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Confused about health insurance? You’ve come to the right spot.
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There are other ways to have health insurance coverage. One big way is through your job. Federal law requires all employer-sponsored plans to meet minimum standards of quality and affordability. Your employer will know if their insurance plan meets these requirements. If it doesn’t, you can buy insurance on your own through healthcare.gov and receive a tax credit to lower your costs, if you qualify.

If you don’t have insurance through work — and you don’t have other kinds of coverage — you will need to buy it on your own. There are lots of ways to buy insurance and lots of people who can help. Depending on your income and the number of people in your family, you can receive financial assistance to lower your costs.

All insurance sold in Montana must meet certain basic requirements. We spelled out all the legal requirements for health insurance on our Law page.

All insurance must also be organized in a way that makes it easier for you to see how much it will cost you every month — and throughout the year. All plans must be ranked by the portion of your medical costs the company pays: Platinum, Gold, Silver, Bronze. Platinum plans pay the greatest portion, but cost the most every month. Bronze plans pay the least portion, but also cost the least.

Regardless of the plan you buy, there are caps on the amount of money you can be asked to pay out-of-pocket each year. An individual will not pay more than $6,600 a year out-of-pocket; a family will not pay more than $13,200. This doesn’t mean you will always pay that much out-of-pocket. Many plans sold in Montana have much lower caps built into them.

These rankings give some information about your insurance plan, but they cannot tell you how much you will actually end up paying. We recommend looking at the details of the plans side-by-side. We’ve done that work for you under Digging Into the Details.

You can buy health insurance:

  • THROUGH HEALTHCARE.GOV. The only way to get a tax credit to lower your costs is to buy your insurance through healthcare.gov. Your tax credit will come from the federal tax agency and will be based on your income and family size. Only healthcare.gov can connect with the IRS. We know from statistics gathered in 2014 that almost 85 percent of Montanans who bought their own health insurance last year qualified for and received a tax credit to lower their monthly bill and other medical costs.
  • WITH A TRAINED EXPERT. Hundreds of trained Montanans — including insurance agents, hospital and clinic workers, and others, are certified to help Montanans enroll in a health insurance plan. This assistance is free and you can still qualify for and receive a tax credit if you buy your insurance this way. We keep a list of all the people who can help you under Talk to a Human.
  • THROUGH AN INSURANCE AGENT. Your insurance agent may offer major medical health insurance plans outside of healthcare.gov that meet the federal insurance requirement. If you purchase a plan outside of healthcare.gov, you will not be eligible for tax credits or subsidies to offset your cost. You’ll want to make sure you are purchasing a major medical health insurance plan that meets the insurance requirement to avoid a tax penalty. Learn more about major medical plans here.

No matter where you buy it, all health insurance sold in Montana is private insurance offered by private insurance companies.

Plans sold inside healthcare.gov are offered by Montana’s three largest health insurance companies. Together, they sell more than 99 percent of all the insurance sold in Montana. Plans sold inside healthcare.gov are virtually identical to health insurance plans sold outside the site.

The Montana Health and Economic Livelihood Partnership (HELP) Plan expands health coverage in Montana to an estimated 70,000 new adults with incomes up to 138 percent of the Federal Poverty Level (FPL). Coverage began January 1, 2016. The HELP Plan offers medical, behavioral health, dental, vision, prescription drug benefits, and much more. The HELP Plan works to keep you healthy, not just treat you when you are sick.

Three ways to apply:

  • Online at healthcare.gov
  • Call 1-800-318-2596
  • Find in-person help by visiting covermt.org/find-local-help/ or dphhs.mt.gov/hcsd/OfficeofPublicAssistance

What is covered? All the essentials are covered, including:

  • Doctor, hospital, and emergency services
  • Prescription drugs
  • Dental care
  • Vision care
  • Laboratory and x-ray services
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Rehabilitative services and supplies
  • Transportation to appointments

Who is eligible? People earning below $16,000 a year, or $33,000 for a family of four who are:

  • Montana residents
  • Ages 19-64
  • Not already in or able to get Medicare

The Affordable Plan for Healthcare:

  • No or low monthly premiums depending on your income.
  • Small co-pays for doctor visits, with no co-pays for preventive services such as health screenings, help to quit smoking, or flu shots.
  • No out-of-pocket above 5% of your total income.

No. Open enrollment for 2016 coverage runs from November 1, 2015 through January 31, 2016. If you haven’t bought insurance during that time, you generally won’t be able to buy during the year.

If you bought insurance last year, that plan will be automatically renewed for 2016 — even if you do nothing. If you haven’t already received it, you should be getting a letter in the mail from your insurance company alerting you to the automatic renewal. However, the only way you can ensure you are getting the full tax credit for which you are eligible is to go back into healthcare.gov and update your information. Even if your income has not changed, we encourage Montanans to re-enter their information. Since you have already created your account at healthcare.gov, it will take you less time to update that information for 2016.

If you do not update your financial information, you may receive a tax credit that is too low — or too high. If you receive a tax credit that is too high, you could be asked to pay money back to the IRS next spring, or the IRS will take the difference from your tax refund.

Insurance plans for 2016 are not the same as last year. You may find a new plan that better meets your needs. We encourage Montanans to shop around here — or elsewhere — to ensure the plan they buy for 2016 is the best one for them.

If you don’t buy insurance during open enrollment, there are a few major changes in your life that can trigger a special enrollment period for you. Major changes include, but are not limited to:

  • Losing job-based insurance coverage;
  • Marriage or divorce;
  • Birth or adoption; and
  • Death of a spouse
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There are many of different health insurance plans for sale in Montana for 2018. We’ve stacked them up side-by-side for you here — along with everything you need to understand your insurance plan and see how much you’ll pay for it.

There are few key words you’ll need to know when doing your health insurance homework:
Deductible is the dollar amount you must pay for medical costs each year before the insurance company begins paying certain claims. Some health plans for sale in Montana do not apply the deductible to certain kinds of services, such as office visits or counseling sessions. Certain care, like immunizations and physicals, are covered even before you pay your deductible.
Federal law caps the amount of money any person or family must pay in a single year on medical costs. This is called your “out-of-pocket maximum.” You might see it written as “MAX OOP” in some insurance documents. If you have insurance just for yourself, your out-of-pocket maximum cannot be more than $7,150 in 2017. If your insurance is for yourself and your family, your out-of-pocket cannot be more than $14,300 in 2017.
A co-pay is a set amount of money you pay every time you receive certain medical care. Not every plan in Montana has co-pays. Co-pays are usually charged instead of a deductible, but plans differ. We recommend researching plans side-by-side below. Some may have a combination of co-pays, deductibles and coinsurance.
Coinsurance is the percentage of your medical bill that you must pay. You usually pay coinsurance after you have met your deductible. For example, if your plan has 20 percent coinsurance for MRIs, you will pay 20 percent of the MRI after you have paid your deductible.
An insurance provider network is the list of all the doctors, nurse practitioners, hospitals, clinics and other health care providers who have signed special contracts with your insurance company. Every company has a network and practitioners can belong to more than one. When a practitioner signs a network contract with an insurance company, they agree to charge certain prices for certain services. In exchange, the insurance company promises to pay for those services. You will want to be sure your doctors are in your company’s network. If they aren’t, the insurance company will make you pay a greater portion of the medical bill. It could cost you up to four times as much to seek care out of your company’s network.
checklist_thingstoconsider_plansPart of knowing which plan is best for you is considering the medical needs of you and your family. Do you mostly use preventive care, like immunizations or get a yearly physical? Do you or a family member see doctors regularly? And what about prescription drugs? We’ve put a list together of things to consider when shopping for insurance.
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HOW OFTEN YOU GO TO THE DOCTOR: Preventive care, like certain immunizations and screenings, must be covered 100 percent — at no cost to you — provided you see an in-network healthcare provider. If most of the healthcare you receive in a year is preventive, a lower-cost Bronze plan may be best. If you go to the doctor a lot, you may want to consider a plan further up the metal tier.
THE DOCTORS YOU USUALLY SEE: If your regular doctor is not in your insurance company’s provider network, you will pay up to four times more for healthcare — or you will have to switch doctors to find one in-network. Insurance companies are required to post a list of all their network providers alongside their plans on their websites.
THE MEDICINE YOU REGULARLY TAKE: If you take certain drugs, you need to make sure they are covered by your insurance. You also need to see how the company handles prescription drugs — plans vary widely. Prescription drug coverage is such an important part of picking the right plan, we gave its own page.

Three insurance companies — Blue Cross Blue Shield, Montana Health CO-OP, and PacificSource — are selling insurance in healthcare.gov for 2018. Compare the plans by tier level, deductible, out-of-pocket max, coinsurance and copay here.

You will also want to know exactly what each of the plans cover, which physicians and health care facilities are in their provider networks, etc. All of that information is available through healthcare.gov, the insurance company website or through the agent, navigator or certified application counselor who helps you enroll. If you need help with term definitions, check out our Dictionary page.

Now how much is all this going to cost you? We broke the premiums out for you by company. Click on the company logo below for the list of all their product prices. The prices listed are for one person in an age bracket. Let’s say you are a family of four: A 35-year-old, a 40-year-old, and two kids, aged 4 and 7. To find the total price for the family, you take the price listed under your plan for the age of each family member. All children under age 20 are the same price. Then, you add all the premiums together for your family cost. However, you cannot be charged for more than three children under 20.

Download PDFs of 2018 Insurance Rates By Company

PacificSource Montana Health CO-OP BCBS_downloadrates

There is a lot of flexibility in the kind of policy you can buy. If you only need coverage for a child – even an infant – you can buy just that. Or if the children are covered by Healthy Montana Kids, you can buy plans just for Mom and Dad.

Price is only one part of the equation in figuring exactly what you might expect to pay each month in premium. Federal tax credits can help you bring down the monthly premium cost. These credits are paid directly to your insurance company every month. You can also choose to receive your tax credit all at once at tax time. Eligibility is based on income and family size.


Enter your income, family size, and age into this calculator to get an estimate of your eligibility for subsidies and how much you could spend on health insurance. Please remember this is only an estimate. Actual amount may be higher or lower.

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