New carrier in Montana exchange
Assurant is joining the exchange in Montana for 2015, so residents will be able to select from four carriers when open enrollment begins on November 15. The three carriers that offered plans in 2014 are all continuing to participate in 2015: Blue Cross Blue Shield of Montana, PacificSource and the Montana Health Co-op.
The Montana Health Co-op was created under the co-op provisions of the ACA, and was one of the first seven co-ops to receive federal funding in early 2012. By mid-June, the Co-op had enrolled more than 12,000 members in Montana, and is expanding into Idaho for the 2015 open enrollment that begins in November.
And 2015 rate increase “historically low”
Across all carriers, the lowest cost bronze plan in the Montana exchange averages $251/month in 2014, which is very close to the national average of $249.
And things are looking good for 2015: In late August, the state announced that rates for 2015 would only be increasing an average of 1.6 percent for individuals (when combined with small group premiums, the average increase is even smaller, at 1.35 percent). Insurance Commissioner Monica Lindeen described the upcoming rate hike as “historically low”
2014 enrollment numbers
As of April 19, private plan Obamacare enrollments had been completed for 36,584 Montana residents (HHS will release updated enrollment figures in November). Another 4,638 people had qualified for the existing Medicaid program in Montana (Montana has not yet expanded Medicaid under the ACA).
In addition to the people who purchased plans through the exchange, nearly 35,000 people enrolled in Obamacare-compliant plans outside the exchange by mid-April. One of the provisions of the ACA requires that carriers use a single risk pool for all of their individual plans in a state, so each carrier’s off-exchange enrollments will be merged with its on-exchange enrollments for risk purposes – meaning that the additional off-exchange enrollments will be helpful in stabilizing rates.
By mid-July, the number of uninsured residents in Montana was about 30,000 lower than it had been in 2013 – more than a 15% drop in the uninsured rate in the state. This was achieved with both on and off-exchange enrollments of previously uninsured folks, as well as the “woodwork” effect that has increased Medicaid enrollment even in states like Montana that haven’t expanded Medicaid under the ACA.
No Medicaid expansion yet
Montana also opted out of expanding Medicaid. Unfortunately, it was an accidental “no” vote that doomed the expansion effort, but there’s no way to undo such a vote after it happens.
The governor’s office is supportive of some aspects of Medicaid expansion, but no steps are likely to be taken towards expansion until at least 2015.
The Healthy Montana Initiative gathered more than 25,000 signatures this spring in an effort to get Medicaid expansion on the November ballot in Montana, but ultimately failed to reach their goal and the issue will not be on the 2014 ballot. Supporters have vowed to redouble their efforts to secure health insurance for the 40,000 Montana residents who are currently in the coverage gap – unable to qualify for Medicaid, and also ineligible for subsidies to purchase private health insurance in the exchange.
The issue will almost certainly be addressed again in the 2015 legislative session, and appears to have broad public support in the state.
Exchange history in Montana
Montana’s legislature not only failed to authorize a state-run exchange, it also passed a bill in 2011 to prohibit the creation of an insurance exchange in Montana.
While Democratic Gov. Brian Schweitzer vetoed that bill, neither he nor Monica Lindeen, the state auditor and insurance commissioner, were able to generate legislative or public support for an exchange.
Consequently, the federal government is operating the exchange in Montana at Healthcare.gov. Montana is also one of nineteen states that has passed laws making it more difficult for people to serve as navigators for the exchange.
Under the federal model, most aspects of the exchange are managed by the federal government. However, states can retain control of “plan management” functions, and Montana opted to do so. Lindeen’s office released final exchange rates for the first round of open enrollment in mid-August 2013, nothing that the premiums are similar to what they would have been without the ACA. Her office regulates plans that operate on the exchange, as it does for plans sold outside the exchange.
HHS is also running the SHOP exchange in Montana, providing health insurance for small businesses. Montana is one of 18 states where the employee-choice feature of the SHOP exchange will be delayed until 2016 – meaning that instead of allowing employees to select from among a variety of options, there will be only one plan for each group in 2015.
Three organizations in Montana received federal grants in August to serve as navigators and assist residents with the enrollment process: Planned Parenthood, Montana Primary Care Association, and the Montana Health Network. Consumers may contact any of these organizations in order to ask questions or receive personal help with enrollment.
On November 25, Lindeen announced that Montana would allow health insurance carriers to extend 2013 policies that had been scheduled to terminate at the end of the year, but it was left up to each carrier to decide how to proceed. Insureds with a policy that was eligible for renewal into 2014 also had the option of switching to an exchange plan.
Montana is not allowing those plans to continue to renew into 2015 however. People with non-grandfathered pre-2014 plans will need to replace them with ACA-compliant plans at their renewal date in 2014, or during the upcoming open enrollment that runs from November 15 to February 15.
Montana health insurance exchange links
State Exchange Profile: Montana
The Henry J. Kaiser Family Foundation overview of Montana’s progress toward creating a state health insurance exchange.
Montana Consumer Assistance Program, Office of the Commissioner of Securities and Insurance
Serves as the state government watchdog for citizens of Montana in the insurance industry
Health Insurance Exchange Page from Montana Commission of Securities and Insurance
Details about how the exchange works, along with legislative history in Montana regarding the exchange creation process.