Madison Health Insurance

Facts and Figures

  • Insured 0
  • Uninsured 0
  • Insurance
    Carriers
    9
  • Number of
    Primary Care Physicians
  • Number of
    Hospitals

Insurance Carriers

  • Allegiance Life & Health
  • American Family Life
  • BCBS of MT
  • Humana Ins. Co.
  • John Alden
  • New West Health
  • Sterling Life
  • Time Insurance
  • United Health Care

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. 

State Government Insurance Programs Offered

Montana Comprehensive Health Association (MCHA) www.mthealth.org 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

Medicaid 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.

Healthy Montana Kids (HMK) 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.

Women-Infant-Children (WIC) 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

Medicare (Age 65 and up) 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

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email [email protected]