Sometimes it can be difficult to find affordable health insurance that offers sufficient coverage. Here at HealthQuoteInfo, we can make the search easier for you. You can find thousands of Montana health insurance plans offered by private carriers such as Cigna once you enter your zip code.
ESI (Employer-Sponsored Insurance) & Small Business Health Insurance Montana
For more affordable insurance, you may try finding a health plan through your workplace. Large companies with at least 50 full-time employees are required to provide health insurance as part of their benefits package, and it would be wise to take advantage of it. These plans are more affordable because the employer pays for a significant percentage of the premiums.
On the other hand, small businesses with fewer than 50 full-time employees are not required to offer health insurance benefits to their employees. The government also does not levy tax penalties to those small businesses that do not provide health insurance to their workers.
However, the state does offer tax credits for at least two years if the small business offers health coverage from plans obtained through Montana’s SHOP marketplace. If your business has fewer than 25 employees, your earnings average less than $50,000 a year, and you contribute at least 50% towards the employee premiums, you can get tax credits.
Even without tax credits, offering health coverage to employees can be a good investment. It attracts more qualified workers, and the health coverage helps make sure that their health is maintained so they can work continue to be productive at work.
Medicaid & Low Income Health Insurance Montana
Montana Medicaid offers health coverage for those with low incomes and who cannot obtain health insurance coverage from the marketplace. It uses a primary case management program called Passport to Health, and as a member, you need to choose a Passport provider to act as your primary care provider. The Passport provider must first give their approval before you can see other healthcare providers.
Montana Medicaid requires copayments for various medical services you receive under the plan. These copayments depend on what services you receive and on your income level.
If your annual household income is less than 100% of the federal poverty level, this means that your family of three has an income that doesn’t exceed $20,780. For four members in the household, it becomes $25,100.
If your annual income is within these limits, the outpatient services will only require a copay of $4. The copay for inpatient services is $75. Your copay is $4 for preferred brand name pharmacy drugs and $8 for non-preferred brand names.
Those Medicaid members whose annual income exceed 100% FPL pay higher for copayments will pay higher copays, except for pharmacy drugs which remain the same. The copay will be equivalent to 10% of the provider’s reimbursed amount for any Medicaid service.
Some services do not have copays. These include Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), ER emergencies, transportation, and eyeglasses purchased under Medicaid volume arrangement. It also includes family planning, generic drugs, home and community-based waiver services, hospice services, and some preventive services.
Some members are also exempt from copays. These include those who are under 21 years of age, pregnant women, Native Americans, and those who are receiving hospice services and are terminally ill.
Out of pocket costs also have a limit for Medicaid members. These copayments cannot total more than 5% of the family’s income quarterly. Once the limit has been reached, copays will no longer be required.
Healthy Montana Kids (HMK)
This is Montana’s version of the Children’s Health Insurance Plan (CHIP). It offers coverage for children under the age of 19 whose families exceed Medicaid limits. However, there are still income and other eligibility requirements.
The medical benefits are administered through the Blue Cross Blue Shield (BCBS) of Montana Provider Network. The exceptions are of the services also come from federally qualified health centers, rural health clinics, and community-based psychiatric rehabilitation and support services.
The covered services include medical, dental, and eyeglasses along with other related services. These include pharmacy and transportation services. Medical services must be deemed medically necessary.
Montana Healthcare Prescription Drug Program Benefit
Many Montana Medicaid programs come with this benefit. However, not all drugs are covered even if you have a prescription from your doctor. First of all, you must use a pharmacy that is also a Montana Healthcare Programs Provider.
While the program does cover most prescription drugs, other drugs may require prior authorization. Some over the counter drugs may also require a written prescription from your healthcare provider.
Covered drugs include self-injectable drugs like insulin, contraceptives, aspirin, antacids, and non-sedating antihistamines. It also covers head lice treatment and drugs to help you quit smoking.
On the other hand, it doesn’t cover investigational or experimental drugs or any drug that doesn’t have FDA approval. It’s not covered if the drug is sued for weight loss or it helps you to get pregnant. It also doesn’t cover drugs meant to treat erectile problems. The list of non-covered drugs also includes drugs that aren’t on the OTC Drug Formulary, as well as cosmetic drugs.
For the most part, the coverage is only for a 34-day supply. However, for some products, the program may authorize a supply for 90 days. You’ll need to confirm with your pharmacist if your medication can be filled with a 90-day supply. In some instances, prescriptions may still require prior authorization.
Montana Open Enrollment 2019 & Montana Obamacare Insurance
The Montana Open Enrollment period for health insurance in 2019 will run from November 1st, 2018 to December 15th, 2019.
For all your other questions regarding health insurance in Montana, please do not hesitate to give us a call at 1-855-614-5057. We stand ready to guide you so that you can get the health & medical insurance coverage you need and deserve.