Medicare in Montana

In this article...
  • Older residents in Montana are probably eligible for Medicare. Learn more about what options you have and when you should apply in this guide.

What Montana Medicare Plans Are Available?

Medicare is a federal program that provides insurance coverage and financial assistance for health care and medical services. The program is for those age 65 and older and some qualifying individuals with disabilities. It is broken up into various parts, each of which covers a different aspect of health care. 

Part A

Medicare Part A is the component created before any of the others. It is funded by the U.S. government and offers insurance for inpatient services. This includes hospital stays, standalone surgical facilities and hospice, home and skilled nursing care. Premiums are dependent on participation in payroll taxes during years of employment. 

Part B

Part B functions more like traditional health insurance in that it covers doctor's visits, some in-office services and other elements of preventative care. It may also cover diagnostic testing. Premiums for Part B coverage are based on income, and the patient is responsible for paying any copays, coinsurance costs and deductibles. 

Both Part A and B can be purchased as a standalone package for those who don't automatically qualify. 

Medicare Advantage

The Advantage program covers many of the same things as Parts A and B and acts as a privatized replacement of the two. To qualify for a Medicare Advantage program, individuals have to already be enrolled in the original program components. 

The Advantage program covers inpatient services, preventative care and aspects of health care not covered by Parts A and B. This includes dental and vision services and some prescription medications. 

The structure of the Advantage plan is offered in four options: 

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service
  • Special Needs Plan

Part D/Prescription Drug Plan

Part D of Medicare is also known as the prescription drug benefit. Individuals may opt to purchase Part D as a standalone plan or may forgo it entirely if the Medicare Advantage plan of their choosing covers their medications. 

When signing up for Parts A and B, Part D is optional; however, enrolling at a later date may mean incurring a penalty. 

Medigap

Medigap coverage is a supplemental plan that covers some of the expenses associated with Medicare that are out-of-pocket for enrollees. This includes elements such as coinsurance costs, copays, deductibles, prescription drug costs and even some medical supplies. 

Medigap coverage is administered through private insurers, so each state has a different range of offerings when it comes to the number of companies participating in this supplemental insurance. 

About 22% of Montana residents are enrolled in Medicare, with 13% of that demographic falling in the age 65 and under category because of a disability. Of this, 20% of enrollees have an Advantage plan. Advantage plans are available in every county, but the number of offerings vary. Some counties have only one plan option while others have as many as nine. 

There are 27 insurance companies offering Medigap coverage in Montana, with almost 85,000 people enrolled in one of these plans. 

Who Is Eligible for Montana Medicare?

Medicare eligibility in Montana is automatically extended to those age 65 and up. Enrollment is automatic with the receipt of a Social Security benefits package starting four months prior to turning 65. 

For those who are not enrolled automatically, there are other options to do so. First-time enrollees can sign up three months prior to their 65th birthday, throughout their birth month and three months after that point. 

Medicare also offers an annual enrollment period from January 1 through March 31, with benefits starting July 1. The fall enrollment period extends from October 15 through December 7, with benefits starting January 1. This second period is the point at which enrollees can change Advantage or Part D insurers. 

Individuals who qualify for Medicare in Montana but missed the enrollment period can sign up at any time if they have just moved back into the country, lost coverage from another insurance plan or no longer qualify to receive Medicaid coverage. Those outside of these parameters may also enroll but may have to pay a fee to do so. 

How Do I Enroll in Medicare in Montana?

Those interested in enrolling in Medicare in Montana may do so in one of several ways, including: 

  • Applying via the Social Security Administration website
  • Applying over the phone by calling the Social Security Administration at (800) 772-1213
  • Enrolling in-person at a local Social Security Administration office

Contact Information for Montana Medicare, Medicaid and Insurance Help

Individuals interested in signing up for Medicare in Montana or even other forms of insurance, including Medicaid, can benefit from assistance through one of the many local resources available. 

  • HelpAdvisor: Check out the HelpAdvisor site to learn more about Montana Medicaid, which provides financial assistance for those having trouble with their Medicare costs. 
  • Montana State Health Insurance Program (SHIP): Reach out to the Montana SHIP program to get counseling on choosing the right Medicare programs or dealing with obstacles in enrollment. This program can be accessed online or via phone at (800) 551-3191. 

Montana Prescription Drug Assistance Program: There are a slew of prescription drug assistance programs available for Montana residents to aid in the cost of medications not fully covered through Medicare.