The Federal Medicare Program is available to any senior citizen age 65 or above. During the year in which you turn 65 is the year that you enroll in the program (enrolling after you turn 65 could result in late enrollment fees and penalties). Once you are enrolled, you will begin receiving health care benefits from Medicare Parts A and B (also known as “Traditional Medicare”). The chart below outlines all of the benefits which Traditional Medicare offers. What it does not outline are the potentially expensive gaps in this coverage – but don’t worry, we’ll get to that part later.
Coverage and Benefits
Speaking of expenses, Medicare isn’t completely free. There are some basic fees associated with parts A and B. Part B expenses can be calculated according to the data on this page, but they are designed to be affordable for those retired individuals living on a fixed income. Part A might be free, but that depends on your previous employment history. Anything less than 10 years (or a total of 40 quarters) will, unfortunately, require you to pay a premium for Part A benefits. For those with a longer work history, this premium is not required.
As a Montana resident over the age of 65, you qualify to utilize Medicare coverage for your healthcare costs. Medicare Part A is free to any residents with 10 years of work history or 40 quarters of work over their lifetime. Part A coverage includes things like inpatient care, hospice care and some outpatient services. Medicare Part B is a more expanded coverage that includes more outpatient services, better medical equipment and more preventative care for a minor monthly premium.
If you want to go beyond the coverage offered by Medicare Part A and Medicare Part B, you can invest in Medicare Part C as well; a private insurance policy offered to Montana seniors with Medicare. If you have Parts A and B already, you can go through a private company to obtain Part C and get additional coverage including items you decide on like prescription drugs or dental care. Medicare Part D is another option worth considering that specifically offers prescription drug coverage to you. You must have Medicare Parts A and B in order to qualify for Part D as well, and it comes at an added monthly premium amount.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
The Different Types of Montana Medicare Plans
In the state of Montana, there are 177,835 seniors currently receiving their federal Medicare benefits. 17% of them (30,232 residents) have replaced their federal Medicare coverage with a Medicare Advantage policy. However, Medigap supplement policies are more popular in Montana: 50,954 seniors are supplementing their Traditional Medicare with such policies. The remaining 96,649 beneficiaries are likely managing their benefits through some other means, such as an employer benefit program, or relying on Traditional Medicare alone to manage their health care needs.
If you are approaching the age of 65 but have not enrolled in medicare yet, click that link to get the process started. Enrolling late could cost you in both time and money later on down the road.
Protect your Savings with Medicare Supplemental Health Insurance
Health care costs are rising at an alarming rate with virtually no relief in sight. For the most part, your Medicare benefits will protect you from the brunt of these costs. However, there are some dangerous gaps in Traditional Medicare coverage which, if you aren’t careful, will become 100% your financial responsibility. Some of these gaps can result in the following expenses:
|Medicare Part A Costs||Medicare Part B Costs|
Having Medicare coverage in Montana often isn’t enough to make medical costs easy to afford. The cost of quality health care is increasing annually, especially for seniors in Montana. With these ever-increasing costs to deal with, people often look for additional coverage options to help them limit out-of-pocket expenses for their care.
This is why an increasing number of seniors are choosing to supplement their Traditional Medicare with either a Medicare Advantage or a Medigap supplement policy. These are the two most popular forms of supplemental coverage available for retired persons 65 and older who are currently receiving Medicare benefits.
If you can’t afford your out-of-pocket healthcare costs, or you’re looking for a way to save even more, a supplemental health insurance policy is worth considering. These special policies add on to your standard Medicare policy and provide additional care without taking away from your basic Medicare benefits. With a supplemental policy you can lower your overall medical costs if chosen wisely.
Every Medicare policy has gaps that leave you with some costs that you have to cover yourself. When you get a supplemental policy, it can help with filling your Medicare coverage gaps. Some policies will leave you with no bill left over for your services, while many will leave you with a lower bill for you to cover after your basic Medicare coverage kicks in. Either way, a quality supplemental policy can help reduce your overall medical expenses.
Additional insurance policies for Medicare are powerful tools to help you reduce your unexpected insurance costs. If you’re concerned with how much money you’re expected to pay for these healthcare costs, you can use a Medicare Supplement plan or a Medicare Advantage plan to reduce your risk. Both plans offer additional coverage, but they do so in very different ways. Learn these differences and you’ll have a better idea of which policy is right for you.
Coverage Choice #1: A Medicare Supplement Plan
Medicare supplement insurance (usually referred to as Medigap) is designed to cover the “gaps” which are so common in Traditional Medicare. Private insurance companies and government Medicare experts have collaborated to create ten comprehensive health insurance policies which offer affordable coverage and protection from out-of-pocket expenses. Plans A-N (minus plans E, H, I, and J, which were discontinued in 2010) are now available and universal across all 50 states. Prices and providers will vary by region, however.
Here’s what type of coverage you can expect from each of the ten plans:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$108||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$111||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$93||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$92||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$76||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$92||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$67||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$73||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$43||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$97||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Coverage Choice #2: A Medicare Advantage Plan
Medicare Advantage can seem a little complicated, but we’ll attempt to clear up some of the confusion here. For starters, these policies act more like a replacement of Traditional Medicare than a supplement. However, as required by law, the private companies who underwrite these policies have to offer you the same or better coverage that Traditional Medicare; they cannot offer you any less. Some plans even include additional coverage options, such as prescription drugs or dental, for a modest additional cost. Also, for many seniors, the convenience of having all benefits under the same policy makes their life just a little bit easier.
You should keep in mind though that Medicare Advantage policies aren’t perfect. While they may be priced competitively in certain areas, this is likely due to a more restrictive network of physicians and hospitals. The possibility that you may have to switch doctors is highly likely. And once you sign up, you will be transferring responsibility for your health care from the federal government to that of a private company, which is more vulnerable to market whims. It is a good idea to do plenty of research on the stability of the company and the doctors available in their Advantage network before signing the dotted line on any new policy.
Depending on your area, your local Medicare Advantage plan will rely upon a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO) for your care. Getting care outside of either one of these networks could be costly.
More about Medigap Supplement vs. Medicare Advantage
The first difference between Medicare Advantage and Medicare Supplement is how the policy pays for your healthcare costs. With a Medigap plan Medicare is allowed to pay toward the health costs first and foremost. Once Medicare is done, the Medigap policy pays toward a portion of what is left. Then you are responsible for paying whatever is left if there is a bill left at all. The amount you pay depends on the Medigap plan you choose to get.
Whether you use a Medicare Supplement plan or an Medicare Advantage plan you’re getting coverage from a private company. Supplement plans are highly standardized by the government though, so you know what coverage you’re getting no matter what company you work with. Coverage amounts for each specific plan tier are the same regardless of the state you live in or insurance company that you work with. The only variable that you have to think about is the monthly premium that you’ll pay for that coverage, which makes comparing plans simple.
A Medicare Advantage plan is more comprehensive and more confusing to think about and work with. These plans will give you Part A and B coverage that you get with a Medicare Supplement plan, but they offer additional coverage as well. You get to pick and choose the coverage that you want and you can get nice features like dental or vision coverage for an added cost.
Pricing is very different between a Supplement plan and an Advantage plan. Supplement plans have fixed premiums every month and you know what costs you’re expected to cover for the services you get. Advantage plans have more variable premiums, more deductibles, more co-pays and more confusing terms and policies to try and figure out.
We’ve gone over the major differences between a Medicare Supplement plan and a Medicare Advantage plan, but there are additional differences as well. We take the time to answer the most common questions that people have about either of the two options down below. We can also answer additional questions that you have, or offer you guidance on choosing your own personal policy if you contact one of our representatives. Talk with us today and get the help you need for the ideal Medicare policy.
|Questions||Medicare Advantage||Medicare Supplement|
|How does each plan take care of your medical expenses?||With this plan your private insurance company determines your custom costs depending on where you live in Montana. You’ll get a custom premium, co-pays and other costs, and Medicare will pay a portion of those things for you. You are expected to pay the rest and your policy will cover your healthcare costs.||This plan covers some or all of your costs after Medicare pays its standard amount depending on how comprehensive your plan is.|
|Am I responsible for paying for Medicare Part B?||Yes||Yes|
|What are my expected costs?||Advantage plan costs are variable and depend on your policy, your location in Montana, and the care you need. You can’t predict what you will pay very accurately.||You’ll be expected to pay a set premium each month and to cover any leftover medical costs after your policy and Medicare pay the initial costs.|
|What does this plan cover for me?||Your Advantage plan covers Medicare Part A and Medicare Part B services and extras like vision or prescription drug coverage depending on the plan you decide on.||A Supplement plan covers just Original Medicare services.|
|Is this plan easy to budget for?||No, an Advantage plan is difficult to budget for because expenses change based on your health needs.||Yes, budgeting for a Supplement plan is easy, especially if you have one with no co-payments. You just pay the fixed premium costs.|
|Am I guaranteed coverage?||Unfortunately, you are not. You could lose your Advantage coverage if your company doesn’t want to cover you any longer.||Yes, you are. If you make your premium payments, you will receive coverage as long as your insurer is still in business.|
|Am I guaranteed to get this policy?||No, there is a pre-approval process that you must go through to get covered by most Advantage plans.||Yes, if you have Medicare you can get a Medicare Supplement plan.|
|Is there a care network I have to work with?||Yes, you will be locked into a specific network of doctors and hospitals that you can use for all your care.||No, you have your pick of any facility and professional that accepts Medicare insurance.|
|Which plan is the right one for me?||An Advantage plan is the cheaper option if you are healthy and you live in a city with many hospitals and professional caregivers to choose from.||A Supplement plan is best if you need frequent care, you’re older or you don’t have access to many different medical facilities or caregivers.|
Helpful Medicare Resources
This article contains enough helpful information to get you started on your search for the right supplement policy. But because the topic is so nuanced, it is difficult to provide enough information for everyone. For this reason, we’ve included the searchable directory below. It contains contact information for local Montana insurance experts in your area who are qualified to answer any questions you may have.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.