Daniels Health Insurance
Facts and Figures
- Insurance
Carriers
9
- Number of
General Doctors
- Number of
Hospitals
Insurance Carriers
- Allegiance Life and Health
- American Family Life
- BCBS of MT
- Humana Ins. Co.
- John Alden
- New West Health
- Sterling Life
- Time Insurance
- United Health Care
State Government Insurance Programs Offered
Montana Affordable
Care Plan (MACP)
Federal program run by MCHA
www.mthealth.org
www.PCIP.gov
NOTE: In Helena, add extension
2128 to the 800 number.
MCHA: Comprehensive plans to
choose from, the primary differenc
is the annual deductible. Lifetime
maximum of $2,000,000. Waiting
periods for certain pre-existing
conditions may apply.
MACP: Covers broad range of
benefits, including primary and
specialty care, hospital care, and
prescription drugs.
Pre-Existing Health Conditions
Covered
MCHA: Must have lived in Montana for
at least 30 days, cannot be eligible
for COBRA or any other government
programs (except “endstage renal
disease” covered under Medicare),
must prove denial of coverage by 2
insurance companies due to qualified
pre-existing conditions or proof of
offer paying 150% higher premium
than MCHA. Trade Adjust Assistance
(TAA) beneficiaries have same
requirements but must have at
least 3 months prior coverage, else
a 12-month pre-existing waiting
period may apply. HIPAA-eligibles
also qualified.
MACP: Must be a U.S. citizen or
lawfully present in the U.S. and
have been uninsured for at least 6
months prior to applying. Must be a
Montana resident. Must have had a
problem getting insurance due to a
pre-existing condition
www.dphhs.mt.gov
(Search: Medicaid)
Among the services the
Montana program may cover:
Treatment by physicians,
Nurse practitioners,
Nurse midwives, Dentists,
Denturists, Podiatrists,
Lab services and x-rays,
Inpatient hospital visits,
Outpatient hospital visits,
Family planning, Nursing
facilities, Home health care,
Durable medical equipment;
Outpatient drugs, Mental
health, Ambulance, and
Eyeglasses.
Pre-Existing Health
Conditions Covered
Must be a Montana resident
and U.S. citizen or qualified
legal alien.
Income limits:
Pregnant women: 150% FPL
with asset limit of $3,000.
Children under age 19: 133%
FPL.
Parents/caretakers living with
children ages 0–18: 56% FPL
Aged, blind, and disabled:
75% FPL with asset limit of
$2,000 for singles; 83% FPL of
with asset limit of $3,000 for
couples
Medically-needy: $625 per
month, with asset limit of
$2,000 for singles and $3,000
for couples.
hmk.mt.gov
Physician, Inpatient and
outpatient hospital services, Routine
sports or employment physicals,
General anesthesia services, Surgical
services clinic and ambulatory
health care services, Prescriptions,
Laboratory and radiological services,
Inpatient, outpatient, and residential
mental health and substance abuse
services, Dental, Vision exams,
Eyeglasses, Hearing exams.
: Must be U.S. citizen or legal
qualified alien and resident of
Montana. Must be children under
age 19. Must not be eligible for
Medicaid, or currently insured, or
covered by health insurance in the
past 3 months (some employment-related exceptions apply). Parents
must not employed by the state of
Montana. Income limit of 250% FPL.
wic.mt.gov
Nutrition education and services,
breastfeeding promotion and
education, monthly food prescription
of nutritious foods, and access to
maternal, prenatal and pediatric
health-care services.
Pre-Existing Health Conditions
Covered
Must be a Montana resident, and
a pregnant woman, a breastfeeding
woman, or a woman who recently had
a baby, or child 0–5 years old. Must be
determined by a health professional
to be at nutritional or medical risk.
Income must be at or below 185% FPL
www.medicare.gov
Medicare offers Part A, inpatient
care in hospitals and rehabilitative
centers; Part B, doctor and some
preventive services and outpatient
care; Part C allows Medicare benefits
through private insurance (Medicare
Advantage); Part C includes Parts A,
B, and C not covered by Medicare.
Part D covers prescription drugs.
SHIP is a Medicare counseling
service.
Pre-Existing Health Conditions
Covered
Must be U.S. citizen or
permanent U.S. resident, and:
1) If 65 years or older, you or your
spouse worked for at least 10 years
in Medicare-covered employment,
or
2) You have a disability or end-stage renal disease (permanent
kidney failure requiring dialysis or
transplant) at any age
Heath Care Reform
Small business tax credits. 26,000 small businesses in Montana could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 13,600 Medicare beneficiaries in Montana hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Montana who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 15,900 people from Montana retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 512,000 Montana residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 79,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Montana peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 433,000 residents of Montana with health insurance from their employer, along with anyone who signs up with a new insurance plan in Montana.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 4,340 individuals in Montana who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $15.8 million federal dollars are available to Montana starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 81 Community Health Centers in Montana but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 23% of Montana’s population who live in an underserved area.
New Medicaid options for states. For the first time, Montana has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.