2016 Montana Individual and Family Plans

The information on this page is for plans beginning January 1, 2016.  

Medical Plans

All plans are available direct with PacificSource and through HealthCare.gov.


 

Plan

Deductible*

OOP*

Co-insurance

HSA-eligible?

SBCs and Policies
by Network
Summaries
by Network
  Balance Bronze 6850
$6,850
$6,850
0%
No
SHNPSN
Balance Bronze 6850 (0)***
$0
$0
0%
No
SHNPSN
Balance Bronze 6850 (AI)***
$6,850
$6,850
0%
No
SHNPSN
Value Bronze 6450
$6,450
$6,450
0%
Yes
SHNPSN
SHN / PSN
Value Bronze 6450 (0)***
$0
$0
0%
No
SHNPSN
Value Bronze 6450 (AI)***
$6,450
$6,450
0%
No
SHNPSN
Value Bronze 3500
$3,500
$6,450
50%
Yes
SHNPSN
Value Bronze 3500 (0)***
$0
$0
0%
No
SHNPSN
Value Bronze 3500 (AI)***
$3,500
$6,450
50%
No
SHNPSN
  Balance Silver 2500
$2,500
$6,850
30%
No
SHNPSN
Balance Silver 2500 (0)***
$0
$0
0%
No
SHNPSN
Balance Silver 2500 (AI)***
$2,500
$6,850
30%
No
SHNPSN
Balance Silver 2500 (73)**
$2,000
$5,450
30%
No
SHNPSN
Balance Silver 2500 (87)**
$500
$1,600
30%
No
SHNPSN
Balance Silver 2500 (94)**
$250
$500
30%
No
SHNPSN
Value Silver 3600
$3,600
$3,600
30%
Yes
SHNPSN
Value Silver 3600 (0)***
$0
$0
0%
No
SHNPSN
Value Silver 3600 (AI)***
$3,600
$3,600
0%
No
SHNPSN
Value Silver 3600 (73)**
$3,200
$3,200
0%
No
SHNPSN
Value Silver 3600 (87)**
$1,200
$1,200
0%
No
SHNPSN
Value Silver 3600 (94)**
$500
$500
0%
No
SHNPSN
  Balance Gold 1000
$1,250
$6,350
10%
No
Balance Gold 1000 (0)***
$0
$0
0%
No
Balance Gold 1000 (AI)***
$1,250
$6,350
10%
No
  Catastrophic
$6,850
$6,850
0%
No

*Deductible and out-of-pocket limit amounts shown above are the costs for individuals. Amounts for families are twice the individual amounts.

**This is a cost-sharing plan. Cost-sharing plans are only available to those who qualify financially and enroll through HealthCare.gov.

***The Affordable Care Act (ACA) has special provisions for members of federally recognized American Indian tribes that purchase healthcare coverage through the Marketplace, including zero-cost health services for those whose income is at or below 300 percent of the Federal Poverty Level. Please note that even with a zero cost-sharing plan, out-of-network providers can bill for the amount over the network rate.

Dental Plans


  Dental Choice 0/20/50
   Kids Dental Choice 0/20/50    Sample Handbook

Rates


  • Rate Book: All Rate Areas
  • Area 1: Carbon, Musselshell, Stillwater, Sweet Grass, and Yellowstone Counties
  • Area 2: Broadwater, Cascade, Chouteau, Deer Lodge, Gallatin, Jefferson, Judith Basin, Lewis and Clark, Silver Bow, and Teton Counties
  • Area 3: Flathead, Lake, and Missoula Counties
  • Area 4: Beaverhead, Big Horn, Blaine, Carter, Custer, Daniels, Dawson, Fallon, Fergus, Garfield, Glacier, Golden Valley, Granite, Hill, Liberty, Lincoln, Madison, McCone, Meagher, Mineral, Park, Petroleum, Phillips, Pondera, Powder River, Powell, Prairie, Ravalli, Richland, Roosevelt, Rosebud, Sanders, Sheridan, Toole, Treasure, Valley, Wheatland, and Wibaux Counties
  • Dental Rates

Brochure and Forms


Brochures:

Enrollment Forms:  

Enroll Online:  

Limitations: Dental Choice

Visit our Montana Forms and Materials page for more sales materials.

Network Availability


All network plans are available direct with PacificSource and through HealthCare.gov.

PacificSource Network (PSN)

 
Montana The PacificSource Network (PSN) is our PPO network. It gives members the freedom to choose any participating provider any time. Members can also see providers outside of this network, but they'll pay a little more (nonparticipating benefit costs). Because members have more freedom to choose any participating doctor, PSN plans will have slightly higher premiums.

SmartHealth Network (SHN)

 
Montana

SmartHealth is a coordinated care network (CCN). A CCN is a network where members choose a primary care provider (PCP) who will work with them to help them meet their health and wellness goals. Should a member need to see a specialist, their PCP will work with them and their specialist to coordinate the care they receive. Providers and facilities in SHN are connected through common care goals and work together to provide the best possible care at the lowest possible cost for our members. Premiums for SHN plans are typically lower than those for our PSN plans.