Private insurance companies provide Medicare Part C plans (more commonly known as Medicare Advantage). Thanks to increased benefits and plan options, the program becomes more popular every year. More than 30 million people had an Advantage plan in 2023, which is more than one-half of eligible Medicare beneficiaries. This page describes Medicare Advantage plans in Montana.
What is Medicare Advantage in Montana?
At a minimum, Medicare Advantage plans in Montana must provide the same coverage you would get with Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance.
Prescription drug coverage is provided by Medicare Part D; it is not included with Original Medicare.
Choosing to join a Medicare Advantage plan does not exempt you from the Medicare Part B premium.
Medicare Advantage plans with prescription drug coverage in Montana
Medicare Advantage Prescription Drug plans (MA-PD) combine your Medicare Parts A, B, and D benefits into a single policy.
Additional coverage you may get with an MA or MA-PD plan include:
- Fitness programs
- Hearing aids
- Routine dental care
- Routine vision care
As private insurance companies provide Medicare Advantage plans, coverage varies according to the plan you choose.
Who is eligible for Medicare Advantage in Montana?
If you have Medicare Parts A and B, you are eligible for Medicare Advantage in Montana.
If you are an American citizen or permanent legal resident aged 65 or older, you qualify for Medicare. Those who began collecting Social Security benefits at least 4 months before turning 65 are automatically enrolled in Parts A and B. Everyone else must apply for Medicare through the Social Security website.
You may qualify for Medicare before turning 65 if you collect either Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically in month 25 of collecting disability.
When can you sign up for a Medicare Advantage plan in Montana?
You may only sign up for a Medicare Advantage plan in Montana during specific times.
The first is your Initial Enrollment Period (IEP), which lasts for 7 months and begins 3 months before you qualify for Medicare. So, if your 65th birthday or 25th month of collecting disability is in March, your IEP runs from December 1 through June 30.
Anyone who did not sign up for Part A and/or Part B may do so during the General Enrollment Period. It lasts from January 1 until March 31 and once it ends, you have from April 1 until June 30 to join an Advantage plan.
Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7. During this 8-week period, current beneficiaries may make any desired changes to their Medicare coverage, including joining an MA plan.
If you are currently enrolled in Medicare Part C, you may participate in the Medicare Advantage Open Enrollment Period. It lasts from January 1 through March 31 and allows current MA enrollees to either switch to a new MA plan or return to Original Medicare. You may also join a standalone Part D plan if that change causes you to lose your prescription drug coverage.
Special Enrollment Periods are available to people who experience certain life changes. Find the full list of qualifying special circumstances on Medicare.gov.
Types of Medicare Advantages plans in Montana
The four main types of Medicare Advantage plans in Montana are:
- Health maintenance organizations: HMO plans employ a variety of measures to help control costs. The first of these is the provider network, which may include any entity that supplies healthcare services (doctors, labs, hospitals, durable medical equipment, etc.). Care received from an out-of-network provider is generally not covered except in cases of emergency. HMOs also require members to choose a primary care doctor and get a referral before seeing a specialist.
- Preferred provider organizations: PPO plans also have provider networks, but they allow members to see an out-of-network provider for a higher cost. You also don't need to choose a primary doctor or get a referral to see a specialist with a PPO plan.
- Private fee-for service: PFFS plans determine how much they – and members – will pay for covered services. Most PFFS plans have a provider network but allow members to use an out-of-network provider for a higher cost.
- Special needs plans (SNPs) limit membership to people who meet specific criteria. Guidelines vary according to the plan but include one of the following: having a chronic condition, living in an institution, or qualifying for both Medicare and Medicaid. SNPs tailor their coverage to fit the specific population they serve.
How to choose a Medicare Advantage plan in Montana
When comparing Medicare Advantage plan options, consider the following:
- Costs: These may include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Compare your options carefully and don't forget the drug formulary if it's MA-PD plan. The formulary is the list of prescription medications that the plan covers.
- Network: If you have complex or preexisting health conditions, you may want to make sure the plan's network includes your providers.
- Ratings: Medicare rates plans on a 5-point scale, publishing their findings every autumn to help members compare their options during Annual Enrollment.
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Montana. Just enter your location information and estimated coverage start date to review the Medicare plan options in your area.
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