Alternative Coverage Options
If you choose not to enroll in the State of Montana Benefit Plan as a retiree, there are alternative coverages available. Many retirees have had State Plan coverage for years and aren’t aware of other available options. A lot has changed in the health insurance market, 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.
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.
not yet medicare eligible but are unable to work?
Public Consulting Group can assist!
The State Plan has partnered with Public Consulting Group (PCG) to assist retirees with applying for Social Security Disability Insurance (SSDI) and early Medicare coverage. This service applies to State Plan members who are experiencing health conditions that would prevent them from working full-time. These services are paid for by the State, with no cost to you. PCG is a nationally recognized leader in Social Security disability advocacy and has been successful with helping plan members navigate through what can be a complex process.
If you, or your dependents, are interested in learning more about these services, PCG is ready to answer questions and provide you with assistance. Call (800) 805-8329 or email disability@pcgus.com.
Coverage Considerations
Premiums: Coverage sold through the Health Insurance Marketplace or Medicare Supplements may be less expensive than State Plan coverage.
Preexisting Conditions: Non-Medicare Eligible 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 verify 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, or out 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 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 or facilities may have high cost-sharing. Be aware of how going out-of-network or using non-participating providers or facilities could affect you.
Non-Medicare eligible alternative coverage options
If you are not eligible for Medicare, you may be able to get coverage through the Health Insurance Marketplace that costs less than State Plan Retiree coverage.
- Certified Insurance Agents or Certified Exchange Producers (CEPs) are registered Montana Insurance Agents who have taken special training to understand the Health Insurance Marketplace. CEPs are found throughout the state.
- Certified Application Counselors (CACs) are health care provider staff who have been trained to help people understand, apply for, and enroll in insurance coverage through the Health Insurance Marketplace. You will find these individuals in hospitals and community health centers throughout the state.
- Navigators are public advisors who help people compare the health insurance options on the Health Insurance Marketplace website. Navigators have taken Federal and State training and have been fingerprinted and undergone a Montana background check.
You should consult only with insurance professionals who are certified by the Montana Insurance Commissioner. For assistance finding an expert in your area, contact the Office of the Commissioner of Securities and Insurance at (800) 332-6148 or go to csimt.gov.
Medicare eligible alternative coverage options
If you are eligible for Medicare, you do not qualify for a plan on the Health Insurance Marketplace, but you might want to consider Medicare Supplemental Insurance or Medicare Advantage Plans.