October 15th 2024
By Ari Parker
Medicare Advantage Plans in Montana
Choose the best Montana Medicare Advantage plan based on your unique health and financial needs. Get help and enroll today!
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October 15th 2024
By Ari Parker
Choose the best Montana Medicare Advantage plan based on your unique health and financial needs. Get help and enroll today!
Medicare enrollees have two main options for health insurance coverage: Original Medicare or Medicare Advantage. Each type of coverage comes with additional decisions to make. People on Original Medicare can choose to add a Medicare Supplement and/or a Medicare Part D plan. Those who choose to enroll in Medicare Advantage have an average of 43 plans to choose from—and there’s a lot of variance between those plans.
When comparing Montana Medicare Advantage plans, it’s important to first understand the pros and cons of Medicare Advantage. Once you understand the pros and cons and what to look for as you compare your options, you can narrow down your choices based on your specific needs. In this guide, we’ll cover everything you need to know to choose the best Montana Medicare Advantage plan for you. We’re also here to help you as needed! Give us a call at (855) 900-2427 to get help comparing plans and enrolling today.
As we mentioned above, Medicare Advantage plans vary widely. Plan availability also varies between counties. That said, the quick facts below will give you a good idea of what the Medicare Advantage landscape is like in Montana.
30% of Montana Medicare enrollees are on Medicare Advantage plans, which is significantly less than the nationwide enrollment rate of 54%.
Lincoln County has the highest Medicare Advantage enrollment rate in the state, at 45%.
There are only 27 Medicare Advantage plans in Montana, 21 of which are local PPOs.
Several counties have fewer than 5 Medicare Advantage options, and Blaine County, MT, has zero options.
Medicare Advantage plans are a popular option among Medicare beneficiaries (although they’re notably less common in Montana). As an alternative to Original Medicare, they must cover at least the same things as Original Medicare. They often provide additional coverage for things like eye exams, dental care, hearing aids, and prescription drugs.
There’s a reason over 50% of Medicare beneficiaries nationwide choose to enroll in Medicare Advantage plans. Many people are able to squeeze a lot of value from their Medicare Advantage plans.
Extra benefits
Probably the biggest reason people are attracted to Medicare Advantage plans is because they provide extra benefits that Original Medicare does not. Many seniors are frustrated by the fact that Original Medicare doesn’t cover dental, vision, and hearing care. Original Medicare also doesn’t cover prescriptions (although you can enroll in a separate Part D plan to get your prescriptions covered). Medicare Advantage plans may also include other benefits, including:
Gym memberships
Flex spending cards
Transportation services
Part B rebates
Coverage for acupuncture
Out-of-pocket maximums
When choosing health insurance, it’s important to understand how premiums, deductibles, and coinsurance work. Your premium is what you pay every month to secure insurance. Your deductible and coinsurance then make up your out-of-pocket costs. Your deductible is how much you’ll pay on healthcare costs before your insurance plan kicks in (starts paying). Your coinsurance is the portion of the cost of care that you pay.
With Original Medicare, your Part A deductible is $1,676, and your Part B deductible is $257 (in 2025). Your coinsurance amount is 20%—your Medicare insurance pays the other 80% of costs. With Medicare Advantage, deductibles and coinsurance amounts vary, which can make it difficult to compare options. While Medicare Advantage out-of-pocket costs can vary, these plans come with an out-of-pocket maximum that limits your total healthcare costs in a year. Once you spend up to the amount listed as your out-of-pocket limit, you’ll owe nothing more for healthcare covered by your plan that year. Original Medicare has no out-of-pocket maximum (but Medigap plans are there to limit costs).
The majority of Montana Medicare beneficiaries are not enrolled in a Medicare Advantage plan. Below are some disadvantages of Medicare Advantage plans that may cause Montana residents to stay on Original Medicare.
Provider networks
Medicare Advantage plans limit coverage to a local network of providers. These networks limit which doctors you can see. They may also cause delays in receiving care if you have a difficult time finding a new doctor who’s in network and accepting new patients. Conversely, Original Medicare doesn’t have network limitations. With Original Medicare, you can see any doctor who accepts Medicare (which is the vast majority of doctors nationwide).
Prior authorization requirements
Original Medicare doesn’t require prior authorization, which means you can get the treatments you need when your doctor recommends them. Medicare Advantage plans have become notorious for frequently requiring prior authorization—and denying it! This has caused so many nightmares among Medicare Advantage enrollees.
Most people will enroll in a Medicare Advantage plan when they first get Original Medicare or during the Medicare Open Enrollment Period. The Medicare Open Enrollment Period occurs every year from October 15 - December 7. It’s a good opportunity to enroll in Medicare Advantage or switch between Medicare Advantage plans. You are also able to switch from Medicare Advantage back to Original Medicare during this time.
Every year, Medicare Advantage plans are assigned a star rating from 1-5. A 1-star rating is given to low-quality plans, and a 5-star rating is given to high-quality plans. Looking at top-rated Medicare Advantage plans in Montana is one way to narrow down your options. That said, the plans with the best ratings may not be the best plans for you.
The best Medicare Advantage plan for you depends on your unique health and financial situation. Every plan has different premiums, deductibles, coinsurance, networks, and extra benefits. You should choose the one that covers your doctors and prescriptions while saving you the most money!
Whether you really like your doctors or don’t want to worry about finding a new doctor in a plan’s network, you should make note of the doctors you want to keep seeing. Your Chapter Medicare agent will help you sort through plans to choose from only those that have your doctors in network.
Most Medicare Advantage plans come with prescription drug coverage. If the plans you’re considering include prescription coverage, you need to make sure your specific prescriptions are covered! Every health plan that has prescription coverage will provide a list of covered drugs as well as details about the coinsurance or copay you’ll owe for those prescriptions.
Many people choose to enroll in Medicare Advantage because of the extra benefits. Whether you want to get some cash back through a grocery benefit or OTC card or you want additional coverage for dental, vision, and hearing services, make a list of extra benefits you’re interested in! Once you’ve narrowed your list of Montana Medicare Advantage plans down to those that cover your doctors and prescriptions, you can make the most of these extra benefits.
Choosing among the several Medicare Advantage plans in Montana can feel overwhelming. Especially if you have multiple doctors and prescriptions that you need to be sure are covered, comparing costs and benefits can take hours. That’s why we’re here to help answer your Medicare questions and get you enrolled in the best plan for your needs. Give us a call at (855) 900-2427 or schedule a time to talk to get Medicare checked off your list today!
