Looking for health insurance in Big Sky Country? According to a study by US News, Montana has the 26th best health care in the nation. That study focuses on health care access, quality, and public health.
Health insurances options in Montana
MT residents have several options when it comes to health care in their state:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Montana residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 44% | ||
| Individual or family | 7% | ||
| Medicaid | 21% | ||
| Medicare | 17% | ||
| Military | 2% | ||
| Uninsured | 8% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Eight percent of MT residents are uninsured, less than the national average. That’s a boost for policyholders. A high percentage of uninsured people raises rates for insured people.
Montana health insurance companies
There are a few health care providers that offer coverage to MT residents. These health insurance companies offer both individual and family plans in your state:
- BlueCross BlueShield of Montana
- Montana Health CO-OP
- PacificSource
Montana health insurance costs and rate factors
MT residents spend an average of $8,221 per year on health care, slightly more than the national average. What influences your prices in Big Sky Country? Prices vary person to person, but are based primarily on these factors:
Health insurance plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. It’s no surprise that the more coverage you want, the more you’ll have to pay in monthly premiums.
How much should you expect these premiums to be in your state? These are the average rates for each plan type for a middle-aged MT resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $328 | $455 | $502 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
A gold plan costs about 53 percent more than a bronze plan. Gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
Some people may qualify for a catastrophic plan, the lowest level of coverage available in the marketplace. Catastrophic plans come with low monthly premiums but a high yearly deductible of $8,150. Even with those higher monthly premiums, it can save you money to buy a bronze or silver plan if you need to use your health insurance.
Body mass index
According to the CDC, a high body mass can cause serious health risks. That’s why insurance companies analyze your BMI to determine your risk-level. A higher BMI means more expensive health insurance.
In 2019, MT had a 28 percent obesity rate, the tenth lowest in the nation. Of the Montanans who used QuoteWizard to compare health insurance plans, 26 percent have a BMI in the obese range.
Tobacco use
Smokers pay more for health care due to the high risks from tobacco use. About 18.5 percent of MT residents are smokers, the 33rd lowest rate in the country.
Age
According to HealthCare.gov, health care costs up to three times more for older people than for younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 42 years old.
Location
Your location pays a big role in your rates. That’s because every state has different laws, regulations, and providers for health insurance.
Also, health insurance providers use community-rating to determine your prices. That means rates are based in part on the combined claims everyone files. So, if your neighbors file an unusually high number of claims, it could hurt your rates.
That means that living in a health-conscious state could help keep your prices low. According to America’s Health Rankings, Montana is the 22nd healthiest state in the country.
Montana health insurance laws
The Affordable Care Act limits what factors insurance companies can use to determine your prices.
- Pre-existing conditions: Thanks to the ACA, insurance companies can’t use knowledge of a pre-existing condition to charge you more for coverage. Companies used to charge people with pre-existing conditions significantly more.
- Gender: The ACA doesn’t allow insurance companies to charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to charge people with previous medical problems or lapses in insurance more for health care.
There’s a limit to how much you’ll pay out-of-pocket with a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
MT law requires health care providers to offer at least some coverage for the following services:
- Well-child care
- Outpatient diabetes management
- Minimum hospitalization after childbirth
- Coverage for mental illness, alcoholism, and drug addiction
- Autism spectrum disorders
- Coverage for severe mental illness
There are additional services that companies need to provide. Find the full list on cms.gov.
Medicare and Medicaid in Montana
Medicare and Medicaid are both federal-funded health care programs in the US. The programs cater to two different groups in MT. Medicare aids seniors, whereas Medicaid covers kids and low-income families.
Medicare
MT residents 65 and older qualify for Medicare. There are several coverage options within this program, including parts A, B, C, D, and supplemental coverage plans. You may be eligible for a Medicare Savings Program if your income is below these limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $12,760 |
| 2 | $17,240 |
| 3 | $21,720 |
| 4 | $26,200 |
| 5 | $30,680 |
| 6 | $35,160 |
| 7 | $39,640 |
| 8 | $44,120 |
Office of the Montana State Auditor
- Website:
- Homepage
- Commissioner: of Securities & Insurance
- Matt M. Rosendale
- Insurance Hotline:
- (800) 332 – 6148
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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