Are you a Montana resident who’s having trouble finding affordable health care coverage? You’re not alone. There are thousands of residents in the state who are trying to decide between major medical coverage, short-term health insurance, health share plans, and more right now. But the decision that’s right for them and the decision that’s right for you will vary based on your own personal circumstances. Below, we’re going to take a closer look at all of your options so that you can make the best decision for yourself and your family. If you want to learn more so that you can make an easier decision, just keep reading.
Major Medical Insurance in Montana
As of this writing, this year marks the 10th anniversary of the Patient Protection and Affordable Care Act passing into law. It was signed by then-President Barack Obama in March of 2010, and the health insurance marketplace was set up just a few short years later. All you have to do to find out whether or not you qualify for coverage and a money-saving subsidy is to visit HealthCare.gov and fill out a quick, easy application.
Most people have to wait until Open Enrollment in order to sign up for an ACA Health Insurance Marketplace plan. Open Enrollment happens every year starting on November 1st and typically ending on December 15th, although it isn’t uncommon for the deadline to change based on demand. You might also qualify for a special enrollment period if you have some extenuating circumstances, such as the birth of a child or moving to a new zip code. For more information on special enrollment periods (SEPs), you can visit HealthCare.gov to read more about the topic or contact a representative directly to ask questions.
ACA health insurance, also known as major medical coverage, is designed by law to be the most comprehensive health insurance coverage available. One of the best things about it is that these policies are guaranteed issue, meaning you are guaranteed a policy if you qualify for coverage. All you have to do is pick one, and pay your first month’s premium. Guaranteed issue insurance protects you from being rejected for coverage or having to pay a higher monthly premium because of a pre-existing condition. You may still be charged a higher rate with an ACA policy, but that higher rate can only be based on one of the following four factors:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another good thing about major medical coverage through the ACA is that each plan must come with all of the benefits in the list below. These are called the Essential Health and Wellness Benefits, and medical experts agree that offering these benefits can help keep people healthier for longer thanks to things like preventative care and comprehensive health management:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
But one of the most appealing things by far is the fact that many working Americans can easily qualify for a tax credit which makes these insurance policies highly affordable. If you live in Montana and make between 138% and 400% of the federal poverty limit, you will likely qualify for a subsidy. Offering guaranteed issue policies with all of the comprehensive health benefits mentioned above does tend to make these health plans more expensive; so for many people, the only way they can afford ACA coverage is due to the tax breaks offered by the federal government. The chart below can help you figure out whether or not you and your household fall above or below this 138% threshold.
|Household Size||Annual Income (138% of FPL)|
Some of you may be looking at the chart and thinking to yourselves “what happens if I fall below that 138%?” The answer to that is the Medicaid expansion. Montana was a late adopter of this expansion, but finally agreed to accept federal funds designed to expand Medicaid for low-income families back in 2016. The Montana Department of Health and Human Services is the state office that handles both Montana Medicaid and healthy Montana kids Plus, the state-run versions of health insurance for adults and children, respectively. For more information on the application process and whether or not you qualify, you should visit the Montana Medicaid website.
Short Term Health Insurance in Montana
Montana does more than most States in order to help make sure that enough people get covered; however, that doesn’t mean that every single Montana resident will qualify for an ACA major medical coverage plan. For some people, the monthly premiums are too expensive, even with a tax credit. Other people may simply choose to explore other options. And one of the options which is available to them is short-term health insurance.
Why would someone go with a short-term health insurance plan, instead of a major medical policy through the ACA? It could be a matter of preference, it could be a matter of affordability, or it could be both. Either way, it’s important to educate yourself on what exactly short-term health insurance is so that you can make a decision between the two. Rules for short-term health insurance in Montana are standard to those rules on the federal level – meaning that you can apply for 12 months of short-term health insurance coverage with the option to renew for a total of 36 months. But these policies are not guaranteed issue, so every time you renew, you will have to undergo medical underwriting. With medical underwriting, you may be rejected for coverage, you may have your coverage canceled, or you may be charged a significantly higher premium due to pre-existing conditions.
You have the option to customize your short-term health insurance in ways that you can’t with an ACA plan. You can work with your provider to compile a tailor made set of benefits based on your unique healthcare needs; but keep in mind your short-term health insurance provider has the option to refuse to sell you certain types of coverage (mental health services, for example) if they so choose. You can also add supplemental forms of coverage like a fixed indemnity plan in order to help reduce your out-of-pocket costs that much further. You don’t need to apply through the ACA if you want short-term coverage; all you need to do is approach the company who is selling the plan and follow their application process. Provided you don’t have any pre-existing conditions that might disqualify you for coverage, getting a plan should be easy from there.
People who are in good health tend to get a bigger financial benefit out of short-term health insurance. These plans typically come with high deductibles, sometimes as high as $5,000 or more, and also impose annual and lifetime benefit caps on policyholders so that they cannot be paid out increasing amounts of money on medical claims. Your out-of-pocket expenses, on the other hand, will have no caps. At the same time, paying a monthly premium for a short-term health insurance policy that you don’t use often can still end up saving you a considerable amount of money if something unfortunate happens and you suffer an unexpected medical emergency.
Christian Health Plans/Health Share Plans in Montana
Another alternative option is a Christian health plan. Although to tell the truth, these plans were a lot more useful back when the individual mandate was still a federal law. But as of the beginning of 2019, the federal government stopped charging a tax penalty for individuals and families who refused to purchase qualifying health care coverage. Even though Christian health plans don’t meet the standards of qualifying health coverage according to the ACA, the fact that they are offered by religious institutions did provide people a religious exemption to the individual mandate. But that doesn’t mean that these plans can’t be useful now that the mandate is gone.
To understand what a Christian health plan is, it helps to know that they have many things in common with short-term health insurance. The things they have in common include:
- No guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
However, these plans are not identical. Short-term health insurance comes with certain consumer protections which, if your insurance provider ever denies you a claim for an unjust reason, you can take them to court and sue them over the money you are owed. Christian health plans, on the other hand, offer no such consumer protections. You will have to adhere to a set of participation guidelines if you want to receive benefits through a Christian health plan. These guidelines usually include things like declaring a typically Christian faith, living a biblical lifestyle, or making health improvements like the cessation of tobacco use. And although the payment structure is similar to typical insurance, the jargon is a bit different. You won’t pay a monthly premium, you will pay a monthly share amount instead. And you won’t necessarily pay a deductible, a co-pay, or any amount of coinsurance, either; but you will likely be asked to pay similar expenses which are referred to as personal responsibility amounts or unshared amounts.
Fixed Indemnity Plans in Montana
Then you have fixed indemnity plans. These are more commonly sold as a supplement to major medical coverage, short-term health insurance, or similar plans. Fixed indemnity plans cover so few of your medical costs that it doesn’t make a whole lot of sense to use them as a replacement for major medical coverage; however, it can still be an affordable alternative which is better than nothing, especially if you are relatively healthy and don’t require that much medical care in the first place.
The fixed indemnity plan you purchase can vary according to your medical needs. Some fixed indemnity plans offer hospital benefits, some offer doctor visit benefits, some may even offer dental services, or a combination thereof. Your benefits are paid out based on either a per day, per week, per month, per visit, or per incident basis. A fixed indemnity plan will only pay out a fixed amount of money per claim, regardless of the medical services you receive. Between major medical, short-term health insurance, and Christian health plans, it’s safe to say that fixed indemnity plans cover the most limited percentage of your total medical costs – which is why they usually work better as supplemental coverage instead of replacement coverage.
Discount Cards in Montana
You have some options when it comes to medical discount cards in the state of Montana. You can go to MontanaRXcard.com to get statewide prescription drug assistance and save up to 80% on your pharmacy costs. It’s a free service where you can download and print pharmacy coupons which will help you get access to discounts. You don’t have to apply, and you don’t have to pay any money in order to get access to the service. Best of all, it’s convenient enough that you can access coupons via email, text, or your personal computer.
But if you want access to discounts for things other than just prescriptions, you might want to sign up for a medical discount card program provided by a private company. Just remember that these discount cards are not insurance, and any company that markets their medical discount card as an insurance policy or as an insurance replacement is breaking the law. Getting a card is a fairly simple process: you pick a company based on the discounts they advertise and the providers they advertise working with, pay a monthly or an annual fee, and you receive a discount card in the mail. Then when you get medical services or make medical purchases, you present the card at the register in order to get your discount. Just be careful, because not all companies who advertise medical discount cards actually honor the discounts they offer or work with the providers they claim to work with. Be sure to do your research before you sign up with a medical discount card company. You might want to start here with this list of companies that have been legally authorized to sell medical discount cards in Montana.