With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Montana, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Montana
Montana placed 22nd in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include low prevalences of obesity and diabetes, low levels of air pollution, and a low rate of cancer deaths. Challenges Montana faces include a high prevalence of binge drinking, a high percentage of uninsured population, and limited availability of primary care physicians.
Montana individual and family health insurance
Montana opted for a federally facilitated health insurance exchange, as opposed to forming a state or partnership exchange. Individuals and families who live in Montana may shop for and enroll in qualified health plans through the federal marketplace website. Those who buy coverage through Montana’s federally facilitated exchange may be eligible for income-based premium tax credits and cost-sharing subsidies when they do. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Montanans can also buy qualified health plans away from the Obamacare exchanges in the private marketplace.Websites such as HealthCare.com can help consumers find affordable coverage that meets their healthcare needs. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Montana’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 36,584 individuals in Montana selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Montana enrolled in a marketplace plan increased to 54,266 during the open enrollment period.3
|Montana’s health insurance exchange:||healthcare.gov|
|Montana department of insurance:||csi.mt.gov|
Montana small group health insurance plans
Small businesses with 50 or fewer employees can find group coverage options through the SHOP portal, which is accessed through the federal Health Insurance Marketplace website. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Montana’s federally facilitated exchange.
Montana state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Montana does not have a mini-COBRA or small group COBRA continuation law.
Montana high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated. 4
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).5
Montana has not expanded Medicaid to low-income adults without dependents.6 In 2014, a coverage gap was created in states where Medicaid was not expanded. This coverage gap includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
The information below is specific to Montana’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Montana Public Health and Human Services|
|Where to apply||apply.mt.gov|
|Additional application options||dphhs.mt.gov/medicaid|
|Open-enrollment period||Year-round in all states|
|Eligibility7||Montana residents and U.S. citizens or qualified non-citizens; must meet financial requirements that take your income and resources into account; additional full or basic Medicaid eligibility requirements apply based on age and life situation|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Montana’s health insurance program for low-income children:
|Program name||Healthy Montana Kids|
|Where to apply||apply.mt.gov|
|Phone number||877-KIDSNOW (877-543-7669) / TTY — 711|
|Eligibility8||Children up to age 19 who are Montana residents and U.S. citizens or qualified non-citizens; income guidelines for household size apply|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
5 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
6 Centers for Medicare & Medicaid Services. “Montana.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/montana.html.
7 Montana Public Health and Human Services. “Health Care Coverage: Are You Eligible.” http://www.dphhs.mt.gov/medicaid/eligibility.shtml#basic.
8 Montana Department of Public Health and Human Services. “About Healthy Montana Kids.” http://www.dphhs.mt.gov/hmk/abouthmk.shtml.