A Guide to Health Insurance in Montana (MT)

Understanding Montana Health Insurance and the protections it provides is important because you need to protect your health, and that of your family. And yet at the same time you don’t want to spend fortunes on doing so, and hence getting an appreciation of the costs that you face even if you have good health insurance in Montana is also important.

There are three primary out of pocket expenses related to medical care that you are going to face even if you have a comprehensive insurance policy:

1/ Deductibles

This is an amount that is ‘deducted’ from the amount that your insurance company will pay out to meet your bills.

This is usually a flat fee and not a percentage, so the good news is that regardless of whether your medical bill comes to $10,000 or $50,000, in most cases you are going to pay the same amount of deductible, which might typically be a couple of hundred dollars.

Deductibles can be a bit confusing, because often you will find that certain treatments are eligible to be paid in full by your Montana Health Insurance Company, and are not subject to any deductibles.

This is often the case with preventative treatments such as certain childhood vaccinations, cancer screenings, annual check-ups and mammograms.

In order to check exactly what is covered you should read through your policy carefully.

You may also find that if you have a family policy that there may be two types of deductibles that are applied. An ‘individual deductible’, and a ‘family deductible’ and there may well be different terms and conditions for each so you need to read the details thoroughly.

2/ Co-Payments

This is an amount that you will have to pay out every time that you go for medical treatment.

This is typically much less than the deductible, and is generally set around $30 or $35.

So, for example, if you have to visit the Doctor because you suspect your child has flu, then you will have to pay this each time that you go to the surgery.

Often times your Individual Montana Health Insurance or Group Montana Health Insurance will set down the specifics of how this should be paid, which will usually be in person to the Doctor themselves, before receiving the treatment.

There can be variations in how much co-payments cost though depending on the type of Doctor that you are seeing. For example there may be one level set for going to see a general practitioner, but a different (higher) level set if you are going to see a specialist or visit en emergency Doctor.

3/ Co-Insurance

This is another area of health insurance in Montana that can be confusing, but essentially co-insurance is the percentage of the cost of the medical bill that you have to pay even after you have met the deductible.

With many types of insurance this is set at 80/20, so that the insurance company pays 80% of the bill, whilst you pay 20% after the deductible has been met.

There are many factors that can affect co-insurance and a very common one is the physical location of the hospital where you choose to actually have any medical treatment.

Most policies will stipulate networks of hospitals which they have special arrangements with and the co-insurance percentage will often vary depending on whether you use these or hospitals that are outside the network.

The reason for this is that hospitals in the network have already worked out pricing and bulk discounts with your Montana Health Insurance Company, and so the insurance companies are keen to encourage the holders of their medical plans to use them.

Another factor that can affect co-insurance percentages is the sort of treatments that you are receiving.

There will often be maximum co-insurance amounts and out of pocket expenses that are set down in many policies, above which the insurance company will meet all of the expenses for the rest of the year.

These can still be reasonably high (for the average family budget), but do at least ensure that if you end up having to have open heart surgery, or some other surgery that costs $500,000 plus, that you don’t have to pay 20%, but rather just a few thousand.

You should check with your insurance company exactly when your policy starts and finishes (so that you know what they consider to be ‘the year’), and what the annual out-of-pocket expense limits are.
Clearly the lower the limits, the more desirable the policy.

You should still make sure to regularly check Montana Health Insurance Quotes to make sure that your policy has stayed competitive, and to see if there are any improved policies out on the market.


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