The Affordable Care Act did not create a government-managed health insurance plan, also known as a “public option” or “single-payer.” All insurance sold on the Marketplace will be offered by private health insurance companies. Many Montanans are already covered by some form of government-managed health insurance or health care system, like Medicare or Medicaid. Others may be eligible for government health insurance programs, but don’t realize it. The information on this page will help you understand the relationship between existing government programs and Obamacare.
Medicare and Obamacare
All Medicare benefits remain the same under Obamacare, with the exception of several new benefits. These new benefits include:
- Discounts on prescription drugs under Medicare Part D (read more at HealthCare.gov);
- Closing the “donut hole” for prescription drug coverage;
- Annual wellness exams at no cost to you; and
- Preventative services, like flu shots and cancer screenings, at no cost to you.
If I have Medicare, what do I need to do?
In short, nothing. If you are receiving Medicare benefits, whether through Original Medicare or Medicare Advantage, your benefits will remain the same. You do not need to purchase insurance. You automatically fulfill the requirements of the individual mandate.
Medicaid and Obamacare
Medicaid is a state and federal partnership that provides coverage to people with lower incomes, people with disabilities, and some families and children. Each state operates a Medicaid program with varying eligibility rules. In Montana, the Department of Public Health and Human Services (DPHHS) manages Medicaid.
Obamacare originally required states to expand their Medicaid programs to include all individuals and families making less than 133% of the federal poverty level. The federal government would pay all of the medical claims for people covered under the Medicaid expansion the first two years. Over the following years, the federal government would gradually reduce its share of the costs. From 2020 on, the federal government would pay 90% of the medical costs and states would pay 10%.
The U.S. Supreme Court, however, ruled that the federal government couldn’t require states to expand their Medicaid programs. As a result of the court’s decision, each state was free to expand their Medicaid program with federal money or leave their Medicaid program in its current form.
A majority of legislators in Montana’s 2013 legislative session decided not to expand Medicaid. Montana’s current eligibility standards will remain, and the state will not receive additional federal money to cover low-income Montanans. If you are curious if you qualify for Medicaid or would like to enroll, Montana’s eligibility information and online application are available here.
What If I Don’t Qualify for Medicaid?
If your income is at or above the federal poverty line, you should buy insurance through the Marketplace, an online market for private health insurance. You may be eligible for federal tax credits and cost-sharing subsidies to make coverage affordable.
If your income is below the federal poverty level and you do not qualify for Montana Medicaid, no assistance will be available to you in the Marketplace. Although you may not be able to afford health insurance, you may be eligible for discounted health care at community health centers across Montana. Click here to search for a health center near you.