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Small Business Employee Benefits and HR Blog

Montana Health Insurance Exchange Guide

This guide provides an overview of the Montana Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Montana residents and small businesses.

Montana Health Insurance Exchange Introduction

Montana Health Insurance Exchange

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.

All states have three options for setting up a state health insurance exchange for 2014:

  1. Build a state-based exchange
  2. Enter into a state-federal partnership exchange
  3. Default to a federally-facilitated exchange

Montana will default to a federally-facilitated health insurance exchange, however Montana will maintain oversight of the plan management functions.

Montana Health Insurance Exchange - History

Originally, Montana introduced legislation to establish a state-based health insurance exchange, however two bills (HB 620 and HB 124) failed to pass. A third piece of legislation was introduced in 2011 to prohibit the establishment of a state-based exchange (SB 228). This bill passed, but was vetoed by Governor Brian Schweitzer. Eventually, a joint resolution was issued to allow a committee to evaluate implementing a state-based exchange. 

Despite these efforts, however, Montana announced on December 9, 2012 that Montana would default to a federally-run health insurance exchange. Montana received approval to maintain control over the plan management functions of the Exchange, meaning they will have full authority to review their state health insurance exchange rates and carriers.

Montana Health Insurance Exchange - What is It?

The Montana Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013 Montana residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 185,904 or 22% of Montana’s non-elderly residents are uninsured, of whom 169,491 (91%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Montana participates in Medicaid expansion.

Click here for information via healthcare.gov.

Montana Health Insurance Exchange - What Plans will be Available?

All plans offered through the Montana Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).

On May 16, 2013, the Montana Insurance Commissioner Monica Lindeen announced three (3) health insurance carriers plan to sell plans through the Montana Health Insurance Exchange:

  • Blue Cross Blue Shield of Montana

  • PacificSource Health Plans 

  • Montana Health CO-OP

All health insurers intending to sell insurance on the Montana Health Insurance Exchange were required to file their forms by May 15, 2013. Insurance carriers and plans will be finalized by August. (See Commissioner's press release here.)

Montana Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Montana Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange, and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Montana Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). 

The Montana Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Montana.

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