Common Insurance Questions and Answers

​​Having health insurance protects you and your family from financial losses in the same way that home or car insurance does. Even if you are in good health, you never know when you might have an accident or get sick. Other key benefits of health insurance are access to a network of doctors and hospitals, and other resources to help you stay healthy. ​

If you purchase a health plan for yourself and your family, you have an individual and family plan. This means you don’t have coverage from an employer, Medicare or Medicaid. 

Individual and Family plans are plans you enroll in on your own during the Open Enrollment Period or with a qualifying event during the Special Enrollment Period. These plans cover a wide range of services and: 

• Last a year or longer 
• Can usually be renewed  
• Meet the essential requirements set by the Affordable Care Act (ACA), including: 
• Emergency services, hospitalization, and preventive care 
• Maternity, newborn and pediatric care 
• Mental health care and substance abuse treatment  
• Lab services, prescription drugs, and disease management 
• Rehabilitative services and devices 

If you enroll in Individual health insurance and family coverage, you may be able to get help paying for it with a premium tax credit, also known as a subsidy. Learn more about getting financial help to lower your monthly bill. 

Medicare is coverage for people 65 or older, or people under 65 with certain disabilities or illnesses. You can enroll in individual Medicare or get Medicare as a retiree through your employer. 

“Original” Medicare includes Part A (hospital) and Part B (medical). You can also add these pieces to help strengthen your health insurance safety net: 

• Part C – Medicare Advantage Plans can be seen as all-in-one coverage, some with built-in prescription drug coverage
• Part D – Prescription drug coverage that pays for approved drugs not covered by Original Medicare Part A and B 
• Medicare Supplement Insurance Plans – May help pay for health care costs not covered by Original Medicare 

Need more information? Attend an event with us.

Medicaid is a joint federal and state-funded program that provides health care coverage for low-income children and families, and for certain aged and disabled individuals. 

Medicaid and CHIP are types of low- or no-cost health insurance offered by the government. Your eligibility is based on your household size and income, and you can apply any time of year. If you qualify, coverage can start right away. 

• For Medicaid, visit Medicaid.gov.
• For CHIP, visit insurekidsnow.gov  or call 1-877-543-7669.  

Worried you may be having a heart attack? Did you black out after a nasty fall? Are you coughing up blood? Go to the hospital emergency room (ER) or call 911 when you have a medical emergency. ER doctors and staff are trained to treat serious and life-threatening health issues. Plus, the ER is open 24/7. Use Provider Finder^® to make sure a specific hospital ER is in your plan’s provider network.

If you get your coverage through your employer, an association or other organization, you are in a group plan. 

Many plans cover health, dental, vision and more health care needs. But some may only cover health, so you may need a separate policy for dental and vision coverage. 

Dental insurance plans help cover dental costs or vision costs for you and your family. These types of plans: 

• Can cover a wide range of dental and vision services, including routine care like annual visits. 
• Can be bought as part of your individual and family health plan or as stand-alone plans.  

Most health plans include prescription drug benefits.  And Medicare has a stand-alone prescription drug plan. Your coverage will depend on your plan. Some prescriptions, like specialty drugs used for chemotherapy, may be covered under your medical benefit. 

Blue Cross and Blue Shield of Montana has network pharmacies, just like we have network doctors and hospitals. We get you discounts on your drug costs by contracting with these pharmacies. Our network includes retail and local pharmacies in your area, plus national chains and mail order pharmacies.

Learn more about prescription drug coverage

An HMO is a type of health plan that provides health care coverage to its members at a lower cost because you have one doctor, a primary care physician, coordinating your care. You’ll have lower copays and other out-of-pocket costs as long as you work through your PCP to schedule appointments with other health care providers. 

Learn more about HMOs

A PPO is a type of health plan that lets you choose where you go for care, without a referral from a primary care physician (PCP) or having to only use certain providers. It typically has higher monthly premiums and out-of-pocket costs like copays, coinsurance, and deductibles. And if you use a provider outside your health plan’s network, you will pay more of the bill. 

Learn more about PPOs

A Consumer Directed Health Plan, or CDHP, is a health plan with a health savings account (HSA) or other tax-advantaged account. Consumer directed health plans give members more control of health care expenses, as the deductible is higher and care is paid for with the health savings account. 

 Learn more about CDHPs

A Health Savings Account, or HSA, is an account that you can use to pay for qualified medical expenses, including dental and vision services.  

Things To Know About An HSA 

• Pre-tax contributions: If you are eligible for an HSA, you and your employer can make tax-free contributions (up to the annual limit) to your HSA.Tax-free withdrawals: 
• As long as you are paying for a qualified medical expense, withdrawals from your HSA are tax-free.  
• Portability:  You take your HSA account with you, even if you change jobs or health plans. 

Learn more about HSAs