Do you qualify for Montana Medicaid? One out of every six adults and four out of every nine children in Montana are Medicaid members. Generally, you can qualify by earning less than 138% of the Federal Poverty Level, which in 2019 is about $17,236 for a single person and $35,535 for a family of four. This guide explains who is eligible for what benefits and how to apply.
The MT Medicaid program includes comprehensive benefits like doctor and hospital visits, family planning, emergency services, mental health, prescription drugs, rehabilitation, transportation to medical appointments, dental, and vision.
Some MT Medicaid members will be responsible for copayments for certain services. If you have an annual income below 100% of the Federal Poverty Level (FPL), you may owe up to $4 for outpatient services, up to $75 for inpatient services, $4 for preferred brand-name drugs, and $8 for non-preferred brand-name drugs. If your income is at or above 100% of the FPL, you may owe up to 10% for any services you receive, plus $4 for preferred brand-name drugs and $8 for non-preferred brand-name drugs.
You will ever be asked to pay copayments valuing more than 5% of your household income. Some services will never require a copayment, like screenings, emergency room treatment, transportation, glasses, family planning, hospice, preventative care, and generic drugs. Additionally, those who are under 21, in a care facility or hospice, pregnant, under the breast/cervical cancer waiver, or an American Indian/Alaska native will not owe copayments.
Adults with Montana Medicaid will face a $1,125 cap each year for dental treatment but can have dental exams and cleanings every six months. Adults can get partial dentures every five years and full dentures every ten years. Members under the age of 20 can get dental exams and cleanings as often as medically necessary. Adult members will not have coverage for porcelain or ceramic crowns, noble metal crowns, brides, splints/mouth guards, implants, or orthodontics. Members will be responsible for no-show appointments.
Adults will have coverage for one eye exam and one pair of glasses every 24 months, and those under 20 will have coverage for one exam and one pair of glasses every 12 months. More coverage may be provided if it is absolutely medically necessary, like in the case of eye diseases. Eyeglasses are only covered when chosen through Classic Optical Laboratories, Inc.
Prescription Drug Coverage Explained
Doctors who work with Medicaid patients should know that every state Medicaid program has a preferred drug list. Doctors are instructed to prescribe preferred drugs (especially generic drugs) to patients. If for some reason your doctor cannot find a generic and preferred drug for your needs, your doctor will need to ask the Medicaid program for authorization before prescribing you a non-preferred drug.
Walk with Ease Program and other Chronic Disease Management Programs
The Arthritis Foundation hosts the WWE (Walk with Ease) program for individuals with arthritis. Participants meet three times per week for six weeks, beginning with a pre-walk discussion about arthritis recovery and ending with a 10-40 minute walk. Additionally, through the Arthritis Foundation Exercise Program in Montana, trained instructors can help people with arthritis recover their range-of-motion and rebuild endurance as well as practice relaxation techniques and learn more about their diagnosis. Classes typically meet two or three times per week for eight weeks.
Members with arthritis and other chronic diseases can also participate in a wellness workshop called the wCDSMP (Worksite Chronic Disease Self Management Program). wCDSMP participants meet twice per week for six weeks to learn how to increase and improve communication and physical activity while decreasing fatigue levels. Participants learn how to get back into the workforce while working through their chronic illnesses.
The Enhance Fitness program helps older adults at all fitness levels become more active and energized. Trained instructors will walk you through strength, balance, and flexibility training for a full 16 weeks.
The Montana Living Life Well Program provides healthy living incentives to Montana Medicaid members. Some of the benefits include:
Prizes for participants in the sprint Stay Active program, the Summer Challenge, and the Holiday Challenge.
The Medicaid CHIP (Children’s Health Insurance Program) in Montana is called Healthy Montana Kids, or HMK. HMK offers free or low-cost health insurance to eligible Montana children ages 19 and under. The benefits are administered through the BCBS of Montana network, with the exception of qualified rural health clinics, community-based psychiatric services, and other federally qualified health centers. HMK includes medical benefits similar to those of the adult program as well as dental, vision, and prescription drugs.
The Montana HELP Plan was the Medicaid expansion program that started in 2015 for people who need financial assistance for healthcare but do not qualify for the regular Medicaid program. Anyone who was receiving HELP benefits will now receive care through Montana Medicaid. However, members who qualify for HELP (but not MT Medicaid) will still owe premiums and copayments that regular Medicaid members may not owe. Your copayments will never total more than 5% of your income.
The Montana “Passport to Health” is a case management program for Medicaid members. Members will have the option to select a Passport provider; if you do not select one, you will be assigned one. Your provider can be just about any doctor in Montana, as long as they accept Medicaid. In most cases, the doctor you select will be your primary healthcare provider and will have to provide a referral so that you can see specialists and other providers. You can select or change your Passport provider at medicaid.mt.gov by selecting “Choose Your Passport Provider.”
MT Medicaid eligibility is largely based on your income compared to your family size based on the chart below. These numbers are subject to change every year.
The easiest way to apply for Montana Medicaid is through the online application. You can also call HealthCare.gov at 1-800-318-2596 to apply or order a paper application. You can either deliver your printed application to the Office of Public Assistance closest to you, or you can mail it into the address on the application.
If you qualify for both programs, you can get both Medicare and Medicaid in Montana. Medicare is not only for those over the age of 65 - you can also qualify if you receive disability benefits for 25+ months or if you are diagnosed with either ALS or ESRD. If you are eligible for both programs, you can enroll in a Dual-Eligible Medicare Advantage Special Needs Plan (DSNP). A DSNP includes both your Medicare and Medicaid benefits at little or no cost to you.
To speak to an insurance agent about how to enroll in the best plan for your needs, click here or give us a call at 833-438-3676. Our agents are licensed with all of the major carriers, so there is never any bias or any obligation to buy.
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