Understanding The Marketplace
Obamacare created a new way to buy health insurance. The new Health Insurance Marketplace for Montana is an online insurance store where policies offered by different companies can be compared side-by-side. Montanans access the Marketplace by going to the federal government’s main health care website, www.healthcare.gov. You apply for and buy insurance directly through the website and you will only need to fill out a single application. Details like what the plans cover and how much they cost are available on the site. The costs for all of the policies have been analyzed and approved by the Office of the Montana Insurance Commissioner. Insurance sold on the Montana’s Marketplace will be offered by three private companies: Blue Cross Blue Shield, PacificSource, and the Montana Health CO-OP. Click on each insurance company to see the actual prices of the individual and small group health plans they will offer on the marketplace. Compare plans here.
Please note that one year age bands apply, the information was condensed to only show 5 year spreads. Click here to read Commissioner Lindeen’s press release on the rates.
Plans sold in the Marketplace are still regulated by this office and complaints about your insurance –regardless of where you bought it — should be directed to Commissioner Lindeen’s office at 1-800-332-6148.
All insurance sold in the Marketplace will provide comprehensive coverage, including doctor’s visits, emergency services, maternity care, and prescription drugs. All plans sold in the Marketplace must also satisfy all the Montana requirements for health insurance, regulations enforced by this office. Anyone can buy insurance through the Marketplace, however only those Montanans who have no other option for affordable, comprehensive coverage will be eligible for federal help paying for their coverage. If you have coverage through your employer and you choose to waive that coverage and buy in the Marketplace instead, your employer will not contribute anything toward the cost of your insurance.
In 2011, Montana’s legislature chose to let the federal government design and build the Marketplace in Montana.
Lower Monthly Costs
Most Montanans who purchase insurance through the Marketplace will be eligible for advanceable premium federal tax credits to lower their monthly premiums. Some Montanans will also be eligible for cost-sharing discounts, which will reduce what they pay out of pocket for co-pays, co-insurance, and deductibles. These programs will be available only to those who purchase health insurance through the Marketplace.
Obamacare’s tax credits and cost-sharing discounts are tied to your household income. Many middle-income families in Montana will be eligible for some kind of cost reduction. Learn more about eligibility on our Paying for Insurance page.
If your employer offers health insurance:
Tax credits and cost sharing discounts in the Marketplace are only available to those who have no other options for affordable, comprehensive coverage. If your employer offers a health plan that meets the federal benchmarks for minimum value and affordability and you decide to waive that coverage, you will not receive tax credits or cost sharing discounts for plans purchased on the Marketplace, regardless of your income. To find out if your insurance plan meets those benchmarks, contact your employer.
If you plan to buy insurance this fall for 2014 – particularly if you have never purchased insurance before — it may be useful to get some basic information and paperwork ready before you start shopping. When you go to the Marketplace website, you’ll be able to buy insurance right then — and find out if you qualify for tax credits and cost sharing discounts. It will be useful to have your 2012 tax return on hand — if you have one — or other kinds of income information. Without this information, the Marketplace will not be able to determine if you qualify for programs to help lower your insurance costs.
Levels of coverage
All health insurance plans sold on the Marketplace are rated based on something called “actuarial value.” Under Obamacare, a plan’s actuarial value looks at the share of medical spending paid by your insurance company compared with the amount paid by you. Plans with a higher actuarial value will cost more every month in premium, but they will cost you less at the doctor’s office when you pay your co-pay and you will pay a smaller portion of your total health care bill.
- Platinum: insurer pays 90%, you pay 10%
- Gold: insurer pays 80%, you pay 20%
- Silver: insurer pays 70%, you pay 30%
- Bronze: insurer pays 60%, you pay 40%
Some Montanans will also be able to buy “catastrophic” plans, which provide less coverage than a bronze plan. To be eligible for a catastrophic plan, you must be under age 30 or be exempted from the individual mandate because you can’t find affordable coverage — even after the tax credits have been applied.
The “metal tiers” are designed to help Montanans compare similar insurance products. However, they don’t necessarily mean that all the plans in the same category are the same. The plans may cover different things. All insurance products sold must include a Summary of Benefits and Coverage (SBC). The SBC includes details about what is and what is not covered under a plan. SBCs for plans sold in the Marketplace will be available on the Marketplace website. If you intend to buy insurance outside the Marketplace from a registered insurance agent or broker, those individuals will also have SBCs for all the products they sell.
Because insurers can no longer deny coverage based on a person’s health status, Obamacare tries to eliminate the possibility that people will buy insurance only after they are injured or discover some other medical need. The law creates certain “open enrollment” periods — or set months during the calender when people can buy insurance. Most insurance plans sold now already contain “open enrollment” periods, but Obamacare makes them the same for all plans — both inside and outside the Marketplace.
The first enrollment period began October 1, 2013 and ends March 31, 2014. All plans purchased in the Marketplace before Dec. 15, 2013 have an effective date of Jan. 1, 2014. This means that if you are experiencing difficulties accessing Montanan’s Marketplace website, you have until Dec. 15 to purchase a plan. Delays in the federally built Marketplace website before that date will not delay the effective date of your insurance. All future enrollment periods will run from October 1 through December 7.
After the close of the enrollment period, Montanans will not be able to buy insurance unless they have a “life event,” which starts a special enrollment period. Life events include, but are not limited to:
- Losing a job or getting a new job;
- Marriage or divorce;
- Birth or adoption; and
- Death of a spouse or dependent.
Members of Montana’s federally-recognized tribes will be able to purchase health insurance during special, monthly enrollment periods.