Confused about health insurance? You’ve come to the right spot.
We are Montana insurance experts and we already work for you. For free.
Let’s get started.
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 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, for 2021, will not pay more than $8,550 a year out-of-pocket; a family will not pay more than $17,100. 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 2018 that approximately 85 percent of Montanans who bought their own health insurance last year qualified for and received a tax credit to lower their monthly bill.
- 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 health insurance plans outside of healthcare.gov that do or don’t 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. A tax penalty may apply until January 2019 if you purchase a plan that does not meet federal insurance requirements. A tax penalty is no longer applicable beginning in January 2019.
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, with some exceptions if the plan is sold only outside the site.
The Montana Health and Economic Livelihood Partnership (HELP) Plan expands health coverage in Montana to 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 $17,609 a year, or $36,156 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 2021 coverage runs from November 1, 2020 through December 15, 2020. 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 2021 — 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 2021.
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 2021 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 2021 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
There are many of different health insurance plans for sale in Montana for 2021. 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:
Three insurance companies — Blue Cross Blue Shield, Montana Health CO-OP, and PacificSource — are selling insurance in healthcare.gov for 2021. 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 2021 Insurance Rates
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.