2017 Montana Individual and Family Plans

The information on this page is for plans beginning January 1, 2017.  

Medical Plans

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

Medical policy samples by plan and network:


Plan

Deductible*

Out-of-pocket limit*

Co-pay for office visits

Co-insurance after deductible

SBCs
by Network
Summaries
by Network
Bronze HSA 6550 $6,550 $6,550 No charge No charge PacificSourceSmartHealth PacificSourceSmartHealth
Bronze HSA 6550 (0)*** $0 $0 No charge No charge PacificSourceSmartHealth PacificSourceSmartHealth
Bronze HSA 6550 (AI)*** $6,550 $6,550 No charge No charge PacificSourceSmartHealth PacificSourceSmartHealth
Silver HSA 3000 $3,000 $5,000 No charge 25% PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 (0)*** $0 $0 No charge No charge PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 (AI)*** $3,000 $5,000 No charge 25% PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 (73)** $1,800 $5,000 No charge 25% PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 (87)** $750 $1,500 No charge 20% PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 (94)** $250 $600 No charge 20% PacificSource / SmartHealth PacificSource / SmartHealth
Gold 1500 $1,500 $3,000 No charge 20% PacificSource / SmartHealth PacificSource / SmartHealth
Gold (0)*** $0 $0 No charge No charge PacificSource / SmartHealth PacificSource / SmartHealth
Gold (AI)*** $1,500 $3,000 No charge 20% PacificSource / SmartHealth PacificSource / SmartHealth

*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 - Sample policy
Kids Dental Choice 0/20/50 - Sample policy

 

Rates


2017 Montana Individual and Family Plan Rates

 

Network Availability (Medical)


Network availability varies depending on geographic location. 

PacificSource Network (PSN)

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the PacificSource Network (PSN):

  • Beaverhead
  • Big Horn
  • Blaine
  • Broadwater
  • Carter
  • Cascade
  • Chouteau
  • Custer
  • Daniels
  • Dawson
  • Deer Lodge
  • Fallon
  • Fergus
  • Flathead
  • Gallatin
  • Garfield
  • Glacier
 
  • Golden Valley
  • Granite
  • Hill
  • Jefferson
  • Judith Basin
  • Lake
  • Lewis and Clark
  • Liberty
  • Lincoln
  • Madison
  • McCone
  • Meagher
  • Mineral
  • Petroleum
  • Phillips
  • Pondera
  • Powder River
 
  • Powell
  • Prairie
  • Ravalli
  • Richland
  • Roosevelt
  • Rosebud
  • Sanders
  • Sheridan
  • Silver Bow
  • Teton
  • Toole
  • Treasure
  • Valley
  • Wheatland
  • Wibaux
 

Notable features: The PacificSource Network (PSN) includes the broadest access to in-network providers and facilities, such as hospitals and urgent care centers. Plans on the PacificSource Network will typically cost more because members will have more providers to choose from.

 

SmartHealth Network

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the SmartHealth Network:

  • Carbon
  • Missoula
  • Musselshell
  • Park
  • Stillwater
  • Sweet Grass
  • Yellowstone

Notable features: The SmartHealth Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care at a lower cost.