Montana Health Insurance Marketplace

Who is the Marketplace for?

The Montana Health Insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. In Montana, the Marketplace is run by the federal government. The Marketplace, also called an Exchange, is mainly for people who:

  • Don’t have insurance
  • Aren’t insured by their employer
  • Don’t have Medicare
  • Aren’t included in their spouse’s employer insurance
  • Have pre-existing conditions and may have had trouble getting insurance before
  • Have private insurance but want to look at other options
  • Own a small business

The Affordable Care Act requires most Americans to sign up for health insurance or pay a penalty at income tax time. Generally, you don't need to buy insurance through the Marketplace if you are covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll: The next open enrollment period is Nov. 1, 2016, to Jan. 31, 2017. Enroll online at HealthCare.gov or call 800-318-2596. You can also download an enrollment application at HealthCare.gov, or get help in person through a Navigator or insurance  broker.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event. You can also sign up for Medicaid at any time, if you are eligible.

Plans and Costs

Benefits

What’s Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. They include:

  • Outpatient services, such as doctor visits or tests done outside a hospital
  • Emergency services
  • Hospital stays
  • Pregnancy and baby care
  • Mental health and substance abuse services, including behavioral health treatment
  • Prescription drugs, including generic and certain brand-name drugs
  • Lab tests
  • Rehabilitative services, such as those that help people recover from an accident or injury, and habilitative services, which help people with developmental issues.
  • Preventive and wellness services, along with those that help people manage chronic conditions; these are covered at no additional cost.
  • Services for children, including dental and eye care

 

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Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance, such as Medicaid or CHIP. Here’s what’s available:

Premium Subsidies (also known as  Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $16,3941 and $47,520 a year, or if you have a family of four and make between $33,534 and $97,200 a year. Subsidies are based on your estimated household income and the cost of the health plans in your area. The lower your income the more assistance you will receive. You can use your previous year's tax return to estimate your current income. When you file taxes, the IRS will adjust your subsidy based on your actual income.

You also may be eligible for cost-sharing subsidies if your income is below $29,700 for an individual or $60,750 for a family of four. Cost-sharing subsidies will lower your out-of-pocket costs when you get medical care. Cost-sharing subsidies are available only if you buy a silver-level plan.

Medicaid Expansion Some states expanded Medicaid so more people can get health insurance coverage. Because Montana is one of them, you may be eligible if your income is no more than $16,394 for one person or $33,534 for a family of four.

CHIP: The Children's Health Insurance Program, called Healthy Montana Kids in Montana, provides coverage for children of some families who have a low income but are not eligible for Medicaid.

Check with HealthCare.gov or Montana.gov to see if you are eligible for these programs.

Available Resources

In addition to HealthCare.gov, there are several ways you can get help with your insurance decisions:

  • Call Center: You can call the federal government's help line, 800-318-2596, anytime for information, help, and to buy insurance. Montana’s insurance commissioner also has a website, MontanaHealthAnswers.com, that provides basic information about the Marketplace and directs consumers to individuals and organizations that can help.
  • Navigators and Certified Application Counselors: They can teach you about the Marketplace and guide you through your insurance decisions. You can find contact information for navigator and certified application counselors at MontanaHealthAnswers.com or here.
  • Local, State, and Federal Organizations: Many health and community organizations, public libraries, and hospitals are offering help. Find a list at LocalHelp.HealthCare.gov.
  • Insurance Brokers and Agents: People in the insurance business who are specially trained also can help you buy insurance through the Marketplace, and they may have policies that are not offered on the Marketplace. You can only get tax credits or subsidies if you buy through the Marketplace, though. In Montana they are called certified agents. Go to MontanaHealthAnswers.com for a list of agents by city.

 

WebMD Medical Reference Reviewed by Sarah Goodell on October 03, 2016

Sources

SOURCES:

HealthCare.gov.

Federal Register.

IRS.gov.

HHS.gov.

healthinsurance.org.

Montanahealthanswers.com.

Healthy Montana Kids.

Montana.gov.

Kaiser Family Foundation web site.

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