Montana insurance law and regulation
News that affects your health insurance and planning
June 2, 2019 – Status of alternative non-ACA health plans: Montana does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
11/24/2018 – The Montana Department of Public Health and Human Services (DPHHS) was awarded a $3.2 million federal grant and the MHCF pledged up to $1.2 million in funding each year in 2019 and 2020 to launch the Perinatal Behavioral Health Initiative (PBHI), with support expected to continue through 2023. The $5 million help pregnant and postpartum women with behavioral health issues such as mental health disorders and substance abuse.
The history of health care planning in Montana (Information is outdated and links may be expired)
12/23/2015 About 54,000 Montana residents enrolled for 2016 health insurance coverage through the federal insurance exchange. About 8 out of 10 applicants received premium subsidies and most of the enrollees paid less than $75 per month for their coverage after the subsidies. The statistics show that the insurance exchange is more effective for lower income individuals but not so effective in meeting the needs of higher-earning working class residents.12/12/2014 Blue Cross Blue Shield of Montana will pay $1 million to settle a large number consumer complaints.
12/8/2014 – Average premium rates for the cheap “bronze” plans have increased by 3.9% for 2015. Premiums for the middle-of-the-road “silver” plans have increased by an average of by 4.1% over the previous year.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Montana residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross and Blue Shield of Montana is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
1/5/2012 Montana residents are increasingly concerned about the lack of affordable health insurance plans. Most of the nation’s largest and most popular low cost health insurance plans have withdrawn from Montana due to state regulatory restrictions than those in other states. For now we recommend Smart Short Term Medical until other options become available.
11/7/2011 Montana opened its Children’s Health Insurance Program (CHIP) to more than 500 kids of low-income and part-time state employees, an option that was prohibited until the passage of the 2010 health-care law. The program is jointly financed by the state and the federal government to provide coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.
7/10/2011 The U.S. Center for Consumer Information and Insurance Oversight announced that Montana lacks proper resources or authority in the individual or small-group health insurance market to effectively review large rate increases as required by federal law. The federal government will temporarily take over the task of reviewing both individual and small business health insurance rate increases that are greater than 10%.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the month the calendar month before the birth month of the child . All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
12/16/2010 Montana Office of the Commissioner of Insurance and Securities officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Office of the Commissioner of Insurance and Securities said that it would: 1) Conduct several public processes with Stakeholders Involvement Council including interagency work group for program integrations, information technology staff and public comment opportunities, 2) Conduct a demographic scan of current population to ascertain information including insurance and socioeconomic status, 3) Assess resources and capabilities such as available staff, contracting, updated software, and 4) Determine necessary legislation to be implemented when appropriate.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Montana is now available at Freedom Benefits.
4/8/2010 Montana residents covered by Assurant Health are expected to face premium increases following a settlement this week between Time Insurance Company and the Montana Commissioner of Securities and Insurance for offering low priced coverage below the minimum requirements of Montana Law. Insurance Commissioner Monica Lindeen objected to the lower priced basic health insurance policy from Time Insurance because it did not providing coverage to women for prenatal care and pregnancy, mammography, reconstructive breast surgery, diabetes management and care, and severe mental illness. Assurant will pay a settlement of more than $300,000 and replace its lower cost policy with a more expensive policy that includes the cost of the settlement plus anticipated future claims due to the additional state mandates. No estimate of the required premium increase but we expect that 2011 premium rates will rise about 5% due to this settlement with the state plus an additional amount for medical inflation and other actuarial factors. Our experience indicates that the majority of Montana’s health insurance buyers prefer a lower cost policy without the additional mandates that are available in most other states. Montana residents, even more than residents of other states, tend to object to government regulators dictating the insurance provisions they must be included in the policies that they elect to purchase. Even though more freedom in choosing insurance benefits is available in most other states, at this time residents of Montana face significant obstacles purchasing more affordable coverage that is offered in another state. The recently passed federal health insurance reform legislation will remove this obstacle by effectively removing this power from the state. Montana consumers will not benefit from the federal law change until 2014. Until then all Montana residents and insurance companies offering coverage in Montana must pay the cost of the state’s mandates regardless of the need or desire to obtain maternity, diabetes and mental health care benefits.