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Medicare in Montana

October 6, 2016

Medicare, the government-sponsored insurance program, offers health coverage to people 65 and over and those with certain disabilities or conditions. If you’re a Medicare beneficiary in Montana, you may opt to receive your benefits under Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You may also choose to sign up for a Medicare Advantage (Medicare Part C) private health insurance plan and/or a Medicare Part D Prescription Drug Plan.

Original Medicare for Montana beneficiaries

You’re eligible to enroll in Original Medicare, Part A and/or Part B, in Montana during the following enrollment periods:

  • Initial Enrollment Period: Your Initial Enrollment Period begins three months before you turn 65, includes your birthday month, and ends three months after that month. Certain individuals may be eligible for Medicare coverage before age 65 if they have end-stage renal disease or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), or if they’ve received disability benefits for at least 24 months. If you miss your Initial Enrollment Period, you may have to pay a late-enrollment penalty in the form of higher monthly premiums.
  • General Enrollment Period: The General Enrollment Period runs from January 1 to March 31 each year. If you enroll in Medicare during the General Enrollment Period, the effective date of your coverage will be July 1 of the year you enroll. Even though you may sign up for Medicare during the General Enrollment Period, generally you will have to pay a late enrollment penalty—that is, a higher premium for late enrollment in Part A and/or Part B.
  • Special Enrollment Period: If you have group health coverage through an employer or union through your employment or your spouse’s, you may delay your enrollment in Medicare Part A and/or Medicare Part B without incurring a penalty. You may then enroll in Medicare during a Special Enrollment Period when your group health coverage ends.

In general, enrollment in Medicare Part A (hospital insurance) is premium-free for Montana residents, although some individuals may have to pay a monthly premium based upon their income. Benefits under Medicare Part A in Montana (as elsewhere in the United States) include, but are not limited to, the following:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health services

Medicare Part B, which is medical insurance, has a monthly premium. If your annual income is above a certain limit set by Medicare, you may have to pay a higher monthly premium. In Montana, as elsewhere, Medicare Part B includes coverage for preventive health care services and medically necessary services, such as:

  • Outpatient doctor’s office visits
  • Outpatient laboratory services and x-rays
  • Ambulance services
  • Durable medical equipment
  • Mental health services
  • Getting a second opinion before surgery

You’re eligible for Medicare in Montana if:

  • You’re 65 or older, and
  • You’re a US citizen or permanent legal resident of at least five continuous years, or
  • You receive disability benefits, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, if they’re collecting disability benefits after 25 months from the Social Security Administration (SSA) or the Railroad Retirement Board.

You can apply for Medicare through the SSA. If you’re applying for retirement benefits, you can enroll in Medicare at the same time. In Montana, you can apply:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use the application located on this site.
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To look up office locations in Montana, click here.

Medicare private insurance options in Montana

You may choose to receive your Medicare benefits in Montana through a Medicare Advantage plan (Medicare Part C), which is provided by private insurance companies approved by Medicare. A Medicare Advantage plan in Montana, as in the rest of the United States, is required by the government to offer at least the same medical and hospitalization coverage as Original Medicare, Part A and Part B (except hospice care, which continues to be covered under Part A). Some Medicare Advantage plans also offer extra coverage not available under Original Medicare, like hearing, vision, or dental benefits, so be sure to compare all Medicare Advantage plans available where you live in Montana to find the plan that best fits your individual health needs.

If you’re eligible for Original Medicare, Part A and Part B, and want to receive Medicare prescription drug coverage (Medicare Part D), you may enroll in a stand-alone Medicare Part D Prescription Drug Plan. Costs for Medicare Part D prescription Drug Plans in Montana vary, as they do in the rest of the United States, generally depending on the kind of the coverage you choose. Additional Medicare choices in Montana include Medicare Advantage Prescription Drug plans, which combine health and prescription drug coverage in a single plan.

It’s important for you to remember that even if you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you’re still required to continue paying your Medicare Part B premium to keep your coverage. You may also have a premium for your Medicare Advantage plan.

If you decide to stay with Original Medicare Part A and Part B for your coverage but also want help paying for Medicare-related costs, you may want to consider joining a Medicare Supplement (Medigap) plan available in Montana. Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered by Medicare Part A and Part B.  Medicare Supplement plans offer different standardized benefits (usually identified by a letter—A, B, C, etc.) and the cost to buy a Medicare Supplement plan varies by the coverage type and the insurance company you choose.  You can add a Medicare Prescription Drug Plan to your Medicare Part A and Part B and Medicare Supplement insurance to have Medicare prescription drug benefits.  You cannot have a Medicare Supplement plan if you enroll in a Medicare Advantage plan.

Your Medicare coverage options in Montana will generally depend on the county in which you live. For example, residents of Billings in Yellowstone County may have different Medicare plan offerings than residents of Helena in Lewis and Clark County. With the various Medicare insurance plan options available in Montana, it’s important to customize your search for plans based on your personal health and budget needs.

Montana resources for Medicare beneficiaries

There are a number of resources designed to help Medicare beneficiaries in Montana with Medicare-related issues and concerns. Here are some of the resources from Medicare.gov that may be helpful to you:

  • American Cancer Society, 1-800-227-2345, 24 hours per day/7 days per week. 1903 Central Ave., Billings, MT 59102, http://www.cancer.org
  • Primary Care Association, 1-406-442-2750, Monday – Friday, 8:30 AM – 4:30 PM, MT, 1805 Euclid Ave., Helena, MT 59601, www.mtpca.org
  • State Health Insurance Assistance Program (SHIP), 1-800-551-3191, Monday – Friday, 8:30 AM – 4:30 PM, MT, mt.gov
  • State Hospice Organization, 1-800-351-3551, Monday – Friday, 8:00 AM – 5:00 PM, MT, 2625 Winne Ave., Helena, MT 59601, http://www.mtha.org
  • State Medical Assistance Office, 1-800-362-8312, Monday – Friday, 8:00 AM – 5:00 PM, MT, mt.gov

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.