Medicare is a federal health insurance program primarily for people 65 and older, though it also covers certain younger individuals with disabilities or specific medical conditions like End-Stage Renal Disease (ESRD). In Montana, you become eligible three months before your 65th birthday and can apply anytime during your Initial Enrollment Period, which includes the month of your 65th birthday and the three months after.

Medicare Part A covers hospital and inpatient care. Part B provides coverage for outpatient services and preventive care. Part C (Medicare Advantage) combines Parts A and B and is offered by private insurers, often with additional benefits. Part D is separate prescription drug coverage. Many people choose either Original Medicare (Parts A and B) with optional Part D or a Medicare Advantage Plan (Part C) that includes drug coverage.

Original Medicare includes Parts A and B and allows you to visit any doctor or hospital that accepts Medicare. However, it does not cover prescription drugs or additional benefits like dental and vision. Medicare Advantage (Part C) is an all-in-one plan offered by private insurers, often including prescription drug coverage, dental, vision, and other benefits. Medicare Advantage plans usually require staying within a network.

Your Initial Enrollment Period is a seven-month window that begins three months before your 65th birthday month and ends three months after. If you miss this period, you can sign up during the General Enrollment Period from January 1 to March 31 each year, though you might face a late enrollment penalty. Additionally, there’s an Annual Enrollment Period from October 15 to December 7, when you can switch or add plans.

Medigap policies help cover the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. In Montana, you can enroll in a Medigap policy during your six-month Medigap Open Enrollment Period, which starts the month you turn 65 and enroll in Part B. These plans are standardized and offered by private insurers.

Medicare Part D is optional prescription drug coverage available to those with Original Medicare or some Medicare Advantage plans. If you don’t enroll in Part D when first eligible and lack other credible drug coverage, you may pay a late enrollment penalty if you join later. Many Montanans find Part D helpful, as Original Medicare doesn’t cover prescription medications.

Yes, programs like Medicare Savings Programs (MSPs) can help pay for Part A and B premiums, deductibles, and coinsurance. Additionally, the Extra Help program assists with prescription drug costs for those who qualify based on income and resources. The Montana State Health Insurance Assistance Program (SHIP) provides free help to determine eligibility.

Yes, Medicare covers many preventive services at no cost, including screenings for cancer, diabetes, and cardiovascular disease, as well as vaccinations and an annual wellness visit. Preventive services are essential for early detection and health maintenance, making them a valuable benefit under Medicare.

You can make changes during the Annual Enrollment Period (October 15 to December 7), when you can switch Medicare Advantage plans, change Part D coverage, or return to Original Medicare. Additionally, from January 1 to March 31, Medicare Advantage enrollees can switch to a different Advantage plan or revert to Original Medicare with a standalone Part D plan.

Yes, the Montana State Health Insurance Assistance Program (SHIP) provides free counseling to help residents understand their Medicare options, compare plans, and determine eligibility for assistance programs. SHIP counselors offer unbiased, knowledgeable guidance on Medicare questions and can be reached through local Area Agencies on Aging.