Montana Health Insurance
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Place in State
Health Report Card 25th
- Insured 815,556
- Uninsured 153,500
Primary Care Physicians 1870
Average Cost of
Health Insurance* $583
- Employer-sponsored health insurance 55%
- Private plans 10%
- Medicaid 14%
- Medicare 19%
- Others 2%
Smoking among Montana adults hasn’t changed for the past ten years. There are still 144,000 making up 18.8 percent of the adult population.
Preventable hospitalizations went down from 67.0 to 60.8 discharges per 1,000 Medicare subscribers in the past year.
Children living in poverty went down from 21.0 percent to 19.2 percent of those under 18 years and below.
Diabetes went up from 5.7 percent to 7.0 percent among adults in the last five years.
During the last ten years, the number adults increased from about 122,000 to 180,000.
Montana health insurance plans are required to be sold with a guaranteed renewability clause. With this, subscribers can renew their coverage as many times they want as long as they keep up with their premium payments and they do not violate their contracts. Health insurers are also prohibited from canceling coverage based on a client’s failing health. All newborn or newly adopted children are automatically covered for up to 31 days under their parent’s health insurance as long as their policy covers dependents. This should give parents enough time to look for a more long-term solution. When writing new Montana health insurance plans, insurers can exclude coverage for a pre-existing condition. This exclusion usually cannot last for more than twelve months. However, insurers can exclude a condition permanently by using an elimination rider. Health insurers in Montana are permitted to decline coverage to new applicants based on age, health, family health history, or any other related factors. In addition, they are required to offer an alternative state-specified standard coverage package to successful applicants. Montana regulations require that at least two different health insurance options must be available to small businesses operating in the state. Businesses with 2 to 50 employees are qualified to access group health plans available to other small businesses in the state. Small businesses with group health coverage may be required to satisfy conditions set by the insurers. Requirements like a minimum number of participants and minimum employer contribution, must be met in order to avoid cancellation of the group plan. Montana health insurance quotes for group coverage can vary according to the risk factors of its members. Health coverage for small businesses cannot be cancelled based on a group member’s deteriorating health. However, the cost of continued coverage may be raised based on this factor. Self-employed individuals do not have access to the same group health coverage available to small businesses. It may be necessary for them to purchase an individual health insurance instead. Fortunately, holders of individual health plans can deduct a portion of their premiums from their tax liability.
With the new health care law, children under the age of 26 can choose to stay under their parent’s Montana health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Montana, 8,389 young adults have insurance coverage through this provision as of June 2011.
With the new health care law, 11,500 Medicare policyholders in Montana received a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 10,415 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plan when they hit the donut hole. An average of $615 per person or a total of $6,409,940 was saved in Montana.
The Pre-Existing Condition Insurance Plan is now available for previously uninsured individuals without health coverage because of a pre-existing condition. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 280 individuals in Montana have benefited from this new law.
When looking at Montana health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. All 277,000 private policyholders in Montana will get greater value for their premium payments because of this 80/20 rule.
Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Montana health insurance with no deductibles or co-pays. In 2011, more than 115,000 million Medicare subscribers and 166,000 individuals with private policies received such services in Montana.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 319,000 residents in Montana have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Montana received a total of $1 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Montana, 83 community health centers received a total of $9.6 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Montana has already received a total of $3.9 million to support its policies, programs, and communities to help its residents lead healthier lives.
Montana Comprehensive Health Association (MCHA)
Montana Comprehensive Health Association (MCHA) offers coverage to qualified individuals living in the state who are deemed uninsurable because of a medical condition. Those leaving group coverage may also avail of this plan. Coverage for this plan include hospital care, diagnostic tests, x-rays, physician care, prescription drugs, and several other services. Eligibility 1. Must live in Montana. 2. Must have a qualified health condition.
Medicaid www.dphhs.mt.gov (Search: Medicaid)
Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Among the services covered under Medicaid include inpatient and outpatient hospital visits; laboratory services and x-rays; physicians, dentists, denturists, podiatrist, nurse midwives, and nurse practitioners services; durable medical equipment; family planning; home health care; ambulance; eyeglasses; nursing facilities; mental health; and outpatiet drugs. Eligibility: 1. Must be U.S. citizens or legal residents living in Montana. 2. Must not exceed income limits: Pregnant women: 150% of the federal poverty line (FPL) with assets not exceeding $3,000. Children 0 to 18 years: 133% of the FPL. Parents and caretakers living with children 0 to 18 years: 56% of the FPL. Aged, blind, and disabled: Singles should earn 75% of the FPL with assets not exceeding $2,000; Couples should earn 83% of the FPL with assets not exceeding $3,000. Medically-needy: Earning $625 a month, assets should be limited to $2,000 for singles and $3,000 for couples.
Healthy Montana Kids (HMK) hmk.mt.gov
Healthy Montana Kids is the state’s Children’s Health Insurance Program (CHIP) for children under 19 years. The program offers comprehensive health coverage. Benefits are based on the type of program the child is under. Some of the services included are: hospital, surgery, emergencies, prescriptions, doctor visits, check-ups and immunizations, vision and hearing, dental, and mental health. Eligibility: 1. Must be a U.S. citizen or qualified residents living in Montana. 2. Must be uninsured, or without health insurance for the past 3 months. 3. Must be below 19 years. 4. Must have an income not exceeding 250% FPL. 5. Must not be eligible for Medicaid.
Women-Infant-Children (WIC) wic.mt.gov
Women-Infant-Children (WIC) offers assistance to low-income pregnant, breastfeeding, and non-breastfeeding post-partum women; and children five years and below who may have nutritional deficiencies. The program offers offers free health screening, supplemental food, nutrition assessment and education, breast-feeding support and education, among others. Eligibility: The program is available to pregnant or post-partum women and children aged 5 years and below. Women and children must be residents of Montana, must be at risk nutritionally or medically, must meet income requirements.
Medicare (Age 65 and up) www.medicare.gov
This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.
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