Medicare in Montana

Medicare is the federally run health insurance program for people aged 65 and older and individuals with specific disabilities. As of 2020, more than 235,000 people in Montana receive Medicare, representing almost 22% of the state’s total population. Of the state’s Medicare beneficiaries, it enrolled more than 189,000 in Original Medicare, and more than 46,000 people have Medicare Advantage. In 2019, Montana’s Medicare spend was in excess of $1.5 billion, up approximately $1 million compared with the previous year. On average, the state spent $8,387 per enrollee in 2019.

Original Medicare Part A covers expenses related to care inpatient care in a hospital, nursing home and skilled nursing facility care, hospice care and aspects of home health care. Part A Medicare coverage is free for those who paid, or whose spouse paid, Medicare taxes for a set period. Part B Medicare provides coverage for preventative services and other outpatient medical services and supplies.. As of 2022, the standard premium for Part B Medicare is $170.10.

There are also private plans that provide tailored coverage. Private health insurance companies offer Medicare Advantage plans, also known as Part C Medicare, which include the same benefits as Parts A and B, excluding hospice care. Such plans typically provide supplementary coverage for expenses such as prescription drugs and eye care. 

Part D provides coverage for prescription medications; it can add prescription drug coverage to Original Medicare, some Medicare Cost plans and some Medicare Advantage plans. There are also Medicare supplement plans, known as Medigap, provided by private health insurance companies to minimize costs incurred by Original Medicare policyholders. Those enrolled in Medicare Advantage plans do not need and can’t buy Medigap. 

This guide details Medicare in Montana, with an overview of Medicare plans available in the state and resources geared toward helping individuals understand their options to make informed decisions about health insurance.

Options for Medicare Coverage in Montana

Although Original Medicare provides basic coverage suitable for many seniors, there are times when it’s not adequate for certain individuals. Older adults in Montana have various options for obtaining the best health care insurance policy to meet their needs. As well as the standard federally administered program, private health insurance companies offer alternative policies or extra options for seniors.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage plans, also referred to as Part C Medicare, provide customizable options for health care insurance. Montana enrolled approximately 46,100 people in Medicare Advantage plans in 2020. Private plans cover all benefits as Original Medicare except for hospice care, which Part A still covers. Most Advantage plans include drug coverage (Part D). Seniors with these plans don’t need a separate Part D. Plans may include additional benefits, such as dental and vision care, over-the-counter drugs, home safety devices and telehealth services. Many Medicare Advantage plans have annual caps on personal expenditure, which can help seniors budget for their medical costs.

The four most common types of Medicare Advantage plans are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service Plans (PFFs) and Special Needs Plans (SNPs). Eligibility criteria and costs vary between plans, including premiums, copays and deductibles.

Who Should Consider Medicare Advantage

Medicare Advantage plans may be suitable for individuals who:

• Require benefits above those provided by Original Medicare
• Want greater predictability related to medical expenses
• Feel comfortable receiving managed care

• Are generally healthy, so may benefit from lower premiums

• Would benefit from lower premiums and are usually in fairly good health 

The Top 10 Medicare Advantage Plans in Montana 

Montana seniors can choose between several Medicare Advantage plans, as detailed in the following table. The table shows the total number of people enrolled in each plan and the star rating for each provider. It shows the types of plans, such as local PPOs and HMOs, offered by providers and details typical monthly costs, accurate as of May 2022. The Medicare Advantage Plans in Montana page provides further information on Medicare Part C plans.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Montana

Although understanding the diverse Medicare and private health insurance options can be challenging, seniors in Montana have several avenues for obtaining assistance. The following resources can provide personalized counseling to help beneficiaries make informed decisions and get the most suitable coverage for their needs. Advisors may also assist with enrolling for plans, understanding costs, and gathering information about local Medigap and Medicare Part C plans.