Medicare Advantage Plans in Montana

Medicare Advantage Plans in Montana are a different way to access your Medicare benefits. With a Medicare Advantage plan (MA), you must be enrolled in Original Medicare (Medicare Part A and Medicare Part B) and pay the Part B premium. The standard monthly Medicare Part B premium for 2023 is $164.90. The annual Part B deducible for 2023 is $226.

The private insurance company will be responsible for claims, customer service issues, and plan administration.

Here are some characteristics of Medicare Advantage Plans:

  • MA plans in Montana are becoming more popular year after year
  • Most benefits are attached to a specified network of physicians, hospitals, and medical facilities
  • Advantage Drug plans have built-in prescription drug plans
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Top-rated Medicare Advantage Providers in Montana

  • Montana Blue Cross: Montana has multiple Blue Cross and Blue Shield affiliates. These affiliates have 81 percent of the total enrollment for Medicare Advantage plan in Montana. Blue Cross HMOs and PPOs in Montana have earned relatively good star ratings.
  • Humana: Humana offers a GoldPlus regular and extraordinary needs plan that has received high star ratings in the state for quality.
  • Other notable providers to look for in your area are Aetna and Cigna.

Popular Medicare Advantage Plan Types in Montana

Best network freedom: Medicare Advantage PPO

Preferred Provider Organizations (PPO) offer a more comprehensive network than Health Maintenance Organizations (HMO). Members of a PPO can see a specialist without a referral.

PPO plans typically have premiums between $0 and $100.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

Because HMO plans use a referral network, they offer lower out-of-pocket costs. Their premiums are generally $0 per month.

A referral from your primary care physician is needed to see a specialist.

Best for low income or health conditions: Medicare Advantage D-SNIP

Medicare recipients with certain chronic health conditions and minimal income will likely qualify for a Medicare Advantage D-SNIP plan.

An added benefit for D-SNIP enrollees is receiving Medicaid benefits to decrease out-of-pocket costs like premiums, copays, and coinsurance.

Montana Enrollment Facts:

1. Number of people enrollment in Medicare Advantage in Montana: 46,077

2. Number enrolled by plan, specifically the three plans below:

Local HMO: 13,600

Local PPO: 24,227

PFFS: 1,313

3. Percentage of Medicare beneficiaries enrolled in Medicare Advantage in Montana: 19%

4. Number of people enrolled in Medicare Advantage nationwide: Expected to reach 29.5 million in 2022

5. Percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide: 42%

How much does Medicare Advantage in Montana cost?

In most states, there will be at least one HMO plan with a $0 monthly premium.

PPO plans typically require premiums, but some states will offer a PPO plan with a $0 monthly premium.

Different counties will offer other Medicare Advantage plans. In Montana, the average monthly premium is $48 with a prescription drug plan.

How much do Advantage Plans cost in Montana?

PPO Plan $0.00 to $48.00

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

Everyone has an Initial Enrollment Period beginning three months before the month they turn 65, including the 65th birthday month, and ending three months after. During this time, the recipient can choose their coverage option.

Open Enrollment Period – AKA Annual Election Period

The Open Enrollment Period (Annual Election Period) occurs between October 15 and December 7.

This time allows enrollees to make changes in their Medicare insurance plans. They can join, drop, or switch Medicare Advantage or Medicare Part D prescription drug plans. As long as the change is made by December 7, the new plan will become effective on January 1.

Medicare Advantage Open Enrollment Period

From January 1 through March 31 each year, the Medicare Advantage Open Enrollment Period occurs. One time during each MA Open Enrollment Period, those on Medicare Advantage plans can change their current MA plan for another, drop their Montana Medicare Advantage plan to return to Original Medicare (Medicare Part A and Part B), or purchase a stand-alone prescription drug plan to accompany their advantage plan.

Research plans, list the extras you need most, and look for the plan that meets your needs. Before enrolling, consult an insurance agent familiar with a wide range of options to be sure you get the plan that best meets your needs.

Special Enrollment Periods – Special Circumstances

Some circumstances that may help you qualify for a Special Enrollment Period are:

  • I moved to an area that has more plan options available
  • Provider discontinued your MA plan
  • You just retired, and your employer-based insurance ended

5-star Special Enrollment Period

Information from member surveys, healthcare providers, and health plans are assessed to help Medicare rate health insurance plans on a 5-star basis. These quality and performance ratings are updated each year in the fall. When purchasing Medicare Part C or Part D plans, 5-star plans are in great demand.

During the 5-star enrollment period between December 8 and November 30, once only, if you find a 5-star Medicare Advantage or Part D plan, you can exchange your plan for the 5-star plan.

A word of precaution: Check plan specifics carefully and consult with an insurance agent to ensure you still have both Part C and Part D coverage. If you trade an MAPD plan for a 5-star MA plan without prescription drug coverage, you might have to wait for another enrollment period to get Part D coverage and may have to pay a penalty.

Special Enrollment Periods if you get “Extra Help.”

Extra Help Special Enrollment periods are at these times:

January – March

April – June

July – September

Medicare beneficiaries with eligibility for Medicare and Medicaid can join, drop, or exchange a Medicare Advantage or Part D plan once during each of these intervals.

New plans will be effective on the first day of the following month.

No special enrollment for Extra Help enrollees is available around the Annual Election Period from October 15 to December 7, but everyone can make changes during that time.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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