Medicare Advantage is a type of health insurance program offered to seniors over the age of 65. This program, also known as Medicare Part C or MA, is an offshoot of the federal Medicare program and offers coverage through private health insurance providers. Original Medicare, or Parts A and B, is run entirely through the federal government and each beneficiary receives the same coverage. With Medicare Advantage, recipients can choose from a wide range of plans with different coverage options and premiums. Similar to health care plans offered through employers, Medicare Advantage offers seniors the option to add coverage that may not be offered in Parts A and B, such as prescription drug, dental and vision coverage.
On a national level, Medicare Advantage has doubled in popularity over the last decade. As of 2020, around 39% of all Medicare beneficiaries are enrolled in Part C, but the program’s popularity varies greatly by state and county. About 20% of Medicare recipients in Montana use Advantage plans, which is roughly on par with its neighboring states. Idaho has far greater participation, with 36% of all Medicare users enrolled in Part C. Wyoming, on the other hand, has far lower enrollment at just 3%. North and South Dakota are comparable to Montana with 19% and 22% Medicare Advantage enrollment, respectively. The popularity of Medicare Advantage varies greatly across Montana’s 56 counties, ranging from less than 1% to over 30%.
Montanans over 65 can choose from several Medicare Advantage plan types, including HMO, MSA, PPO and PFFS plans. MA-SNP plans are also available in at least one county. In this guide, we’ll break down the differences between each type of Medicare Advantage plan offered in Montana and explain how prescription drug coverage works for Part C beneficiaries. We’ll also cover enrollment and eligibility requirements for Medicare Advantage in Montana and spotlight some of the key resources available to seniors who need help enrolling, switching to an Advantage plan or managing a current plan.
Before choosing Part C over the other forms of Medicare, it’s important to understand the types of plans that are available. There are five different forms of Medicare Advantage plans offered in Montana: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), Medical Savings Accounts (MSAs) and Private Fee-For-Service (PFFS) plans. Some of these plans, including HMOs and MSAs, are common in Montana while others, such as SNPs, are harder to find.
Health Maintenance Organizations (HMO)
HMOs are a lower-cost option when compared with other Medicare Advantage plans, but they have a few limitations. Most of these plans use a network system and require referrals from primary care physicians to see specialists. Beneficiaries usually incur the full out-of-pocket expense for any care received outside their network. However, HMOs can be a good choice for users with minimal health care needs who don’t plan to travel regularly outside their network.
Preferred Provider Organizations (PPO)
Like HMOs, PPOs provide coverage within a network of doctors, hospitals and other health care providers. However, PPOs also offer members the option to use out-of-network care providers at an increased cost. Beneficiaries pay the lowest co-pay and coinsurance rates on in-network doctors, and PPO plans typically offer some coverage for out-of-network providers. Additionally, PPO plan members often have more flexibility to visit specialists without a referral. While these plans are usually more expensive, they can work well for those seeking more freedom in a plan.
Special Needs Plans (SNP)
SNPs are designed for beneficiaries with specific health needs, including chronic illnesses and disabilities. For these plans, insurance companies and care providers work hand-in-hand to develop a coverage plan tailored to the beneficiary. Enrollment in SNPs is limited to those with special needs, and these plans can be subject to more strict networks than other plans, such as HMOs and PPOs. Referrals are required for specialist visits in most cases.
Medical Savings Accounts (MSA)
With MSA plans, users get a combination of a high-deductible Medicare Advantage plan and a savings account used to pay for medical expenses. These plans are similar to health savings account plans found outside the Medicare system, but they include all of the coverage options available through Original Medicare. Depending on the plan, Medicare Advantage deposits a certain amount of money into the savings account each year. If a beneficiary uses all the money, they are responsible for all medical costs until they have reached the yearly deductible.
Private Fee-For-Service (PFFS)
Medicare Advantage PFFS plans are a good option for beneficiaries who need added flexibility. With these plans, the private insurers administering the plan determine co-pay and coinsurance levels when the care is provided. PFFS plans usually allow users to receive care from any provider nationwide, as long as the provider agrees to accept the plan’s payment terms. Referrals are not usually required to see a specialist with PFFS plans, and most beneficiaries are not required to list a primary care physician.
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
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.
Most Medicare Advantage plans in Montana cover everything in Original Medicare, as well as prescription drugs offered through Medicare Part D. Those who already have a drug plan outside of Medicare may be able to save some money by choosing nonprescription Advantage plans. Additionally, seniors who only need prescription drug coverage can enroll in Medicare Part D plans, instead of Medicare Advantage.
The state requires all Medicare users to have some form of prescription drug coverage, such as an Advantage plan including drugs, a standalone Medicare Part D plan or non-Medicare plans that qualify for a Part D credit. Examples of plans that may qualify for a Part D credit include VA and IHS prescription plans. Those who fail to enroll in a prescription drug plan when eligible will be assessed a penalty of 1% of their Medicare premium per month for every month delayed.
Medicare Advantage plans can be an ideal option for seniors who want to enroll in Medicare but need more flexibility or coverage that isn’t included in Original Medicare. While this program opens a wide range of insurance options, the various forms of Medicare Advantage can feel overwhelming to those enrolling for the first time or shopping for a new plan. Fortunately, there are many valuable resources in Montana that can help seniors navigate the enrollment process and find a Medicare Advantage plan that fits their needs.
Overseen by Montana’s Aging Services Bureau, the state’s 10 Area Agencies on Aging (AAAs) offer a diverse mix of resources to seniors. These agencies are located statewide and serve senior Montanans in their local communities. Accessible rides, delivered home meals, health and wellness initiatives and senior center amenities are just a few programs managed by AAAs statewide. These agencies also serve as coordinating hubs for several of the state’s Medicare assistance programs. In-person and remote counseling is available through Montana AAA locations, and seniors who want to learn more about the various Medicare assistance programs can call the program’s central contact number. The agencies are run by a combination of private, public and nonprofit organizations, and Medicare assistance is offered for free to anyone who qualifies.
Montana’s State Health Insurance Assistance Program (SHIP) is an independent service that offers counseling and advice to Medicare beneficiaries or their families and caregivers. The services available through Montana’s SHIP are completely free and facilitated by the state’s many Area Agencies on Aging. SHIP guides Montana seniors through every phase of the Medicare program, from plan choice to enrollment and management. Counseling sessions are available in-person or over the phone. This program is funded by the state’s Administration on Community Living without any money from the insurance industry, so the advice offered is objective and unbiased. Seniors who contact SHIP are paired with a dedicated counselor who has been specially trained to understand the ins and outs of Medicare eligibility, plan choices and benefits. SHIP counselors can also help with long-term care planning and educate seniors on how to avoid Medicare fraud, abuse and waste.
Seniors can call SHIP’s main contact center at 1-800-551-3191 to set up a telephone counseling session or arrange an in-person meeting with their local AAA.
Montana Senior Medicare Patrol (SMP) is a volunteer-based organization in which seniors help other seniors become educated Medicare consumers. This program focuses on helping seniors spot errors in their medical bills, instances of Medicare fraud and other forms of abuse. Through extensive community outreach, including community presentations and one-on-one sessions, SMP volunteers teach their peers how to compare Medicare Summary Notices with other medical bills to identify irregularities. If seniors notice discrepancies or suspect any form of Medicare fraud, SMP can help correct the problem or make a referral to the appropriate authorities. This peer-to-peer service is free of charge and open to any Montanans who receive Medicare benefits, as well as those who will qualify in the near future. SMP services are available statewide, and there are active volunteers in 44 counties.
Montana SMP is headquartered at the Missoula Aging Service Center. Seniors can get more information by contacting the program’s manager Renee Labrie-Shanks at 1-406-728-7682 or by email at [email protected]. Seniors can also get information about how to connect with SMP volunteers in their area by calling the Montana AAA hotline at 1-800-551-3191.Email
The Office of the Montana State Commissioner of Securities and Insurance (CSI) is the watchdog agency that helps securities and insurance consumers within the state. This agency conducts examinations of the insurance marketplace, issues forms, responds to policyholder inquiries and reviews rates of insurance products that enter or change in the state. CSI also offers a deep knowledge base regarding the legalities of Medicare and other insurance within Montana. The office produced a free guide for seniors, which offers helpful tips on getting approved for Medicare, working past the age of 65 and obtaining supplemental coverage. CSI can also help seniors file insurance complaints and fraud reports and help them find legal support specializing in insurance and securities.
Seniors can contact CSI by visiting their office at 840 Helena Avenue in Helena during regular business hours. Many CSI services, including forms, complaint submissions and information, are available at the office’s website. General information is available by calling 1-800-332-6148 or 1-406-444-2040.
Missoula Aging Services is the leading senior advocacy resource in Missoula and Ravalli Counties. Serving as the state’s Area VII AAA, this resource promotes senior independence and well-being through a range of services, including meals on wheels, social programming, nutrition programming and respite care for caregivers. Missoula Aging Services is the home base of the Senior Medicare Patrol and also offers classes and workshops for community members who are new to Medicare. A resource center within this organization coordinates referrals and information about health care services. Staff at the resource center helped area seniors save a combined $531,285 in Medicare prescription drug plans, homeowner/renter tax credits and Medicare savings accounts in 2019. This robust resource center has an operating budget of over $4 million and a staff of 56 staff members dedicated to senior advocacy.
The Adult Resource Alliance of Yellowstone County (formerly the Yellowstone County Council on Aging) has been serving seniors in Billings and the surrounding areas since 1975. This facility’s goal is to help Montana’s senior population stay active, independent and informed with a range of services, such as transportation, senior meals and social programming. While the Alliance’s stated mission is to serve Yellowstone County residents over 60, family members and caretakers may also benefit from the facility’s resource center. Medicare counseling services are available free of charge through the resource center, and the staff is trained to help with affordable housing, long-term support and financial assistance. Specialized support is available for seniors who are about to turn 65 and are considering their many options with Medicare.
With locations in Billings and Billings Heights, Adult Resource Alliance of Yellowstone County offers a flexible schedule for in-person counseling. Appointments can be made by calling 1-406-794-0083, and general information is available at 1-406-259-9666. Staff can also answer questions via email at [email protected].Email
The Bozeman Senior Center is a nonprofit organization focusing on support services for adults over 50 in southwest Montana. The Center has locations in Manhattan, Three Forks and Yellowstone. The senior center offers information about Medicare through the resources portal on its website. There, visitors can find a mix of helpful articles about health care and financial planning, as well as links to various state and local agencies on aging and health.
The Belmont Senior Center in Butte offers counseling through Montana’s SHIP program with a focus on Medicare Part D prescription drug plans. General counseling and advice about Medicare are also available with help from the facility’s senior care advocates and case managers. The Belmont Senior Center focuses on helping seniors stay fit and find the right insurance plan. Health screenings are offered regularly at the center and free transportation is available to off-site medical appointments.