage plan in Montana to determine which one offers benefits and costs that best suit your individual needs.
To start comparing Medicare Advantage plans in Montana today, enter your zip code in the eHealth plan finder on this page for a customized list of plans available in your area. You can also enter your prescription drugs to further customize your search and cost estimates.
To get more details about Medicare in Montana, see the following pages:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.