A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
Montana uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Montana exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $47 to $89 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Montana in 2022 was $51.32.
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
The stand-alone pediatric dental plans available in Montana will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $375 per child in 2023 (or $750 for all the children on a family’s plan), and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.
The Montana benchmark plan includes coverage for both basic and major dental services for children.
In 2023, five insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in Montana. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Montana. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Montana Insurance Department. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Learn about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in Montana are eligible for extensive dental services up to an annual limit of $1,125 (anesthesia, dentures, diagnostic and preventative services do not count towards the annual cap). Children eligible for Medicaid also receive extensive dental benefits including bridges, crowns and dentures.
Healthy Montana Kids (HMK), which is Montana’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
Montana's exchange has three insurers offering plans. For 2023, insurers increased average premiums by nearly 10%, but premium subsidies are designed to keep pace with the benchmark plan cost, keeping coverage affordable for most enrollees.
On November 2, 2015, CMS approved Montana's Medicaid expansion waiver. Enrollment became available immediately, for coverage effective January 1, 2016. More than 115,000 people are enrolled under Medicaid expansion as of 2022. Lawmakers reauthorized Medicaid expansion in 2019, but the legislation called for a work requirement. That proposal was sent to CMS in August 2019, but was not approved. CMS has approved an end of 12-month eligibility guarantees, but is requiring Montana to stop charging premiums for Medicaid expansion enrollees after 2022.
For all information on Medicare in Montana, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
