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Montana health insurance exchange

MT enrollment ranks still swelling after open enrollment ends

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The 2014 Obamacare open enrollment period ended in April, but enrollment in the Montana exchange has continued to grow this summer because of qualifying events that trigger individual special enrollment periods.  HHS will release updated enrollment figures in November, when the 2015 general open enrollment period is scheduled to begin.  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.

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  Montana is also one of nineteen states that has passed laws making it more difficult for people to serve as navigators for the exchange.

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.  And on the other hand, opponents of the ACA were gathering signatures in late December for a ballot initiative that would block Medicaid expansion, prevent the state from spending any money to enforce ACA rules, and would go so far as to provide a tax credit to any residents who owe a penalty under the shared responsibility (individual mandate) provision of the ACA.

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.

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 who have a policy that is allowed to renew into 2014 also have the option of switching to an exchange plan.

Residents in Montana can select from three health insurance carriers within the Montana exchange: 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.  Across all carriers, the lowest cost bronze plan in the Montana exchange averages $251/month, which is very close to the national average of $249.

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 rates for the exchange in mid-August, 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 ParenthoodMontana 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.

According to Kaiser’s, about 180,000 people — 18 percent of the population — in Montana do not have health insurance.

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.