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Medicare Advantage Plans in Montana

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There are a few different options for Medicare coverage in Montana. Generally you can do either of these:

  • Sign up for Medicare Advantage in Montana to receive your Medicare Part A and Part B benefits – and sometimes more.
  • Stay with Original Medicare (Part A and Part B) and enroll in other optional coverage, such as Medicare prescription drug coverage and/or a Medicare Supplement plan.

What is Medicare Advantage in Montana?

You might have heard about Medicare Part C – that’s another name for the Medicare Advantage program. Medicare Advantage in Montana works the same way in the other states.

Medicare Advantage plans provide your Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. (Hospice services are directly covered under Part A.) Private insurance companies contract with Medicare to administer and deliver your benefits through a Medicare Advantage plan in Montana, as in other states.

Most Medicare Advantage plans in Montana provide prescription drug coverage. This is coverage you’d have to get separately if you stayed with Original Medicare. (Part A and Part B generally cover certain prescription drugs in limited situations, but don’t cover most medications you’d take at home.)

Some Medicare Advantage plans in Montana may offer benefits that go beyond Original Medicare. For example, some plans include routine dental or hearing services.

What are the types of Medicare Advantage plans in Montana?

There are several types of Medicare Advantage plans. Here’s a summary of some of the more common plans. Please note that not every plan may be available in your part of Montana.

  • Health Maintenance Organization (HMO) plans may have lower costs than other types of Medicare Advantage plans in Montana. HMO plans usually require you to use doctors in the plan’s provider network, and choose a primary care physician (PCP).
  • Preferred Provider Organization (PPO)* plans also have provider networks, but generally let you visit out-of-network providers. You may have higher out-of-pocket costs when you go outside the plan network. Typically, you don’t have to choose a PCP.
  • Private Fee-for-Service (PFFS)** plans generally set their own payment details, including how much you will pay for medical services. You can generally go to any provider that accepts the plan’s terms of payment, although some plans might have provider networks. Read more about PFFS plans.

No matter what type of Medicare Advantage plan in Montana you may sign up for, you need to keep paying your Medicare Part B premium, as well as any premium the plan may charge.

When can I sign up for a Medicare Advantage plan in Montana?

If you want a Medicare Advantage plan in Montana, you can sign up during certain enrollment periods. Note that you need to have both Medicare Part A and Part B to qualify for Medicare Advantage, you need to live in the plan’s service area, and (in some cases) not have End-Stage Renal Disease (ESRD).

  • You can go with Medicare Advantage in Montana from the get-go if you want. As soon as you qualify for Medicare, typically you can enroll in a Medicare Advantage plan during your Medicare Initial Enrollment Period (IEP). For most people, that’s a seven-month period that starts three months before your 65th birthday month, includes your birthday month, and continues for three more months. If you qualify for Medicare because of a disability or illness, your IEP may be different; read details about your when your Medicare coverage starts if you’re getting Social Security disability benefits.
  • You’ll get another chance to enroll, or to switch plans, during the Annual Election Period (October 15 – December 7). You can also drop plans and make certain other coverage changes during this period.
  • If you’re in a special situation, such as staying in a skilled nursing facility, you might be eligible for a Special Election Period to enroll in a Medicare Advantage plan.

How many people have Medicare Advantage plans in Montana?

Around 219,000 Montanans have Medicare coverage, but only about 17% are enrolled in Medicare Advantage plans in Montana (or in other Medicare health plans). Around 67% of those with Medicare coverage in Montana have some kind of Medicare prescription drug coverage.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

** A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

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