From Billings to Whitefish, Medicare is a treasure in the Treasure State.

While Montana may be sparsely populated, it’s well known as a great place to retire. Low taxes and a low cost of living make the state very practical. Breathtaking mountain scenes, fly fishing, and hot springs make it the perfect place for folks who love the great outdoors.

All this, plus Montana has hundreds of options for Medicare. Of course, with many options come many decisions—often, Medicare beneficiaries have a tough time choosing the right option for them. This article will break that process down and show you how to find the best plan for you. Let’s get started.

Ready to shop Montana plans now? Use the Insurify Medicare comparison tool to find the right Medicare plan for you. Start with your ZIP code to compare Medicare Advantage, Medigap, and Prescription Drug plans. Try it today!

 

 

How Much Does Medicare Cost in Montana?

The cost of Medicare will depend a lot on where you live and the type of Medicare plan you choose. Remember that the cost of Medicare is not limited to the monthly premium. You should also account for:

  • Coinsurance rates
  • Covered care vs. not covered care
  • Caps on out-of-pocket costs
  • Deductibles

The cheapest plan is not necessarily the cheapest monthly premium. In fact, people who pay a little more in monthly premiums for plans that offer a lot more care often pay less overall for their healthcare.

The goal should be to find a plan that covers everything you need covered at a rate you can afford. If you’re having trouble affording your Medicare plan, you should talk to a representative at Montana’s Medicaid program to see if you qualify for government assistance.

The Cost of Original Medicare in Montana

Original Medicare, sometimes called Traditional Medicare, has standardized costs across the nation. Every year, the CMS releases updates to Original Medicare coverage and costs of coverage. You should expect incremental rises in costs each year. 

In 2021, the Medicare Part A premium is free for most beneficiaries. To qualify for premium-free Part A, you must have at least 40 work credits (approximately 10 years of work). Those with fewer than 40 can still purchase Part A, but they must pay a monthly premium:

  • $259 for people with at least 30 work credits
  • $475 for people with fewer than 30 work credits

The premium for Part B in 2021 is $148.50 for most beneficiaries. People with low income may be eligible for lower costs through state Medicaid or the federal Extra Help program. People with high income (more than $87,000 for singles and $174,000 for couples) will pay more for monthly premiums

The annual deductible for Medicare Part A is $1,474 and for Part B is $203. The Part B coinsurance rate is a flat 20 percent. That means you should expect to pay 20 percent of your covered medical expenses. Part A has a range of coinsurance rates, but you should expect to pay anywhere from $60 to $300 per night, depending on the facility and level of care you receive. 

Original Medicare is quite expensive on its own. This is why many beneficiaries choose to add a Medicare Supplement Plan—a.k.a. Medigap—to their coverage plan.   

The Cost of Medigap Plans in Montana

Medigap is supplemental insurance that helps Medicare beneficiaries cover the costs of:

  • Deductibles
  • Co-payments
  • Coinsurance

There are several types of Medigap plans designated by letters—Medigap Plan G, for example. It’s important to note that every plan of the same type is virtually identical to any other Medigap plan of the same type. However, as different insurance companies fulfill Medigap plans, plans from one company may have a different price point than plans at another insurance company.

For example:

  • Medigap Plan G at Company A costs $124 a month.
  • Medigap Plan G at Company B costs $189 a month.

The coverage is the same, but Company A can offer the coverage for a lot less than Company B. The reasons behind this are varied, as every insurance company has its own business practices, care agreements, and other factors that can influence overhead and other costs. 

As a final note, while the plans may be the same, the companies will not be. Some insurance companies are known for excellent technology or customer service. Other companies may be struggling in these areas. Be sure to look for a company that has a track record of being easy to work with in addition to being cost-effective.  

The Cost of Medicare Advantage in Montana

Medicare Advantage can be a real advantage for some Medicare beneficiaries. This is especially true if the plan offers additional coverage like:

 

  • Dental
  • Hearing
  • Vision

Many plans will also include prescription drug coverage. Often, bundling care makes things less expensive and less complicated.

Most Medicare Advantage plans work as health maintenance organizations (HMOs). With an HMO, the cost of care is usually low, but the insured must use healthcare professionals within a pre-designated network. 

Medicare Advantage plans can also be organized as preferred provider organizations (PPOs), which have fewer restrictions on out-of-network care. However, PPO plans are typically more expensive. 

If you enroll in a plan and decide you don’t like it, you’ll have the chance to make changes to it during the Medicare Advantage Open Enrollment period from January 1 to March 31 every year.

Medicare Advantage Plans as Low as $0/month

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The Cost of Prescription Drug Plans in Montana

Medicare prescription drug plans (PDPs) are relatively new to the Medicare world. First used in the early 2000s, PDPs help reduce costs for millions of seniors. The cost of prescription drugs continues to rise, making plans more costly every year.

However, there are ways to make sure that you get the best coverage for yourself:

  • First, make a list of all the medications you currently take.
  • Next, find prescription drug plans in your area using the Insurify Medicare comparison tool.
  • Finally, narrow your options to plans that cover your medications at favorable rates.

PDPs use a four-tier system to price prescriptions, with Tier 1 being the least expensive and Tier 4 being the most expensive. Try to choose a plan that covers your medications in Tier 1 or 2. 

Cost of Special Needs Plans in Montana

Special Needs Plans (SNPs) work like Medicare Advantage plans but are designed for people with special health or financial circumstances. For eligibility, you must meet one of the following criteria:

  • You are a dual-eligible Medicare beneficiary (eligible for both Medicare and Medicaid).
  • You have been diagnosed with HIV.
  • You have been diagnosed with chronic heart failure.
  • You have been diagnosed with dementia.
  • You have been diagnosed with ESRD.
  • You have been diagnosed with ALS.

Like Medicare Advantage, most SNPs are HMOs. Again, this means you’ll need to work within a network of providers for your care. 

What Is Medicare?

Medicare is a federal health insurance program for seniors and people with certain health conditions. The purpose of Medicare is to provide affordable healthcare to people who were historically left out of affordable health insurance coverage.

Medicare is divided into a few parts. Some parts can work together, while others cannot. These parts are:

  • Medicare Part A, which is one half of Original Medicare, covers inpatient care, such as a stay at a hospital or skilled nursing facility. Part A also covers long-term care.
  • Medicare Part B, which is the other half of Original Medicare, covers outpatient care, such as an annual checkup.
  • Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare. Part C plans cover everything Original Medicare covers and may offer additional Medicare benefits
  • Medicare Part D, also known as prescription drug coverage, works with Original Medicare or Medicare Advantage to help cover prescriptions.
  • Medicare Supplement Insurance, also known as Medigap, works in conjunction with Original Medicare to cover some of the costs of care, such as co-pays, coinsurance, and deductibles

Medicare is regulated by the Centers for Medicare & Medicaid Services (CMS), which is part of the federal government. 

Who Qualifies for Medicare in Montana?

To qualify for Medicare in Montana, you need to first be a citizen of the United States or a permanent resident of at least five consecutive years. Beyond residency, you must also meet at least one of the following criteria:

  • You are 65 years of age or older.
  • You are diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
  • You are diagnosed with end-stage renal disease (ESRD).
  • You are receiving disability benefits (SSDI) and have been for the last 24 months.

How Do I Choose Between Original Medicare and Medicare Advantage?

Arguably, the choice between Original Medicare (often with Medigap) and a Medicare Advantage plan is the biggest choice you’ll make. We’ve outlined the essential advantages and disadvantages of each option. Be sure to consider how these apply to your specific situation. 

Plan Type Advantages Disadvantages
Original Medicare
  • Extensive network of providers
  • Large service area across the U.S.
  • Low monthly premiums
  • Many Medigap plan options to help cover costs
  • No caps on out-of-pocket coverage
  • Must purchase add-ons like Medigap, prescription drug coverage, and stand-alone dental, vision, and hearing 
Medicare Advantage
  • Can purchase a comprehensive plan to cover medical, medication, vision, dental, and hearing
  • Many plan options, including types of plans like HMO, PPO, or PFFS (private fee-for-service)
  • A smaller network of providers
  • Small service area restricted to your state or a region within your state
  • Premiums can be more expensive

Bear in mind that choosing one doesn’t bar you from changing your mind later. If you decide to try Medicare Advantage, you’ll be granted a 12-month trial period. If you decide to return to Original Medicare during that time, you can do so without being subject to medical underwriting. That means you can’t be denied a Medigap plan due to pre-existing conditions.

This special protection keeps your costs low if you return to Original Medicare. Beyond these special protections, you’ll have the option to make changes to your plan annually during the fall Open Enrollment Period (OEP).

How Do I Apply for Original Medicare in Montana?

Applying for Original Medicare is easy and may even be automatic. People receiving Social Security benefits—retirement benefits or SSDI—should be automatically enrolled in Medicare when they’re eligible.

However, just because you should be enrolled doesn’t mean you will be. Always check on your enrollment

You can check on your enrollment or enroll yourself:

  • Online at the Social Security website SSA.org
  • Over the phone by calling Social Security at 1 (800) 772-1213, TTY users can call 1 (800) 325-0778
  • In person at your local Social Security office

How Do I Apply for Medicare Advantage Plans in Montana?

To apply for Medicare Advantage, you must first apply for Original Medicare. Once you receive your Medicare number, you can apply for Medicare Advantage. To do so, find an insurance plan for you using the Insurify Medicare plan comparison tool. 

Once you’ve found the right plan, you can typically enroll online or over the phone. 

What’s the Best Medicare Advantage Plan in Montana?

The best Medicare Advantage plan really depends on the person using the plan. Additional health coverage benefits are great unless you don’t plan to use them. So always start with yourself: your needs, preferences, and budget.

Remember that two plans of similar costs and coverage can have different technology, customer service, and networks. Never let price be the only deciding factor. The key is to strike a balance between price and what you need and want from your insurance company

Learn More: Best & Worst Medicare Advantage Plans 

 

 

FAQ: Montana Medicare

Do I qualify for Medicaid in Montana?

To be eligible for Medicaid as a Medicare beneficiary in Montana, you must meet income and asset requirements. For income, you cannot make more than $794 a month as an individual or $1,191 as a couple. Your assets must be less than $2,000 as an individual or $3,000 as a couple. Asset exemptions include your personal belongings, one vehicle, your primary residence, burial plot, and prepaid funeral agreements.  If you’re unsure whether you qualify—or you’re nearly eligible—be sure to contact the Montana State Health Insurance Assistance program to learn more about your coverage options.  

How much do you pay for Medicare when you turn 65?

That depends on the type of Medicare plan you set up for yourself. You should expect to spend a few hundred dollars a month in premiums, especially if you get additional coverage like dental. Beyond this, you should expect to cover the costs of co-pays, coinsurance, and deductibles. According to the Kaiser Permanente Foundation, the average Medicare beneficiary paid $5,460 out of pocket for Medicare coverage in 2016.

Do you automatically get Medicare when you turn 65?

So long as you are a citizen of the U.S. or a permanent resident of the last five years, yes. You should automatically get Medicare when you turn 65. That doesn’t mean you’re automatically enrolled. Be sure to check the status of your enrollment or enroll yourself in Medicare.  Failing to enroll on time can result in permanently more expensive Medicare costs.

Conclusion: Compare Montana Medicare Plans Before You Buy

Whatever plan you choose, comparison shopping before you buy is the right way to go. There are hundreds of options available to you. With a little time and effort, you can make a sound decision for yourself.

Remember that the Insurify Medicare comparison tool is always here to help you. Just enter your ZIP code, and uncover coverage options in your area. Try it today!

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Updated April 9, 2021

J.J. Starr is a health and finance copywriter who enjoys helping readers find the information they need. In addition to her background in banking and financial advising, she is also a poet with an MFA from New York University. She lives in Amherst, Massachusetts. You can learn more at jjstarrwrites.com.