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Montana Health Insurance

The state of Montana has several health insurance companies that offer various plans to fit your personal lifestyle and needs. Therefore, it is important to do enough research and comparing to find that plan that is best for you. Today in Montana, the number of uninsured has reached 122,158 which are approximately 22% of the population. In the six year period from 2000-2006, the price of family health insurance coverage increased 70.2% and individual health coverage increased 60%.www.statehealthfacts.org

In Montana, medical underwriting is allowed without restriction. There is a 36 month look back and 24 month exclusionary period for preexisting conditions. The state allows health insurance companies to turn people down for individual health insurance coverage based on the status of your health. You can, however, never be turned down for health insurance that is offered through an employer.

High Risk Pool
There is a high-risk pool in Montana called the Montana Comprehensive Health Association(MCHA). This program offers policies of individual health insurance to eligible Montana residents who are considered uninsurable due to medical conditions. It also offers coverage to individuals leaving group coverage. These plans are administered by Blue Cross Blue Shield of Montana. (www.mthealth.org) You may be eligible for this pool due to your HIPPA rights or you fall under the category of the following guidelines:

  • You are a resident of the state and have been for at least 30 days
  • You were rejected or were offered a restrictive rider by two insurers within the last six months or have specific illnesses
  • You are not eligible for any other health insurance coverage

Coverage under this high risk pool includes doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, physical therapy, and preventive care.

Montana Group Health Insurance

In Montana, medical underwriting is allowed with plus or minus 25% of the indexed rate based on the health status of the group. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare.

The state of Montana offers group health insurance to those small businesses of 2-50 members. Small business coverage offers up to $5M lifetime maximum, assorted deductibles and if an individual is uninsured for a previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply. Today, the premiums for small business health insurance are approximately $320 for the monthly single premium and $838 for the monthly family premium.

There are some guidelines to be followed in Montana in order to receive coverage. If the guidelines are followed, Montana offers guaranteed coverage to their small businesses. The guidelines include:

  • Company size 2-50 employees
  • Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage
  • Owner can count as an employee
  • Owner name on business license must draw wages from the company

For more information on Montana health insurance visit www.coverageforall.org

For more information on small group plans for this state please see our Montana Small Group page.

Montana COBRA Individual Health Coverage

Montana offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.

Medicaid and Medicare in Montana

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Income requirements

Children
Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level

Pregnant Women and Infants
Pregnant Women-133% of the Federal Poverty Level
Infants (ages 0-1)-133% of the Federal Poverty Level

Parents
Non-Working Parents-38% of the Federal Poverty Level
Working Parents-65% of the Federal Poverty Level

Other populations
Medically Needy Individual- 73% of the Federal Poverty Level
Medically Needy Couple- 54% of the Federal Poverty Level
Supplemental Security Income Recipients- 74% of the Federal Poverty Level

Covered Services
Treatment by physicians, nurse practitioners, nurse midwives, dentists, and podiatrists; lab services, including x-rays; inpatient hospital visits; outpatient hospital visits; family planning; nursing facilities; home health care; durable medical equipment; outpatient drugs; mental health; ambulance; and eyeglasses.

Co-Payments
Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about Montana Medicaid at http://www.dphhs.mt.gov/medicaid/.

Click here for information regarding Montana Medicare plans and pricing.

Other Montana Health Insurance Programs

Montana offers the CHIP program to children who are residents of Montana, whose family incomes are up to 150% of the Federal Poverty Level, who do not qualify for Medicaid, and whose parents are not employed by the state of Montana. Please visit the CHIP website for more detailed information at http://chip.mt.gov/index.shtml.