The 2010 passage of The Patient Protection and Affordable Care Act has caused each of the states to re-evaluate existing insurance regulations to ensure compliance with national law. Some of the biggest changes will be in how insurers are allowed to handle the matter of pre-existing conditions. National law already prohibits the exclusion of children from coverage based on pre-existing conditions, and adults will be given the same protection in 2014. Additionally, children may now remain on their parents’ health coverage up to age 26 regardless of their status as students or even if they have married.
General Insurance Regulations
Insurers in Montana offer a guarantee of renewal if the policy premiums are being paid on time. Currently, exclusions for pre-existing conditions are allowed for up to 12 months, and the look-back period is 3 years. Newborns and adopted children must be covered for a minimum of 31 days.
Insurers are required to stipulate a subsidized plan option in addition to any commercial plan that is offered to an applicant. Existing health insurance plans cannot be canceled or denied renewal based on health status.
Creation of Health Care Exchanges
Like many states, Montana is evaluating its options to establish the federally required health care exchanges. In April 2011, Governor Brian Schweitzer vetoed a bill that would have prohibited any exchange established in the state from providing coverage for abortions. Currently, various agencies and committees are collecting data and studying the health exchange question with an eye toward reporting their findings in 2013. It is highly probable, however, that the federal government will wind up operating the Montana exchange in the end.
Pre-Existing Condition Insurance
The Montana Comprehensive Health Association administers the states Pre-Existing Condition Insurance Plan which offers primary and specialty care to qualified residents, as well as hospitalization and coverage for prescription medications. Premiums range from $210 to $681 a month with a deductible of $2,500 and an out-of-pocket limit of $5,950.
Medicaid
Eligibility for Medicaid is figured as a percentage of the Federal Poverty Level, the same standard applied to the distribution of monies from the Children’s CHIP-funded Medicaid Expansions. In Montana, infants under age one are Medicaid qualified at 133% FPL, ages 1-5 at 133%, and ages 6-19 at 100%. The last group is eligible for CHIP funds at 133% FPL.
Pregnant women may access Medicaid benefits at 150% FPL, parents at 36%, and disabled Social Security recipients at 74%.
The Montana Child Health Insurance Plan offers coverage to qualifying applicants below 150% of the federal poverty level. Some members may have to pay a small copay, but their overall charges cannot exceed $215 per year.
Medicare
There are 48 Medicare Prescription Drug Plans available in Montana, with 82% of Medicare recipients in the state accessing assistance to pay for their prescription drugs.
