A Medicare Advantage policy is a type of private health insurance plan which replaces your federal Medicare benefits. For this reason, you may have also heard of it referred to as “Medicare replacement”. Replacing your Medicare with a Medicare Advantage plan can grant you access to equal or better coverage than you would be getting with Medicare Parts A and B alone. You will also gain the advantage of managing all of your health benefits under a single policy, rather than dealing with Medicare separately from your Medicare supplement insurance.

Federal Regulations for Medicare Advantage

By federal law, your Advantage plan must provide you with equal or greater benefits than those which are already available through Traditional Medicare. Most Advantage plans will offer more coverage though, in order to protect seniors from costly gaps in Both Medicare Parts A and B. You will likely also be given additional options, which we will discuss in detail below.

Medicare Advantage Enrollment In Montana

Montana seniors are on the lower end of the Medicare Advantage spectrum, with only 20% of retirees who are enrolled in Medicare choosing to replace their benefits with an Advantage plan. But not all plans are created equal – they vary in popularity, which you can see from the chart below:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in Montana means that you will pay a significantly different rate than someone living in New York or California. We’ve gathered some data and compiled it into the chart below. Keep in mind that these are estimates, and the rates you see may be different based on your personal circumstances.

Most Popular Medicare Advantage Plans in Montana

If you are wondering how the Medicare Advantage plans in Montana rate, check out Medicare’s Overall Star Rating program. Medicare collects information and data on every company that offers Medicare related goods and services and rates them on performance. The more stars a company gets, the better the performance. For companies offering health care services, like Medicare Advantage plans, Medicare considers five areas of performance when assigning stars. Those areas are how effectively the company uses preventive techniques like screenings and tests, their management of chronic diseases, the satisfaction of members and member complaints, changes in performance ratings, and customer service. You can browse the results for Montana and get a unbiased opinion of the companies you are considering.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Make sure you do your research before selecting your provider network. Talk to your doctor in order to find out if they belong to any specific networks, and whether or not you can afford that specific network in your Medicare Advantage plan. You should also have some contingency plan in place should your preferred doctors and/or facilities suddenly no longer be included in your plan.

Where you generally need to get your care and services from for:

  • HMO Plans – If you select a Medicare Advantage plan that offers an HMO, your choices of healthcare providers and facilities will be limited to those in the HMO network. These networks are extensive and include a wide array of specialists and support facilities like labs, imaging, rehab centers, and more. A few HMO plans may offer a Point of Service option that allows the use of providers out-of-network but this is typically a very expensive option.
  • PPO Plans – A Medicare Advantage plan set up as a PPO also has an extensive network. The difference between an HMO and a PPO is a PPO will allow you to select any doctor of your choice in or out of the network, providing the doctor accepts your plan. Be prepared to be charged a higher copay for an out-of-network healthcare provider.
  • PFFS Plans – With a Private Fee For Service (PFFS) plan you can see any doctor who accepts Medicare and your PFFS plan. Not all will. You can see any specialist without a referral from a primary care doctor. It is your responsibility to confirm the doctor you are seeing does in fact accept your plan.You need to confirm this each time you make an appointment.
  • Special Needs Plans – If you qualify for a Special Needs Plan, your choice of providers will typically be limited. A SNP is a Medicare Advantage Coordinated Care Plan (CCP) that operates a network of healthcare providers that specialize in the condition that qualified you for a SNP. While your choices will be limited, they are all specialists in treating your condition.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan

  • HMO Plans – If you are joining an HMO you won’t have to worry about finding a doctor, the doctor comes to you. Because you are limited to using only providers in the HMO’s network, and because your primary care physician is the one who refers you to specialists and other resources, you’ll always be dealing with a provider who accepts your plan.
  • PPO Plans – Almost all PPO plans have online directories allowing you to see their member physicians and facilities, where they are located, specialty, bio, and even a patient rating. Additionally, if you already have doctors you would like to use, but they are not in the network, you can continue to use them provided they accept your plan.
  • PFFS Plans – The Private Fee For Service plan may be the most difficult to locate doctors that you can work with. Some PFFS plans have networks but it’s important to confirm that those physicians and facilities still accept the plan. Even if you can confirm acceptance, always re-confirm when you are making an appointment.
  • Special Needs Plans – If you have a Special Needs Plan, your choice of physicians is limited to those in the Medicare SNP Network. So, like an HMO, finding a doctor is not a problem because you can only see doctors who are in the network.

For many Montanans, finding a doctor that accepts their Medicare Advantage plan is a big concern. The good news is, you can see who is in the plan’s network using a system similar to Medicare’s physician search tool. Checking out providers before you make a buying decision can make the whole process much less stressful.

Drug, Vision and Dental Coverage

Dental care is not covered by Medicare. But many Medicare Advantage programs do offer a basic dental care benefit. These benefits are typically limited to routine exams, including the cost of x-rays, cleaning, and fillings. Other dental work like crowns, veneers, root canals, and dentures are not covered. Your plan’s directory will provide a list of participating dentists.

Eye care is another area that Medicare doesn’t help with except in the case of exams associated with diabetes or Age Related Macular Degeneration. Most Medicare Advantage plans do offer a form of Eye care. The benefit typically includes an annual eye exam, lenses, glasses, and contacts. Other services may be offered to plan members at a discount. Participating optical shops can be found on the plan’s directory.

Enrollment Options & Best Time To Enroll

Finding a Medicare Advantage provider who will cover you is relatively easy if you are within your Initial Enrollment Period (IEP). But if you wait to enroll, the more information your provider will require before they agree to cover you. And seniors with a costly pre-existing condition, such as ESRD, my find it difficult to get coverage at all. If you need help finding a provider who will cover you, try contacting your local insurance aged (or your state department of insurance). You can also get more information on our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

For the best value in Medicare Advantage plans, it’s important for you to understand what kind of coverage you are likely to need and what kind of budget you can afford. Do your homework. Look at the providers that are in each plan to ensure there are specialists that fit your needs. If the plan includes Part D coverage, check their formulary to ensure they carry the meds you need. Premiums are important but they are not everything. Consider the company’s financial stability, customer service, and reputation, and the time it has been serving your area.

You want to make the right choice the first time. If you become unhappy with your plan, dropping it can become problematic because of certain enrollment period rules. The perfect plan is out there, you just need to do a little work to find it.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.