Health Care FAQ

You or your family members received health care coverage from the Department of Public Health and Human Services in 2015. The attached 1095-health insurance tax form summarizes the coverage and duration for you.

You will use Form 1095-B to verify medical coverage for yourself and your covered dependents on your federal income tax filing, much like you use your W-2 to report wages. You should keep your Form 1095-B with all your tax records as supporting documentation.

You will use Form 1095-B to verify medical coverage for yourself and your covered dependents on your federal income tax filing, much like you use your W-2 to report wages. You should keep your Form 1095-B with all your tax records as supporting documentation.

Even if you cannot pay your premium, you may still be able to keep HELP Plan coverage.  You will remain in the HELP Plan if:
As long as you are in the HELP Plan, you will continue to have access to the health care services covered by the plan.   You are still responsible for the payment of your premiums.   If your payments become more than 90 days past due, the unpaid premium balance will be transferred to the Department of Revenue for collection from your state income tax refund.

  1. Your income is under 100% of the federal poverty level, which is approximately $981 a month for an individual, or $2,021 a month for a family of four.
    or
  2. You meet two of the following:
    • You have been discharged from the United States military service within the previous 12 months;
    • You are enrolled for credit in any Montana University System unit, a tribal college, or any other accredited college within Montana offering at least an associate degree;
    • You are participating the Department of Labor’s HELP-Link program;
    • You see a primary care provider who is part of  a patient-centered medical home;
    • You are in a substance use treatment program; or
    • You are in a DPHHS approved health behavior activity program administered by DPHHS or BCBSMT.  The list of approved programs is located at HELPPlan.mt.gov or call 1-855-324-6259.

As long as you are in the HELP Plan, you will continue to have access to the health care services covered by the plan.   You are still responsible for the payment of your premiums.   If your payments become more than 90 days past due, the unpaid premium balance will be transferred to the Department of Revenue for collection from your state income tax refund.

Your monthly premium payment is a condition of participation in the HELP Plan.  If your premium payment is over 90 days past due, and you do not meet the conditions listed below, you will lose your HELP Plan coverage.    In addition your outstanding premium balance will be transferred to the Department of Revenue for collection from your state income tax refund.

You will remain in the HELP Plan if: 

  1. Your income is under 100% of the federal poverty level, which is approximately $981 a month for an individual, or $2,021 a month for a family of four.
    or
  2. You meet two of the following:
    • You have been discharged from the United States military service within the previous 12 months;
    • You are enrolled for credit in any Montana University System unit, a tribal college, or any other accredited college within Montana offering at least an associate degree;
    • You are participating the Department of Labor’s HELP-Link program;
    • You see a primary care provider who is part of  a patient-centered medical home;
    • You are in a substance use treatment program; or
    • You are in a DPHHS approved health behavior activity program administered by DPHHS or BCBSMT.  The list of approved programs is located at HELPPlan.mt.gov or call 1-855-324-6259.

Yes, you may reenroll after

  1. You have paid your unpaid premium balance in full, or
  2. You have received notice from the Department of Revenue that they have assessed your unpaid premium balance against your future state income tax.  This assessment occurs once per calendar quarter.

Participants that would like to reenroll should contact the Montana Public Assistance Help Line at (844) 792-2460 or apply.mt.gov.

Yes, you will be covered as of the first date of the month you apply. For example, if you apply for Medicaid on 01/21/2016 and were told you were eligible, your coverage will begin 01/01/2016.

The Marketplace sends DPHHS new applications every day. The Marketplace takes a few days to process and then sends us the applications. Then it takes about 15 business days to process a client’s enrollment in the Montana system, but could take up to 45 days when many people are applying at the same time.

If you just applied recently, you don’t need to take any further action and can simply wait to receive your membership information soon. If you applied 6 weeks ago and have not received anything from us, your application could be held up for some reason. You can call our Public Assistance Help Line at 1-888-706-1535 to get more information about your application. You can also create an account at apply.mt.gov to check your application status.

Right now our call volumes are high, so you may have to hold for a long period before getting through. We will help you as quickly as possible. If it is more convenient for you, you can tell us to call you back instead of waiting on hold.

Remember, if you were determined to be eligible for Medicaid on the Marketplace, you are eligible and you will be covered as of the date of your application. It just may take some time to get your state letter and membership card.

If you haven’t received your healthcare ID card yet, you can still get health care. When you go to your appointment, bring the letter you received from Montana DPHHS that says you are eligible. Give your doctor or provider your name, date of birth, and the letter and they can look up your coverage in the system.
No. If you applied during the open enrollment period and then you find out after January 31 that you are not eligible for Medicaid, you will be able to go back on the Marketplace and choose a Marketplace health insurance plan. This is called a “Special Enrollment Period,” and you can find out more here: https://www.healthcare.gov/sep-list/

When you're eligible for the Medicaid, the HELP Plan, or Healthy Montana Kids, you can still purchase a Marketplace health plan, but you won't get help paying for it. Medicaid and CHIP are free or low-cost programs, so if you qualify for either of them, you don't qualify for premium tax credits. If you are enrolled in Medicaid or Chip at the same time you are using advance payments of the premium tax credit, you may have to repay these tax credits when you file your tax return.

If you previously had health insurance through the Health Insurance Marketplace at www.healthcare.gov, you need to cancel your Marketplace health insurance plan right away to avoid any tax penalties. We recommend you take two steps:

  1. Call the Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325) and ask them to cancel both your health plan and your tax credits. Record the date and time that you call and the name of the representative you talk with.
  2. Call the insurance company and let them know that your old health plan must be cancelled because you are currently enrolled in Medicaid.

If you are having trouble cancelling your old health plan, please contact the Office of the Insurance Commissioner for help. Call 1-800-332-6148 or file a complaint at www.csi.mt.gov.

Note: The previous insurance could have been from BlueCross BlueShield, PacificSource, or the Montana Healthcare Coop.

If you have questions regarding your unpaid premiums, please contact contact the Business & Financial Services Division at 406-444-5945
You will then need to contact the Montana HELP PLAN Enrollment line at (844) 792-2460 or go online apply.mt.gov and activate your plan.

Even if you cannot pay your premium, you may still be able to keep HELP Plan coverage.  You will remain in the HELP Plan if:

  1. Your income is under 100% of the federal poverty level, which is approximately $981 a month for an individual, or $2,021 a month for a family of four.
    Or
  2. You meet two of the following:
    • You have been discharged from the United States military service within the previous 12 months;  Go online to apply.mt.gov or contact 888-706-1535 to report this today
    • You are enrolled for credit in any Montana University System unit, a tribal college, or any other accredited college within Montana offering at least an associate degree; ;  Go online to apply.mt.gov  or contact 888-706-1535 to report this today 
      The following items are automatically reported based on your participation in the programs
    • You are participating the Department of Labor’s HELP-Link program; 
    • You see a primary care provider who is part of  a patient-centered medical home;
    • You are in a substance use treatment program; or 
    • You are in a DPHHS approved health behavior activity program administered by DPHHS or BCBSMT.  The list of approved programs is located at HELPPlan.mt.gov or call 1-855-324-6259. 

As long as you are in the HELP Plan, you will continue to have access to the health care services covered by the plan.   You are still responsible for the payment of your premiums.   If your payments become more than 90 days past due, the unpaid premium balance will be transferred to the Department of Revenue for collection from your state income tax refund. 

There are several reasons why the Marketplace may not have been able to tell you if you qualified for Medicaid. We may need to determine which plan is best for your unique health care needs, or we may need additional information from you. We will contact you to tell you if you are approved or if we need more information.

If we need more information, you will get a letter from us telling you what we need.

The Marketplace sends us new applications every day. The Marketplace takes a few days to process and sends us the applications. Then it takes us about 15 business days to process your enrollment in the Montana system, but could take up to 45 days when many people are applying at the same time.

If you just applied recently, you don’t need to take any further action and can simply wait to hear from us. If you applied 6 weeks ago and have not received anything from us, your application could be held up for some reason. You can call our public assistance help line at 1-888-706-1535 to get more information about your application. You can also create an account at apply.mt.gov to check your application status.

If you have Medicaid, the HELP Plan, or Healthy Montana Kids coverage, you're considered covered under the health care law. You don't have to buy a Marketplace plan. You also don't have to pay the fee that people without health coverage must pay.
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