Montana Health Insurance

Montana Medical Insurance Overview
Throughout history, the state of Montana’s overall health has been quite good.  It is ranked in the middle as compared to the other states in the country, but it has seen many improvements in recent years.  A good portion of the state’s population is over the age of 50, which means that the state has seen a higher level of health issues overall.  Recent legislation has changed the landscape of the health status in the country and continued improvements should be seen in the state of Montana for years to come.

With the implementation of the Affordable Care Act, the middle class and seniors of Montana are more likely to see the added benefits of health insurance coverage.  The act also provided the ability for small businesses to receive tax subsidies for providing health insurance benefits to their workers, which leads to an increase in the amounts of residents covered.

Montana’s Health Care Issues
Statistics revealed by the United Health Foundation revealed that Montana has improved from the 28th position to the 23rd since the year 2012.  Still, this trend is low for the overall health of Montana residents, but the state has its strengths as well as its weaknesses.

Among its strengths:

• Low rate of obesity
• Low air pollution levels
• Low rate of Salmonella poisoning

Its weaknesses include:

• High rate of Pertussis
• Low rate of immunizations among children
• High rate of residents who drink in excess

Despite that information, it is hoped that the new healthcare reform law will add to the growing improvements in the health of Montana residents overall.

Understanding Montana’s Uninsured Population
According to the statistics shown by the Henry J. Kaiser Family Foundation, there is 12 percent of Montana’s population who currently does not have insurance coverage.  That translates to 364,100 people in the state who aren’t insured by any means.

In the state of Montana, women are more likely than men to be without insurance benefits, with the highest age group of those without insurance being from 19 to 21 years of age.  For those earning below 100 percent of the poverty line, this number represents 26 percent of the uninsured population.  Those earning between 100 and 399 percent of the poverty level are represented by 39 percent of the uninsured population.  Despite having the financial means to obtain health insurance because of earning over 400 percent of the federal poverty line, 5 percent of Montana’s residents still have no insurance coverage whatsoever.

As of 2014, the Foundation’s website shows an uninsured population of 12 percent of people living in Montana.  This has shown a significant drop from 18 percent in recent years.

Below are some statistics regarding the non-elderly uninsured population of Montana:

• 8 percent of children under the age of 18 have no insurance coverage
• 17 percent of adults between the ages of 19-64 are without insurance
• 13 percent of households that are uninsured have at least one full-time worker
• 19 percent have part-time workers
• 21 percent of uninsured households have no workers at all

Group Health Plans
In Montana, employers cover 40 percent of workers.  The benefits that come with group health plans are typically better than other private policies.  They are also more affordable because of the employer’s contribution.  There are also regulations in place to protect workers from insurance discrimination based on the presence of a pre-existing health condition.  Coverage under group health plans in Montana are required to cover newborns, adopted children and children put up for adoption for 31 days following the event.

All insurance types are regulated by the State Auditor’s Office in the state of Montana.

Signing Up
Joining a group plan is typically restricted to enrollment periods that are designated by the company’s human resources department.  While new enrollees can usually apply upon being hired, there are certain qualifying life events that will allow you to make changes to your policy.

Prior to joining, consider the below factors to aid in the decision making process:

• Does your spouse have coverage that you can join?  Is there a cost difference between plans?
• Do you have a pre-existing medical condition that will affect your medical needs under the new plan?
• What options does the employer-sponsored plan offer?  Usually there is more than one option that has varying levels of coverage.

Pre-Existing Condition Exclusion Periods
While you can’t be denied insurance coverage because of a pre-existing condition, you may have to wait through a 12 month exclusionary period before you can use your coverage.  Insurance companies can look back into your medical records for a period of six months to make the determination of whether or not you have a pre-existing condition.

There are some other factors you will need to know with regard to pre-existing conditions.  Among them are exemptions allowed for pregnant women, infants and adopted children.  If you have creditable coverage, you can be granted credit on the new health insurance plan.  Lastly, if you are subject to the imposition of an exclusion period, your insurance provider must let you know in writing.

Affiliation or Waiting Periods
Affiliation periods apply to everyone enrolling for insurance coverage under group health policies.  This period of time prevents workers from being employed long enough to have larger medical expenses taken care of before quitting the company.  Affiliation periods are usually two months long, but can be three months if you enroll into the plan late.

Individual Health Plans
If group coverage isn’t available to you or you can’t qualify for a state-funded program, the option exists for you to get coverage under an individual policy.  Premiums in most cases are higher for this plan type because there is no portion covered by an employer.  There is also a higher level of risk for the insurance company, because unlike group plans, there is no way to spread out the risk over a large group of people.

Pre-existing medical conditions are more difficult to cover under this plan type primarily because the insurance provider expects to pay higher costs for covering its policyholders.  In the state of Montana, only 5 percent of the population has coverage under an individual insurance plan, which is down from 9 percent in 2011.

For more information on the private and public health coverage options, visit the website for the Foundation for Health Coverage Information.

Continuation Coverage
COBRA coverage is available to those who qualify for insurance if they have lost their dependency status for insurance because of a job loss or divorce.  The Consolidated Omnibus Budget Reconciliation Act provides measures that grants coverage on a temporary basis to those qualified based on the size of the company that originally offered the group policy.  Under COBRA, your insurance can last for up to 18 months.

Montana Health Benefit Exchange
In 2012, the governor of Montana declined to establish a state-managed health benefits marketplace.  Prior to that, two bills designed to create a marketplace in Montana failed.  This led to the state defaulting to a federally-run benefits exchange that met the requirements under the Patient Protection and Affordable Care Act of 2010.  Despite retaining control of the functions related to plan management, Montana’s exchange is operated on a federal level.

Montana State Insurance Programs
While group coverage and individual plans exist to cover individuals and families with the means to pay, there are state-funded plans to those who qualify for coverage.  Some plans offer coverage if you have no other means of getting covered and others offer a wide or limited range of services depending on your age, income level or gender.

Options are available for those who need insurance benefits through state-funded programs.  The programs listed below provide information to guide you with regard to what program is best for you and/or your family members.

Montana Comprehensive Health Association (MCHA)
This program covers people who have been denied insurance or can’t afford to pay the associated premiums because of pre-existing medical conditions.  There are a variety of program options available, with differing premiums based on services needed.  Deductibles can go as high as $15,000 with annual maximums between $5,000 and $15,000.  Qualifying applicants cannot be eligible for COBRA coverage or any other state-funded programs and must show proof that they were denied coverage from two different insurance providers due to a pre-existing condition.

Montana Affordable Care Plan (MACP)
This program offers additional help to people who have had a hard time getting insurance coverage because of a pre-existing condition.  Primary, specialty and hospital care services are offered, as well as prescription medications.  Plans under MACP can run between $186 and $339 every month depending on the plan chosen and the age of the applicant.  To qualify, you must have gone without health insurance coverage for a period of six months.

Medicaid
Medicaid is designed to help people who don’t earn a lot of money obtain health insurance benefits for themselves and their family members.  There are a lot of benefits offered under Medicaid and you could receive retroactive coverage for medical services provided three months prior to your application date.  There are no monthly premiums for coverage, but you may be required to pay a co-payment.

Healthy Montana Kids (HMK)
This program provides medical services for uninsured people under the age of 19 who are not eligible for Medicaid.  If you haven’t had insurance coverage for three months, you may qualify for coverage under HMK.  There are no associated premium costs and co-payments cannot go over $215 annually.  Coverage includes physicals for employment or sports, surgical services, dental, hearing and vision examinations, eyeglasses and prescription medications.

Women-Infants-Children (WIC)
The WIC program works to provide nutrition to pregnant or breastfeeding women and children under the age of five.  Also included in this program are nutrition education, food supplements like milk and peanut butter, along with prenatal and postnatal care.

Montana Cancer Screening Program (MCSP)
This is a service that provides cancer screenings to women with low incomes for free.  Women can get pap tests, mammograms, breast and pelvic exams under this program and those who apply must show that they don’t have insurance or are underinsured.

Medicare, Medicare Prescription Drug Program, and State Health Insurance Assistance Program (SHIP)
Medicare benefits are available to those over the age of 64 in Montana have worked in a job that was covered by Medicare for a period of ten years or more.  Coverage under Medicare is also offered to people with end-stage renal disease or disabled individuals.  Medicare counseling is available to those who qualify through the State Health Insurance Assistance Program (SHIP).

VA Medical Benefits Package
The VA Medical Benefits package guarantees benefits to military veterans if they have been honorably discharged from the service following 24 consecutive months.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance is a free nationwide resource that offers help to consumers by connecting them with 475 available programs designed to help with the costs of prescriptions.

Health Coverage Tax Credit
This subsidy is available to those who receive Trade Adjustment Assistance who are 55 years old or older and receive a pension through the Pension Benefit Guaranty Corporation.  The person applying cannot be enrolled in various state programs, be in prison or receiving a reduction through COBRA.  The Tax Credit offers help with monthly premium payments amounting to 27.5% of the total premium cost.

HIPAA and Conversion Health Plans
HIPAA offers those seeking insurance coverage with a variety of protects with regard to insurance providers.  It enforces strict regulations on insurance companies and dictates that coverage cannot be denied under a group health plan because of a pre-existing health condition.  In addition, it regulates affiliation and exclusion periods and gives freedoms to insurance companies regarding their ability to do underwriting on individual policies.

Continuation coverage is also available for people who have lost their insurance benefits for whatever reason.  For more information on HIPAA and continuation coverage, refer to the linked document.