Medicare in Montana

Medicare is a federal health insurance program providing access to health care for those aged 65 or older as well as individuals with certain disabilities. Original Medicare, or Part A, covers inpatient care services and some elements of home health care. Part B coverage relates to preventative care and outpatient services. Part D provides coverage for prescription medications. Private health insurance providers may offer a Part C Medicare plan known as Medicare Advantage, which adds coverage for eye care and other things not covered by Original Medicare. Seniors who are enrolled in Original Medicare can add supplemental coverage to offset costs not covered by Parts A and B. Those who are enrolled in Medicare Advantage Plans do not typically need additional supplemental coverage.

As of 2023, a total of 69,957 people in Montana are enrolled in Medicare Advantage, out of 254,791 who are eligible, for an enrollment rate of 27%. This is relatively poor compared to the nationwide Medicare Advantage enrollment rate of 48%. Adoption of Medicare Advantage is increasing, with enrollment in plans for 2023 having increased by 12.43% compared to 2022. The state spends about $1.6 billion per year on Medicare Part A and B, making their costs a small portion of the $395 billion spent nationwide.

Most people who are eligible for Medicare in Montana have enrolled in some form of plan. As of 2023, there are 247,799 individuals enrolled in the basic Medicare program. Falling prices for Medicare Advantage may encourage more people to consider choosing one of these plans. In 2022, the average monthly premium for Medicare Advantage was $29.28, and this fell to $23,06 in 2023, a drop of just over 21%.

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 includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care within the United states. Part B pays for other medically necessary items such as durable medical equipment and emergency medical transportation. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,699 for Part A and $226 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 has approximately 70,000 people enrolled in Medicare Advantage Plans as of 2023. Private plans cover all benefits as Original Medicare except for hospice care, which Part A still covers. Most Advantage Plans include drug coverage, plus vision and/or dental coverage. 

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, co-pays 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 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 August 2023. 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 2023 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.