Medicare Advantage in Montana

Medicare provides comprehensive health coverage for tens of millions of eligible American seniors nationwide. Original Medicare, the basic federal plan, splits coverage between the inpatient plan, known as Part A, and the outpatient services plan, known as Part B. A prescription drug benefit, known as Part D, is also available for beneficiaries who opt into the plan. Part C, which is more formally known as Medicare Advantage, is not part of Original Medicare but is an alternative way to get benefits.

Medicare Advantage Plans are offered by private insurance companies, with much of their cost covered by participants’ own Medicare benefits. By law, Medicare Advantage Plans are required to include all the same coverage as Original Medicare Parts A and B, but they’re not limited just to these benefits. For a single monthly premium, many Part C plans fold together inpatient and outpatient services, plus some prescription drug benefits and even a few extras, such as dental or hearing and vision services.

Enrollment in Medicare Advantage has increased in Montana by nearly 9% from 2022 to 2023. During the same period, national participation in Medicare Advantage went up by just 7%, which suggests more interest in the benefits Part C offers in Montana than is the norm nationwide. Seniors who sign up for a Medicare Advantage Plan have a generally wider choice of how their benefits are structured, they may have lower monthly premiums than with original Medicare, and the private insurance company managing their plan for them might offer a more convenient and easily navigated system. 

This guide takes a look at the top Medicare Advantage Plans available in Montana. Unlike the federal Medicare program, Medicare Advantage is issued only within states by authorized providers, so there’s a lot of regional variation in the rules that govern specific plans. The information offered here is meant to help seniors and their families find and apply for the right Medicare plan for them and for their unique situation.

The Top Medicare Advantage Plans in Montana

While enrollment in Medicare Advantage has been going up in Montana, the number of plans available on the market has been going down. In 2022, seven Part C plans were available for older adults in Montana to choose from. By 2023, the total number of providers had dropped to just four. Those four providers still offer a wide range of plan structures, from PPO to HMO and PFFS, each with at least one $0 premium option seniors can choose. The table below lists the top Medicare Advantage providers in Montana, along with enrollment figures, premium costs and consumer star ratings.

How Medicare Advantage Plans Work in Montana

The four main types of Medicare Advantage Plans in Montana are health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS) and special needs plan (SNP). Each one varies in price and differs when it comes to the referral requirements and the network of physicians that is available to you as an enrollee. An insurer may also offer more than one plan type. 

You can compare and contrast the four plan types below. 

What Medicare Advantage Plans Cover in Montana

Medicare Advantage plans cover the same services as Original Medicare, excluding hospice care which remains covered under Medicare Part A. This includes services like preventative screenings, hospital care and durable medical equipment such as wheelchairs and other mobility devices.

Medicare Advantage plan providers can also choose to offer additional benefits like dental, vision, hearing aids and prescription drug coverage. These extra benefits vary by plan, so carefully review your plan documents to find out exactly what extra benefits are available to you. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Montana

In the state of Montana, anyone who’s eligible for Medicare Parts A and B can enroll in Medicare Advantage. However, you’ll need to be enrolled in Original Medicare before you can enroll in Medicare Advantage, 

Some Medicare Advantage plans have additional eligibility requirements. For example, Medicare Special Needs Plans (SNP) are only available to seniors with specific diseases or chronic conditions. 

You can only enroll in Medicare Advantage during specific enrollment periods. It’s important to keep these in mind when considering Medicare Advantage because you can’t enroll or change plans once the enrollment period is over. Medicare Advantage enrollment periods include:

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Montana

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources