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Alternative Coverage Options

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When can I enroll in Marketplace coverage?
The Open Enrollment Period for the Health Insurance Marketplace is November 15, 2014–February 15, 2015.  This is the time when you can sign up for coverage. You may not enroll outside of that timeframe unless you experience a qualifying event that triggers a special enrollment opportunity. Visit www.healthcare.gov or talk to a navigator, Certified Application Counselor (CAC), or certified exchange agent to learn more about Open Enrollment and to shop for plans.

What if I sign up for the State of Montana Health Plan, but later decide to enroll in a different plan?
You have until October 22, 2014 to sign up for the State of Montana Health Plan.  After November 15, 2014, if you have decided to enroll in a Marketplace plan or Medicare Suppliment, you have until December 31, 2014 to cancel your State of Montana Plan Coverage.

Retreat Rights for Retirees
Beginning September 2014 and going forward until further notice:
Retirees who leave the State of Montana Benefit Plan (State Plan) due to enrollment in another health plan offering “minimum essential coverage” as defined by federal law will have a one-time opportunity to return to the State Plan. This is called a Retreat Right.
Click HERE for more on Retreat Rights.

WARNING to VEBA Participants
The Affordable Care Act (ACA) regulations state that participation in a VEBA plan may potentially disqualify participants from becoming eligible for a premium tax credit to purchase qualified health insurance from the Health Insurance Marketplace.  If you have contributed to a VEBA account or are a VEBA participant, please contact the State of Montana’s VEBA administrator, Rehn & Associates, at (800) 872-8979 to inquire about your options.

Factors to consider when choosing coverage options

  • Premiums: The State of Montana retiree premiums for coverage have increased.  Coverage sold through the online Health Insurance Marketplace may be less expensive, however, the cost sharing may be significantly higher. 
  • Guaranteed Issue: Non-Medicare retirees cannot be denied coverage or charged more for coverage because of pre-existing conditions for plans on the health insurance marketplace.
  • Provider Networks: If you’re currently getting care or treatment for a condition, a change in your health coverage may affect your access to a particular health care provider.  You should see if your current health care providers participate in a network as you consider options for health coverage.
  • Service Areas: Some plans do not have extensive out of state healthcare provider networks.  You should check out of state network access if you travel for extended periods of time. If you move permanently to another area of the country, you will need to inform your insurer immediately and you may need to change your health plan or Medicare supplement coverage. Some health plans for sale in the Health Insurance Marketplace have narrower networks, but those plans are often cheaper.
  • Drug Formularies: If you’re currently taking medication, a change in your health coverage may affect your costs for medication – and in some cases, your medication may not be covered by another plan.  You should check to see if your current medications are listed in the drug formularies for other health coverage.
  • Other Cost-Sharing: In addition to premiums or contributions for health coverage, if you purchase coverage in the Health Insurance Marketplace, you will pay copayments, deductibles, coinsurance, or other amounts as you use your benefits.  The cost sharing varies significantly among the different plans offered in the Health Insurance Marketplace, so you should shop carefully for a plan that fits your health and financial needs. For example, one option may have much lower monthly premiums, but a much higher deductible, coinsurance and maximum out of pocket.  
  • Out-of-network: Healthcare services from out-of-network providers have very high cost-sharing in all individual health insurance plans.