2015 enrollment in Montana’s exchange
54,266 people enrolled in private plans through the Montana exchange during the 2015 open enrollment period (through February 22, including the week-long extension). HHS had projected 47,000 enrollees, and Charles Gaba of ACAsignups projected 57,000 enrollees in Montana by the end of open enrollment. Ultimately, the final total was in the middle, but closer to the higher number that Gaba had predicted.
Of the people who selected a plan during the 2015 open enrollment period, 41 percent are new to the exchange for 2015, and 85 percent are receiving premium subsidies. Overall, the second open enrollment was much better than the 2014 round; Montana Insurance Commissioner Monica Lindeen reported that her office fielded far fewer calls this time around from consumers running into difficulties with the exchange.
An additional 2,683 people enrolleed in Medicaid or CHIP through the exchange between November 15 and February 22, qualifying under the state’s unchanged guidelines, as Montana has not expanded Medicaid under the ACA. Medicaid and CHIP enrollment continue year-round.
Open enrollment for 2015 has ended, although there’s a special enrollment period (March 15 to April 30) for people who didn’t know they would have to pay a penalty for being uninsured in 2014. Taking advantage of the special enrollment period means those people can avoid paying another – higher – penalty for all of 2015 as well. Otherwise, the only way you can purchase a plan for 2015 – on or off the exchange – is if you have a qualifying event. The next open enrollment period begins on November 1, but coverage won’t be effective until January 1, 2016.
Lawmakers address healthcare reform
Two ACA-related bills have been introduced in the 2015 legislative session in Montana, but they have very different objectives. HB 249, the “Healthy Montana Act” would expand Medicaid and enhance access to healthcare and health insurance under the ACA. But on the other end of the spectrum, HB 256, introduced by Republican Representative Matthew Monforton of Bozeman, would require legislative approval for any further implementation of Obamacare in Montana, including the expansion or Medicaid or the creation of a state-run exchange.
HB 256 passed the House and moved to the Senate on February 5. The bill is clearly anti-ACA, but at the same time, Democratic Governor Steve Bullock – who supports Medicaid expansion – has indicated that he doesn’t plan to expand Medicaid without legislative approval anyway. The bill also raises concerns about how the state would address the ramifications of a possible Supreme Court ruling against subsidies in the federally-run exchange (Montana’s exchange is federally-run, and the Court ruling is expected in June).
New carrier in Montana exchange
Assurant joined the exchange in Montana for 2015, so residents are now able to select from four carriers. 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 has expanded into Idaho for 2015.
And 2015 rate increase “historically low”
Across all carriers, the lowest cost bronze plan in the Montana exchange averaged $251/month in 2014, which is very close to the national average of $249.
And 2015’s rate increase was historically low: 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”
In all rating areas in Montana, the benchmark plan (second-lowest-cost silver plan) in less expensive for 2015 than it was in 2014. But in order to get the lower rates, consumers need to shop around in the exchange during open enrollment. People who had the benchmark plan in 2014 and let it automatically renew will see higher premiums state-wide for 2015. And because the benchmark plans are less expensive in 2015, subsidies will be lower too, making it especially important to shop around during open enrollment.
Even though auto-renewal was available for most Montana enrollees, it’s not in your best interest. If your plan was auto-renewed and you’d rather shop around, you can still do so as long as you finalize your plan selection by February 15.
Three organizations in Montana received a total of $609,000 in September to fund their navigator and enrollment assistance efforts for 2015. Planned Parenthood, the Montana Health Network, and the Montana-Wyoming Tribal Leaders Council are all serving as navigator organizations in the state.
Navigators in Montana are focusing on outreach targeted at uninsured populations within the state, particularly Native Americans. Native Americans are exempt from the ACA’s individual mandate, and they have access to Indian Health Service care. But Native American leaders caution that relying solely on IHS can mean foregoing some care, and there are excellent plans available through the ACA that provide enhanced benefits for Native Americans.
There’s also monthly enrollment year-round for Native Americans; the normal open enrollment deadline does not apply. But outreach specialists are hoping that the publicity surrounding open enrollment will help them to encourage more Native Americans in Montana to enroll this winter.
Enrollment assisters throughout the state are reporting that HealthCare.gov is working far better than it was last year, and navigators throughout the country are reporting that enrollment is smoother and easier in virtually every state.
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 the legislature only meets every other year in Montana, so the issue couldn’t be re-addressed from a legislative standpoint until 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.
Governor Steve Bullock is pushing forward with Medicaid expansion again in 2015, although the Republican-dominated legislature doesn’t appear to be receptive to his plan to expand Medicaid up to 138 percent of poverty (in line with the ACA’s guidelines). Instead, leaders in the legislature want to expand coverage under their proposed Montana Healthy Family Plan, which would limit expansion to 100 percent of poverty level (people above this limit have access to exchange subsidies, although winning HHS approval to get ACA funding for a plan that limits expansion to 100 percent of poverty level has proven to be difficult in other states).
Many Republicans in the legislature are opposed to the idea of extending Medicaid to able-bodied adults without children, as they prefer to focus Medicaid on low-income seniors and parents, disabled residents, and children. Although opinions about Medicaid expansion are generally split along party lines in Montana, not all Republican lawmakers in the state are opposed to Medicaid expansion. Rep. Frank Garner refused to sign an Americans for Prosperity (AFP) pledge card promising to oppose Medicaid expansion, and has expressed support for some form of modified Medicaid expansion.
2014 enrollment numbers
As of April 19, private plan Obamacare enrollments had been completed for 36,584 Montana residents. 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.
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 2013 to serve as navigators and assist residents with the enrollment process during the first open enrollment period: Planned Parenthood, Montana Primary Care Association, and the Montana Health Network.
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 needed to replace them with ACA-compliant plans at their renewal date in 2014, or during the current open enrollment that ends on February 15. In order to get new coverage effective January 1, you must make your new plan selection by December 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.