MENUMENU
Montana Medicaid is The Treasure State's Medicaid program, a network that aims to help low-income individuals and their families afford greater healthcare coverage. The state of Montana’s Medicaid program covers a wide variety of medical treatments and services, from routine care to prescription drugs and emergency services.
Montana residents who meet the program's income and health requirements can enjoy various benefits under this extensive coverage.
As of June 2023, around 20% of Montana's population is enrolled in the State’s Medicaid program. As a state- and federally-funded program, Medicaid's primary aim is to help low-income residents gain easy access to well-rounded healthcare in Big Sky Country.
In the United States, each individual state carries responsibility for its own Medicaid program, including admitting members, managing the funding, and setting policies around how these programs operate for state-specific facilities and locations. Additionally, while the federal government requires every state's Medicaid program to provide certain benefits as a standard, Montana and its fellow states always have the option of providing additional benefits to their members as well.
Understanding what Montana Medicaid is, how the Medicaid program works, and what its eligibility requirements are can help you better understand your coverage should you decide to join the state-driven program. Also, while Medicaid certainly covers a lot, extending your coverage by enrolling in another policy can give you even more benefits as well as lowering the overall healthcare costs you'll pay out of pocket. To prevent shouldering the debt of unexpected medical expenses, many Montanans extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
The guide below covers how Medicaid works, how to apply for it, and what your eligibility requirements would be to be able to access these benefits in Montana.
The state of Montana’s Medicaid program receives around 64% of its funding from the federal government, and the Montana Department of Public Health and Human Services manages things at a state level. This partnership is essential, as it allows Montana’s various service providers to offer much-needed healthcare coverage to all of the state’s low-income families as various medical necessities arise.
Could you be eligible to apply for Medicaid Montana? If you are, you can enjoy several covered medical services and treatment options at little to no cost. If you live in a single-person household in Montana and earn less than the threshold for the program's benefits, you won't have to worry about any out-of-pocket costs, either.
The state's Medicaid program will also cover 100% of healthcare costs for Montana’s two-person homes that earn less than a certain amount each month, so be sure to check your eligibility if your monthly income falls within these exemption levels.
When you enroll in Montana’s program for Medicaid, they automatically send you a Montana Medicaid card. The card becomes your proof of coverage as you receive care or use medical services. It also provides you with a unique Montana Medicaid number that you will use to enroll in other Medicaid plans or maintain your Medicaid membership from year to year.
Applying for Montana Medicaid is convenient and accessible. Choose the method that suits you: apply online for efficiency, call their dedicated hotline for assistance, or visit in person for personalized support.
If you met the Montana Medicaid Income Limits 2023 guidelines specified, you may want to apply for Montana Medicaid. However, although the Medicaid program offers numerous benefits and well-rounded coverage, it has incredibly strict eligibility requirements that you must meet every year.
Your eligibility will depend on income and health needs. Although it is possible to still receive Medicaid coverage with higher incomes, it's not likely. Still, the Montana Medicaid Expansion now means that some adults who previously didn't qualify could find themselves eligible.
Originally, the requirements to be eligible were residency in Montana and a low or very low income. Candidates also had to have qualifying health or medical insurance needs. For example, Medicaid was available for low-income Montana residents who were also pregnant, disabled, blind, or over 65.
Do you have a child or someone in your home with a disability? You may also be eligible to receive Medicaid benefits.
The Montana program specifies a qualifying annual income based on household size from one to six people. If you have an especially large household or more than six people, each additional person in your house will increase this amount. The best way to determine your eligibility is by applying or contacting the Medicaid program in Montana directly.
A baseline description of the eligibility requirements for Montana Medicaid are:
After submitting your application, you'll typically receive a decision in 45 to 90 days. If Montana Medicaid approves your application, it will automatically send you a card. To streamline the application process, include all the following information for everyone in your household:
If you lose your Montana Medicaid card, you can call DPHHS at 1-888-706-1535 to get a new card.
Is it time to renew? DPHHS will send you a reminder in the mail with your renewal dates, so be sure to submit all the necessary paperwork by this date to avoid losing coverage.
Something important to note here is that April 2023 started the "unwinding process." Due to the COVID-19 pandemic in 2020, the federal government required state Medicaid programs to pause renewals, allowing enrollees to automatically maintain their coverage without having to complete renewal paperwork. However, this "unwinding process" refers to states restarting these Medicaid redetermination and renewals, affecting both the enrollee and Montana Medicaid provider enrollment.
Medicaid's primary care case management program is Passport to Health. In Montana, this program aims to help patients form better relationships with their doctors and other medical professionals.
Depending on your case, you can either choose or have Medicaid assign you a Montana-based Passport to Health provider. You must get referrals from this provider to see specialists or change to another service provider. However, once you establish your Passport to Health primary care provider, you will have access to numerous benefits that range from routine dental care to extended coverage.
What is Montana Medicaid coverage for dental work? Montana’s Medicaid members can take full advantage of various dental services to manage or improve their oral health.
For example, adults 21 and older have an annual cap that covers the following:
Adults can also get partial denture replacements every five years and full denture replacements every ten years. For children 20 years and younger, Medicaid coverage in Montana generally covers exams, cleanings, fluoride treatments, bridges, crowns, and dentures.
Still, the state of Montana’s program will not cover all dental services. For instance, you'll likely have to pay out of pocket for metal dental crowns, cosmetic dentistry services, dental implants, and mouthguards. For this reason, and for those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Montana is advisable.
The Montana Healthcare Prescription Drug Program will help pay for the costs of certain medications if you use a Medicaid-approved pharmacy. It covers most prescription drugs, but you may need prior authorization if Montana Medicaid does not cover your specific medication.
In most cases, you can use your Medicaid card to get a 34-day medication supply (with a 90-day supply of birth control medications, heart disease drugs, and high blood pressure medications).
Medicaid in Montana covers several essential medical services like routine doctors' appointments and prescription drugs. However, it also offers coverage for numerous additional benefits that can expand your healthcare coverage. For example, it may cover the costs of home medical equipment, podiatry services, physical and occupational therapy, hospice care, or prosthetics.
Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
For more information about additional coverage availability, check out the Member Guide for Montana DPHHS.
As with most Medicaid programs, Montana’s won’t cover out-of-state services unless it's an emergency. If you want to see a medical provider outside of Montana you must get prior authorization (which is never guaranteed). Montana Medicaid may offer out-of-state coverage or reimbursement in rare cases. If you are traveling outside of Montana for leisure, invest in proper travelers insurance.
If you’re wondering how to apply for Montana Medicaid as a student, you may be surprised to learn that this program does not offer student-specific coverage. However, you’re still welcome to apply if you think you might meet the program’s other eligibility requirements. Seniors or anyone over 65 are also able to apply for Medicaid, particularly when it comes to long-term care coverage for seniors with the required income and functional needs.
For instance, through Nursing Home Medicaid, you can receive coverage for nursing home services such as room and board, nursing care, medications, mental health counseling, and more. However, you must have a physical need for a nursing facility level of care to qualify for this benefit.
Seniors may also qualify for Home and Community Based Service waivers (or vouchers), which provide the same level of care to those who live at home. Although this waiver covers many of the same services as Nursing Home Medicaid, it does not pay for room and board. Still, other Medicaid services available to seniors include the following:
To determine what long-term care services you are eligible for, you will need to take a functional needs assessment. For instance, to qualify for nursing home benefits, your assessment should show that you need the full level of care that nursing homes provide, such as help with changing, bathing, or eating.
Part of what Montana Medicaid covers are groups of people, such as Native Americans and military members.
Montana’s Native Americans are welcome to apply for Medicaid so long as they satisfy the standard eligibility requirements. If you are an American Indian and Medicaid approves your application, you can enjoy a comprehensive list of coverage benefits in Montana, plus no premiums or copays. Find out more at a local enrollment assistance center.
Current military members enrolled in Tricare and veterans receiving VA benefits can apply for Montana’s Medicaid program but must still meet the standard eligibility requirements. Since military members move around a lot, the military Medicaid waiver is a great idea.
Medicaid waivers help cover the costs of long-term care services for seniors living at home, but due to limited funding, Montana, like most other states, has a waiting list. Normally, this would put military members at a disadvantage. However, the military waiver benefit conveniently allows military members to receive in-state resident treatment so that they can put their names on the waitlist sooner.
Military members and veterans may also qualify for Aid and Attendance Benefits, which address nursing home care, assisted living, and in-home long-term care.
Like any healthcare program, Montana Medicaid does not cover everything, including the following:
Essentially, any service that your doctor does not deem medically necessary will not receive coverage from Medicaid in Montana or anywhere else. It will also not cover the costs of any appointments that you make if you do not show up to without prior notification.
The list above is not exhaustive. For more uncovered services, refer to the Montana Government website.
Another very important service that Montana Medicaid does not cover are funerals. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
The full list of services that Montana Medicaid offers is quite extensive. To give you a better idea of what it covers, here's a list of common services that eligible members receive coverage for:
| Dental | |
|---|---|
| Montana’s Medicaid program offers many additional benefits for enrollees, including dental for adults and children: | |
| X-Rays and Exams | Children can get as many exams and cleanings as necessary. Adults can receive one exam and cleaning every six months. |
| Wisdom Teeth | Medicaid dental benefits cover extractions (including wisdom teeth) as well as anesthesia services in Montana. |
| Vision | Children ages 20 and under can receive one eye exam every month unless they need to treat a disease. Adults can enjoy the following vision coverage: |
|---|---|
| Eye Exams | Medicaid members can receive coverage for one eye exam every two years unless they medically need more frequent visits. |
| Glasses | You can get a new pair of Medicaid-approved glasses once every two years. However, Medicaid will not cover the costs of replacement if you lose your glasses during the first 12 months of wearing them. Additionally, since Montana Medicaid has a contract with Classic Optical Laboratories, Inc., you must get glasses from this company. |
| Laser Eye Surgery | Since laser eye surgery is an elective procedure, Medicaid will typically not cover it unless your physician deems it a medical necessity. |
| Surgery | As with most treatments and services, Montana’s Medicaid program will only cover medically necessary surgeries. For example: |
|---|---|
| Rhinoplasty | Unless you have an injury, deformity, or medical reason for rhinoplasty, Medicaid will not cover this procedure. |
| Breast Reduction | You may receive coverage for the cost of breast reduction surgery if your doctor deems it necessary for your overall health. Otherwise, you will have to pay for this procedure yourself. |
| Hospital | Montana’s Medicaid coverage includes numerous hospital services, ranging from emergency room visits to lab services. It also covers the following: |
|---|---|
| Hospital stays | Medicaid pays for your overnight hospital stays in addition to the services you receive during your stay (such as X-rays, pulmonary rehabilitation, cardiac rehabilitation, and more). |
| Ambulance transportation | If you are in a medical emergency and require ambulance transportation, Montana Medicaid will cover the costs. |
| Giving birth | Montana’s Medicaid program covered the costs of 37% of births in 2023, including the maternity and newborn care services involved. |
| Sexual Health | |
|---|---|
| Gynecologist visits | Women can receive coverage for gynecology appointments if they need STD testing or treatment, pap tests, and other medically necessary treatments. Medicaid will also cover sterilization for mentally competent enrollees 21 or older. |
| Erectile Dysfunction | Montana Medicaid will not pay for Viagra or other erectile dysfunction treatments. The only way Medicaid will pay for this treatment is if your doctor prescribes something for another medically necessary condition that also helps with erectile dysfunction. |
| Birth Control | You can receive coverage for multiple types of birth control, including pills, shots, condoms, and IUDs. However, your primary care provider must prescribe your birth control in order for it to receive coverage. |
| Fertility Treatment | Montana’s Medicaid program does not cover medications that promote fertility or other fertility treatments. You can speak with your doctor to learn more about your options for conceiving. |
| Specialist Services | Typically, Montana’s Medicaid program will only cover the costs of seeing a specialist if your primary care doctor deems it medically necessary: |
|---|---|
| Dermatology | Medicaid will typically not cover the costs of seeing a dermatologist unless you get a referral from your doctor or they deem it medically necessary. |
| Physiotherapy | Although you might need a referral for physiotherapy, Medicaid covers other similar rehabilitative services, such as physical therapy and occupational therapy. |
| Massage Therapy | You won't receive coverage for massage therapy under Montana’s Medicaid program unless your physician deems it medically necessary. |
| Podiatry and Foot Care | You can receive coverage for various podiatry services, including callus removal, nail trimming, skin creams, lab services, and fitting for any foot or ankle devices. You may also be able to get orthopedic shoes if you are under 20 or have a brace. |
| Allergy Testing | Medicaid likely won't cover allergy testing or other allergist services unless your symptoms are severe enough to make them medically necessary. |
| Sleep Physician Services and CPAP Machines | If you have a medical need for sleep physician services or CPAP machines, Medicaid could help cover the costs. Otherwise, you may have to pay out of pocket in Montana. |
Did you know that you can extend your coverage beyond Montana Medicaid's offerings by enrolling in an additional health insurance plan? You can use private insurance providers to fill the gaps in your Montana Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing. Secondary insurance coverage could help you get more well-rounded healthcare with benefits that may include:
In addition to extended coverage, you can reduce the financial strain that medical expenses typically come with. For example, with Medicaid, you have to wait for reimbursement for various services. Separate insurance plans can further protect your finances by paying these things off sooner.
While Montana has just one state Medicaid program, it has several private insurance options, so where do you start? At Insurdinary, our insurance professionals know the ins and outs of healthcare policies, so we understand how confusing it can be to navigate your options. If you're seeking alternatives to Montana Medicaid, skip the online policy search. Benefit from our network of partners to compare quotes and discover the coverage that perfectly suits your needs.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
