Health Insurance Marketplace in Montana
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Montana has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Montana’s current rules 2 ways: Contact your state Medicaid agency right now fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Planned Parenthood of Montana (PPMT) will use funds to establish the Montana Marketplace Connection to assist consumers in navigating the Montana Marketplace. Consumers will be able to access assistance from a Navigator by scheduling an appointment or as a walk-in to a PPMT health center, calling a hotline or by video conferencing.
The Montana Primary Care Association (MPCA) is an association of community health centers aimed at delivering primary and preventive healthcare to under-served and vulnerable populations. MPCA will use funds to partner with 17 affiliated federally-qualified community health centers, which provide primary and preventive health care services to 100,000 Montanans in 20 counties, to serve currently uninsured Montanans. Funding will be used to train community health center staff to expand current outreach and enrollment assistance activities and to enroll patients into affordable health insurance coverage.
Rural Health Development is a non-profit consortium of rural health care providers established in 1990 with a strong network of relationships enabling them to bring value to healthcare through cost savings, research and development of products and services in underserved Frontier communities. Rural Health Development will provide enrollment assistance, through member health care providers, in eastern Montana.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP’s in Montana:
Accountable Care Organizations in Montana
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Mineral Regional Health Center MT – Health Care Innovation Award
- Healthlinknow, Inc. MT – Health Care Innovation Award
- State of Montana MT – Incentives for the Prevention of Chronic Disease in Medicaid Demonstration
Health care facilities where Innovation Models are being tested
- Billings Clinic Billings, MT – BPCI Initiative: Model 2
- St. Vincent Healthcare Billings, MT – BCPI Initiative: Model 4
- Missoula Aging Services Missoula, MT – Community-based Care Transition Program
- Community Health Partners – Bozeman Bozeman, MT – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Community Health Partners – Livingston Livingston, MT – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Cooperative Health Center Helena, MT – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Northwest Community Health Center Libby, MT – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- The Birth Center Missoula, MT – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Montana
In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed in the Affordable Care Act of 2010. Governor Brian Schweitzer (D) vetoed SB 228 on April 13, 2011.4 Later in April, the legislature issued HJR 33, a joint resolution to allow the Economic Affairs Interim Committee to study the implications, options, and repercussions of a state-based health insurance exchange.5
Also in April 2011, the Governor vetoed SB 176, which would have prohibited qualified health plans participating in a health insurance exchange in Montana from covering abortions, except in cases of life endangerment or severe health impairment of the pregnant woman.6
Contracting with Plans: On February 26, 2013, Commissioner Lindeen sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Office of the Commissioner of Securities and Insurance (CSI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). CSI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. CSI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.7
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Montana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Montana- Blue Dimensions.
The Montana State Auditor received a federal Exchange Planning grant of $1 million in 2010.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Montana is not participating in Medicaid expansion.
On March 8, 2013, Montana received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.8
1. Dennison, M. “Lindeen: Feds Will Have Health Insurance Exchange Up Next Year.” Billings Gazette. December 10, 2012. http://billingsgazette.com/news/state-and-regional/montana/lindeen-feds-will-have-health-insurance-exchange-up-next-year/article_bc8af918-c068-5d0b-a62c-78879352a66a.html
2. HB 620. Montana bill to generally revise health care law to create health care gateway. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0620.pdf
3. HB 124. Montana bill to create a state-level health insurance exchange. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0124.pdf
4. SB 228. Montana act prohibiting creation of a state-based health insurance exchange under the Patient Protection and Affordable Care Act. 2011. http://data.opi.mt.gov/bills/2011/billpdf/SB0228.pdf
5. HJ 33. Montana’s joint resolution for an interim study of a health insurance exchange.http://data.opi.mt.gov/bills/2011/billpdf/HJ0033.pdf
6. SB176. Montana’s 2011 act to prohibit plans in the exchange from covering abortion.http://data.opi.mt.gov/bills/2011/billpdf/SB0176.pdf
7. Letter from Commissioner Lindeen to Gary Cohen. February 26, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-exchange-letter-2-26-2013.pdf
8. Letter from Gary Cohen to Commissioner Lindeen. March 8. 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-pm-letter-3-8-2013.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation