As its name and state motto of “Big Sky Country” suggest, Montana is full of mountains and a large expanse of sky over many untouched areas of land. Montana’s great size contributes to the vast amount of wildlife and natural resources it contains, including the highest concentration of grizzly bears in the contiguous United States. As one of the nation’s largest states, Montana is also one of the least populous – just recently reaching the one million mark at the end of 2011.

If you are a resident of Montana and are looking for a new health insurance policy, or are currently uninsured, you have only a few options through companies we have decided are reputable enough to buy from. One company is one of the largest insurers in the nation who will not permit us to use so much as their name if we do not sell them in a certain state, and the other is PacificSource Health Plans. To compare rates and available plans in your town, enter your zip code below and get a quick quote.


Health Status

The quaint population of Montana has interesting health statistics, with one of the nation’s lowest obesity populations, thanks surely in part to the mountains. Not all Montana residents can hike and ski year-round multiple times a week, therefore obesity has increased over the past ten years as the rest of the country has also experienced. The UnitedHealth Foundation ranks Montana right in the center of the country in health status, at number 25 for 2012. This is due to an averaging out of positives, like the low level of obesity and good air quality, with negatives, as we will go on to mention. Another plus is the public health funding of the state is moderate, and diabetes is also less frequent here than other parts of the country at 7% of the adult population.

Montana does need to make some lifestyle changes in other areas, such as excessive alcohol consumption (over 17% of adults binge drink) and smoking (nearly 19% of all adults are smokers). There is also an unfortunately high number of uninsured individuals in Montana, taking up almost 17% of the population. Availability of primary care physicians is also unsatisfactory, and though there are not many people in the state, there is still an insufficient amount of doctors per capita. In order to make changes and improve the health of Montana, it is necessary to use your resources – either a state health program or health insurance if you can afford it – and get healthy. Both the state and health insurers offer preventive care and wellness programs to ward off disease and inform people on exercise (which shouldn’t be too hard when you live on an incline) and nutrition.


Health Insurance Plans


PacificSource Health Plans

  • Value plans from PacificSource in Montana are affordable alternatives for comprehensive coverage. You can choose from a deductible of either $5,000, $7,500 or $10,000 for individuals, all of which cover 60% of in-network medical services after deductible. These plans also include maternity and prescription coverage (50%) after deductible with no separate pharmacy deductible involved. As these are PPO plans, you can receive coverage for designated types of non-network care. As required of all health insurance plans, you receive preventive care in-network at no cost from the start date of your policy.
  • Preferred plans offer traditional PPO coverage with the best set of benefits offered by PacificSource. These plans offer first-dollar benefits such as doctor’s office visits, chiropractic, naturopathic, and urgent care for a $30 copay. Vision, maternity, and prescription drug benefits are also included with Preferred plans, with generic drugs offered for $4 before deductible. Individual deductibles range from $1,000 to $5,000, each requiring you pay 30% coinsurance on hospital care once you meet the deductible.
  • HSA Qualified plans are high deductible plans that are compatible for use with a health savings account (HSA). These plans also cover a large set of benefits, though the only immediate in-network benefits you receive are preventive care covered in full. After you meet the deductible, which can be either $3,000 or $6,050 for individuals, you have access to physicians, prescription drugs, and hospital care of all sorts for no charge. 100% coverage after deductible is often a great choice and makes receiving health care services very simple, and opening a health savings account is a tax-advantaged way to keep track of your medical finances.
  • Uniform plans are designed by the state of Montana and are available with a $1,000 deductible for individuals and $5,000 for families. These plans cover preventive care at 100% as soon as your plan begins, and once your deductible has been met you can receive all covered services for 50% coinsurance. Benefits of a Uniform plan include office visits, home health care, chiropractic, naturopathic care, maternity, emergency and urgent care, prescriptions, outpatient services and inpatient mental health care.



Public Health Options

In the state of Montana, there is a decent amount of state funding for public health programs catering to individuals without insurance. Given that the uninsured population is so high, it is a wonder why not more individuals have Medicaid or are at least accessing these services through the state. Medicaid is offered to low-income residents of Montana who fit into one of the following groups: families, children, pregnant women, over 65, blind or disabled. Montana Medicaid and CHIP offer medical insurance plans to a select eligible population, so it is important to know if you qualify. Other services funded by the state include short-term care solutions such as immunizations, family planning services, prescription coverage and nutritional assistance. For a complete list of services and programs, visit the Montana Department of Public Health & Human Services.

  • Medicaid: health insurance coverage for uninsured Montanans who meet income and other criteria. For more on eligibility, visit our Medicaid Eligibility by State page.
  • Healthy Montana Kids: medical insurance for children up to age 19 living in Montana without any other coverage, which is usually no cost or contains a small monthly premium for higher income levels.
  • Big Sky Rx Program: prescription drug coverage for Medicare recipients in Montana.
  • Montana SNAP: Supplemental Nutrition Assistance Program for eligible families and individuals with low income in Montana.
  • Montana State Health Insurance Assistance Program (SHIP): a confidential and independent assistance program funded by the Centers for Medicare and Medicaid Services (CMS) for Medicare recipients and those in need of long term care.


Health Insurance Laws

The few existing Montana health insurance companies abide by federal and state regulations for how they run their business and regard individuals. A protection put in place by HIPAA in favor of the insured is guaranteed renewability. Because this is a federal law, insurance companies in all states must follow this provision that ensures an individual who pays for their coverage can renew their plan for another term. The insurer is required to ask if their clients want to renew their plan before it expires, so to avoid breaks in coverage and keep the individual’s insurance history intact. Guaranteed renewal also prevents insurers from canceling benefits as a result of illness, if the illness or condition was acquired after the plan’s start date.

Individual health insurance laws highly revolve around pre-existing conditions. As the definition varies from state to state, it is an essential piece of underwriting and eligibility. In Montana, pre-existing conditions are judged by the objective standard, which takes into account any previous care or consultation received for a condition prior to applying for a health plan. Once a person has been decided as one with a pre-existing condition, it is likely that several things take place. One is that the individual is denied a plan (unless they are under 19, then it is illegal), another is that they sell the plan for a higher premium rate and add on a few asides.

Montana permits the use of elimination riders, which represent that the insurer will never pay for care related to the pre-existing condition as long as you have a plan with them. They also have the right to issue an exclusion period, which is more temporary exemption from covering such care, for a maximum of 12 months. One plus, which can be a rare occasion, is that previous health plans with no outstanding bills or breaks in coverage can count as a credit towards care received during the exclusion period, if an individual switches carriers. The amount of credit is decided by your plan and your insurer.

Thanks to the Affordable Care Act, there is another way to get affordable health insurance if you have a pre-existing condition. The ACA set up the Pre-Existing Condition Insurance Plan (PCIP) for qualifying individuals and the plan is state-run in Montana. Benefits are similar to a regular health insurance plan, and they offer a less costly options for individuals who have experienced issues with insurers due to a condition. At the end of 2013, PCIP plans will no longer be relevant, as they are an interim fix for the ACA’s law allowing all adults to receive care as of January 1, 2014. On that date, anyone who used a PCIP will be required to apply for a private health plan or a state health exchange.