2019 Montana Individual and Family Plans

The information on this page is for plans beginning January 1, 2019.  

Medical Plans 


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

Medical policy samples by plan and network (PDFs): 

Plan

Deductible*

Out-of-pocket Maximum*

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
Summaries (PDFs)
by Network
Gold 1500 $1,500 $5,000 Covered in Full 10% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Gold 1500 (0)*** $0 $0 Covered in Full Covered in Full PacificSource /
SmartHealth
PacificSource /
SmartHealth
Gold 1500 (AI)*** $1,500 $5,000 Covered in Full 10% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver HSA 3000 $3,000 $6,650 Covered in Full 25% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver 3000 (0)*** $0 $0 Covered in Full Covered in Full PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver 3000 (AI)*** $3,000 $6,650 Covered in Full 25% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver 3000 (73)** $2,300 $5,000 Covered in Full 25% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver 3000 (87)** $1,000 $1,500 Covered in Full 20% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Silver 3000 (94)** $400 $650 Covered in Full 20% PacificSource /
SmartHealth
PacificSource /
SmartHealth
Bronze HSA 6650 $6,650 $6,650 Covered in Full Covered in Full PacificSource /
SmartHealth 
PacificSource /
SmartHealth
Bronze 6650 (0)*** $0 $0 Covered in Full Covered in Full PacificSource /
SmartHealth
PacificSource /
SmartHealth
Bronze 6650 (AI)*** $6,650 $6,650 Covered in Full Covered in Full PacificSource /
SmartHealth  
PacificSource /
SmartHealth

*Deductible and out-of-pocket maximum 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 (PDFs)


Dental Choice 0-20-50 1000 - Sample policy
Dental Choice 0-20-50 1500 - Sample policy 
Kids Dental Choice 0-20-50 - Sample policy

 

Rates 


2019 Montana Individual and Family Plan Rates (PDF, document revised 11/20/18) 

 

Brochures and Enrollment Forms


Brochures: 

IFP99_080918_Montana_Medical_Individual_cover

You can order sales kits for individual and small group clients online!

Order printed materials today > 

Brochures (PDFs):  

Enrollment Forms (PDFs):  

Enroll Online:  

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

 

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  
  • Gallatin
  • Garfield
  • Glacier
  • Golden Valley
 
  • Granite
  • Hill
  • Jefferson
  • Judith Basin
  • 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
  • Flathead
  • Lake
  • Lewis and Clark
  • 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.