What Are Medicare Advantage Plans in Montana?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Medicare Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Many plans offer added benefits like dental, vision, hearing, telehealth, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, though some may qualify earlier due to disability or conditions such as ALS or ESRD. Be aware of key enrollment periods:

• Initial Enrollment
• General Enrollment
• Special Enrollment

Missing your enrollment window may result in late penalties or gaps in coverage.

What Types of Medicare Advantage Plans Are Available in Montana?

Montana offers several types of MA plans tailored to different healthcare needs:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and get referrals to see specialists, except in emergencies.
• Preferred Provider Organizations (PPOs): Allow access to out-of-network providers at higher costs and usually don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Let you visit any Medicare-approved provider who accepts the plan’s terms. No referrals needed, but not all providers participate.
• Special Needs Plans (SNPs):
  • C-SNPs: For people with chronic conditions like diabetes or epilepsy. These are not currently available in Montana.
  • I-SNPs: Not currently available in Montana.
  • Dual Eligible Special Needs Plans (D-SNPs): Available to Montanans who qualify for both Medicare and Medicaid. These plans may offer extra services and lower costs.
• Medical Savings Accounts (MSAs): Combine a high-deductible health plan with a savings account funded by the insurer. These plans typically do not include prescription drug coverage.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However:

• MSAs and some PFFS plans do not include drug coverage.
• If your plan lacks coverage, you may be allowed to enroll in a separate Part D plan, but only under specific plan types.
• Delaying enrollment in drug coverage without other creditable coverage may result in penalties.

Always check the drug formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Understanding Medicare Advantage costs is essential when comparing plans:

• Premiums: Some plans have $0 monthly premiums, but you still pay the standard Part B premium.
• Deductibles, Coinsurance & Copays: These vary by plan and impact your out-of-pocket costs.
• Out-of-Pocket Maximums: Limits how much you’ll spend annually on covered services.
• Extra Benefits: Many Montana MA plans include dental, vision, hearing, over-the-counter (OTC) items, telehealth, and gym memberships.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during several specific enrollment periods:

• Initial Enrollment Period: A 7-month window around your 65th birthday.
• Annual Open Enrollment (Oct 15 – Dec 7): Switch, drop, or join an MA plan.
• General Enrollment (Jan 1 – Mar 31): For people who missed their initial period; coverage begins July 1.
• Medicare Advantage Open Enrollment (Jan 1 – Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by events such as moving, losing employer coverage, or plan termination.

What If You Want to Change Your Medicare Advantage Plan?

You can switch MA plans during the following windows:

• Annual Open Enrollment (Oct 15 – Dec 7)
• Medicare Advantage Open Enrollment (Jan 1 – Mar 31)

When you enroll in a new plan, your old one will be canceled automatically.

What Are Medicare Resources in Montana?

Montana offers helpful Medicare support services:

• Montana SHIP Program: Provides one-on-one Medicare counseling through trained counselors at Area Agencies on Aging. Call 1-800-551-3191.
• Montana SMP Program: Teaches beneficiaries to protect themselves from Medicare fraud and abuse.
• Montana Commissioner of Securities and Insurance: Handles insurance complaints and consumer protection. Call 1-800-332-6148.
• For low-income residents, Montana Medicaid may help with costs. Visit https://dphhs.mt.gov/montanamedicaid or call 1-888-706-1535.
• Learn about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

• These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, are standardized insurance policies offered by private insurers to cover costs Original Medicare doesn’t—like coinsurance and deductibles.

• You must be enrolled in Medicare Parts A and B.
• The best time to enroll is during your six-month Medigap Open Enrollment Period (starting with Part B enrollment).
• Medigap does not cover prescription drugs; you’ll need a separate Part D plan.
• There are 10 standardized plans. Medicare Supplement Plan G is the most popular and widely chosen as of 2023.
• Plan F is no longer available to new enrollees as of 2020.
• Medigap offers nationwide coverage and stable costs.

Learn more about Medicare Supplement plans in Montana.

Next Steps

If you think a Medicare Advantage plan in Montana is right for you, explore your options using the Medicare Plan Finder. Compare benefits, provider networks, and costs—then enroll during the appropriate window to avoid penalties and ensure continuous coverage.