Medicare in Montana: Everything You Need to Know

There are more than 227,000 beneficiaries enrolled in Montana Medicare. Some enrolled in Original Medicare, a stand-alone Medicare Advantage plan, or a Medicare Supplement or Part D plan alongside parts A and B. Your health is unique to you, and the benefits that you value will be different than your neighbor. Do you know which plan is best for you? 

Click below to learn more about Montana Medicare:

• What Does Montana Medicare Cover?
• Types of Montana Medicare Plans
• Montana Medicare Advantage Plans
• Montana Medicare Supplement Plans
• Medicare Part D in Montana
• Medicare in Montana Eligibility
• Cost of Medicare in Montana
• Can I Have Medicaid and Medicare in Montana?
• Additional Programs in Montana
• How to Apply for Medicare in Montana

What Does Montana Medicare Cover?

Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). Part A covers hospital stays, nursing homes, hospice, and home health services. Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and X-rays. Once you enroll in Original Medicare, you can start to explore other types of plans that offer additional benefits (like health and financial benefits, or prescription drug coverage).

Types of Montana Medicare Plans

There are four different types of Medicare plans in Montana. The federal government regulates Original Medicare (parts A and B), and it is the same regardless of which state you reside. Beyond Original Medicare, you can enroll in a stand-alone Medicare Advantage plan, or a Medicare Supplement or Part D plan alongside parts A and B. You can purchase these plans through private insurance companies, but plan availability varies based on your location.

Montana Medicare Advantage Plans

Medicare Advantage (MA)  plans offer the same coverage as Original Medicare, but can offer additional benefits that parts A and B do not include (like hearing, vision, dental, over-the-counter drugs, non-emergency transportation, and group fitness classes like Silver & Fit or SilverSneakers). MA plans are sold through private insurance companies but can be purchased through one of our licensed agents. To get started, click here or call 844-431-1832.

Montana Medicare Supplement Plans

Medicare Supplement (Medigap) plans work alongside Original Medicare. To be eligible, you must be enrolled in parts A and B. It’s important to understand that Medicare Supplements do not replace your Original Medicare coverage. Instead, Medigap plans add financial protection through a range of benefits. Depending on which plan you select, these benefits can include:

• Blood work copays (up to three pints)
• Foreign emergency travel
• Hospice coinsurance and copayments
• Part A coinsurance and hospital costs
• Part A deductible
• Part B coinsurance and copayments
• Part B deductible
• Part B excess charges
• Skilled nursing facility coinsurance

These benefits are offered in various combinations through ten different plans (A, B, C, D, F, G, K, L, M, and N). Generally, plans with more benefits have a higher premium while plans with fewer benefits have a lower premium. Plan N is a great example as it is one of the more comprehensive plans on the market. However, it will typically cost more than less comprehensive plans like Plan K. One of our licensed agents can help show you all of the available plans in your area. To get started, click here or call 844-431-1832.

Medicare Part D in Montana

Part D (prescription drug) plans work alongside your Original Medicare. When you purchase a Part D plan, you’ll need to meet your deductible before your coverage begins ($415 in 2019). Some plans will waive, reduce, or eliminate the deductible upfront. Once your coverage begins, you will be responsible for a copay per each drug you purchase. This will continue until you reach a spending limit of $3,820 in 2019. 

After this point, you will be in the “donut hole” where you will be responsible for 37% of generic drug costs and 25% of brand-name drug costs. (Don’t worry, the donut hole is going away in 2020.) You will be in the donut hole until you reach catastrophic coverage ($5,100 in spending for 2019). During this time you will only have to pay 5% of your drug costs for the remaining portion of the year.

Medicare in Montana Eligibility

Most people do not qualify for Medicare until they turn 65. However, there are a few exceptions.  If you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you can qualify for Medicare before your 65th birthday. Also, you’ll be automatically enrolled in Original Medicare if you have been receiving SSDI (Social Security Disability Insurance) for at least 24 months. To qualify for Medicare Advantage, Medicare Supplements, or Part D, you must enroll in Original Medicare first.

Cost of Medicare in Montana

The cost of Medicare in Montana will vary depending on which type of plan you choose. The cost of Original Medicare is the same across the United States. If you have worked for 40 or more quarters, you will not have to pay a monthly premium for Part A. If you have worked 30-39 quarters, you will have to pay $240 per month. For any amount worked less than 30 quarters, you will have to pay $437 per month. The Part B premium is based on your income rather than how long you worked. Most beneficiaries will pay $135.50 per month in 2019. The costs for Medicare Advantage, Medicare Supplements, or Part D plans vary based on carrier, location, and plan benefits.

Can I Have Medicaid and Medicare in Montana?

Medicaid and Medicare are two different programs, but it is possible to qualify for both. Medicare is designed for older adults over the age of 65 and people with specific disabilities, whereas Medicaid is designed for low-income families and individuals. If you qualify for both programs, you may be eligible for a Dual Special Needs Plan (DSNP). These plans provide extra benefits, lower costs, and a Special Enrollment Period (SEP). A SEP allows you to make changes to your coverage regardless of the time of year. This is a great perk because most beneficiaries can only make changes to their plan once per year, during the Annual Enrollment Period. 

If you qualify for a DSNP, you may also qualify for other cost-savings programs like Medicare’s prescription drug program, Extra Help, or other Medicare Savings Programs. Extra Help can help you save more than $4,000 per year, and Medicare Savings Programs help cover other Medicare-related costs like premiums, deductibles, copayments, and coinsurance.

Additional Programs in Montana

Several programs throughout Montana help older adults and disabled individuals maintain their health, independence, and comfort. These programs include:

Community Services: The Community Services Program is designed to help people live independently in their community as long as possible through home health and hospice services.

Healthy Living: The Healthy Living Program is designed to maintain good health for those who are aging. The program includes health and fitness classes, mental and emotional support, and nutrition assistance.

Home Living: The Home Living Program is designed to help older adults live comfortably at home as long as possible through help with household tasks and personal care.

Legal Services: The Legal Services Program provides information regarding elder law, legal service referrals, and legal advice for older adults who may fall victim to exploitation or abuse.

Financial Planning: The Financial Planning Program helps older adults nearing retirement start planning a budget for a new fixed income along with other tools needed during retirement.

How to Apply for Medicare in Montana

You can sign up for Original Medicare through your Social Security office. Visit their website (www.socialsecurity.gov), give them a call (1-800-772-1213), or visit your local office. Once you enroll in parts A and B, you can schedule an appointment with a licensed agent to start exploring Medicare Advantage, Medicare Supplements, and Part D plans in your area. Click here or call 844-431-1832.