Alternative Coverage -Things to Consider
Many retirees have had State Plan coverage for years and aren’t aware of other available options. Much has changed in the health insurance market in the last few years including the cost, benefits, and availability of private and marketplace plans. Please take the time to educate yourself and find the best insurance option for you and your family.
Please note: If you elect to terminate State Plan coverage for any reason, you will not be eligible to return to the State Plan in the future. Once you terminate coverage, you are no longer eligible for the State Plan.
Here are a few things to consider choosing coverage.
- Premiums: Coverage sold through the Health Insurance Marketplace (under 65) or Medicare Supplements (over 65) may be less expensive than State Plan coverage.
- Preexisting conditions: Non-Medicare (under 65) Retirees CANNOT be denied coverage or charged more for coverage because of preexisting conditions for plans on the Health Insurance Marketplace.
- Providers: If you’re currently getting care or treatment for a condition, a change in your health insurance may affect your access to a particular health care provider. You should see if your current health care providers will accept any new insurance coverage you consider.
- Service Areas: Some plans do not have extensive out of state healthcare provider access. You should check out of state provider 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 available in the Health Insurance Marketplace have narrower provider access, but those plans are often cheaper.
- Drug Formularies: If you’re currently taking medication, a change in your health insurance may affect the cost of your medication – and in some cases, your medication may not be covered by another insurance plan. Make sure you check if your current medications are listed in the drug formularies for other health insurance coverage.
- Other Cost-Sharing: In addition to premiums or contributions for health insurance coverage, be sure to consider copays, deductibles, coinsurance, and other cost sharing amounts when comparing insurance options. Cost sharing can vary significantly among different plans, 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 much higher deductible, coinsurance and maximum out of pocket.
- Out-of-network: Healthcare services from out-of-network providers may have high cost-sharing. Be aware of how going out-of-network or using non-participating providers or facilities could effect you.
Alternative Coverage FAQs
What if I sign up for the State Plan in retirement, but later decide to enroll in a different plan? If you would like to leave the State Plan, you must contact the Health Care and Benefits Division prior to the 1st of the month in which you would like your coverage to end.
Phone: (800) 287-8266
Address: Health Care & Benefits Division
PO Box 200130
Helena, MT 59620-0130
What if I leave the State Plan but later want to come back? Retirees who leave the State Plan after January 1, 2017, will not have an opportunity to re-enroll at a later date. Once a Retiree terminates State Plan coverage, they are no longer eligible for State Plan coverage.
What if I’m in a VEBA? The Affordable Care Act (ACA) regulations state participation in a VEBA may potentially disqualify participants from becoming eligible for a premium tax credit to purchase qualified health insurance from the Health Insurance Marketplace. If you are a State of Montana VEBA participant, please contact the State of Montana’s VEBA administrator, Rehn & Associates, at (800) 872-8979 to inquire about your options.