Medicare in Montana: 2025 Guide

Montana has approximately 260,000 Medicare beneficiaries spread across one of the largest and most sparsely populated states in the country. Medicare Advantage penetration is only around 25% — well below the national average — because most of Montana has very limited or no Medicare Advantage plan availability. The vast majority of Montana's Medicare beneficiaries rely on Original Medicare (Parts A and B) combined with a Medigap supplement and a standalone Part D drug plan, which together provide the most reliable and flexible coverage across the state's vast geography.

Medicare Advantage Plans in Montana

Montana's Medicare Advantage market is among the most limited in the United States, a direct consequence of the state's low population density and the challenges of building viable provider networks across such a large geographic area. The cities with the most plan availability are Billings, Missoula, and Great Falls, where beneficiaries may find between five and fifteen Medicare Advantage plans — primarily PPO plans, which offer broader provider access than HMOs and are better suited to Montana's dispersed healthcare landscape. Some plans in these cities offer supplemental dental, vision, and hearing benefits, which can be valuable given the limited access to standalone specialty providers in many parts of the state.

Outside Billings, Missoula, Great Falls, and a few other population centers such as Bozeman and Helena, Medicare Advantage plan availability drops dramatically. Many Montana counties have zero to five plans available, and in the most rural and frontier areas of the state, there may be no Medicare Advantage plans offered at all. For Montanans in these areas — and for many in the cities as well — Original Medicare remains the backbone of coverage. Because Original Medicare allows beneficiaries to see any Medicare-accepting provider anywhere in the United States without network restrictions, it is particularly well-suited to Montana's healthcare environment, where patients often travel long distances for care or may need to seek specialty treatment in Billings, Spokane, Seattle, or Salt Lake City. Pairing Original Medicare with a Medigap supplement caps out-of-pocket costs, and adding a standalone Part D plan covers prescriptions. Montana SHIP counselors can help compare all options for your county at no cost.

Montana expanded Medicaid in 2015 under the ACA, administered by the Montana Department of Public Health and Human Services (DPHHS). Expansion has helped low-income Montanans access coverage and increased the number of residents who may qualify for dual Medicare-Medicaid enrollment.

Medicare Savings Programs in Montana

Montana's Medicare Savings Programs are administered through the Montana DPHHS, which oversees the state's Medicaid program. The QMB, SLMB, QI, and QDWI programs help low-income Medicare beneficiaries pay Part A and/or Part B premiums, deductibles, and cost-sharing. Montana's Medicaid expansion under the HELP Act (implemented in 2016 and made permanent by voters in 2018) has broadened the pool of low-income Montanans who may qualify for full dual Medicare-Medicaid enrollment, which provides comprehensive cost protection beyond what MSPs alone offer. Full dual-eligible Montanans may also access D-SNPs, though D-SNP availability in Montana is limited given the constrained MA market overall.

To apply for Medicare Savings Programs in Montana, contact your local DPHHS office or the Medicaid program. Qualifying for an MSP automatically triggers Extra Help eligibility for Part D drug costs, which can represent hundreds of dollars in annual savings on medications. Montana SHIP counselors can assist with applications and identify all programs for which a beneficiary may qualify, including Extra Help, at no charge.

State Pharmaceutical Assistance in Montana

Montana does not have a State Pharmaceutical Assistance Program (SPAP) to supplement Medicare Part D drug coverage. Montanans who need help with prescription drug costs should apply for the federal Extra Help (Low Income Subsidy) program through the Social Security Administration. Qualifying for a Medicare Savings Program automatically grants Extra Help status, which can significantly reduce Part D premiums, deductibles, and copayments. Montana SHIP counselors can assist with Extra Help applications and help identify pharmaceutical manufacturer patient assistance programs for specific high-cost medications.

Getting Free Medicare Help in Montana

Montana SHIP — the State Health Insurance Assistance Program — is a free Medicare counseling service administered through the Montana DPHHS Senior and Long Term Care Division (SLTC) and funded by the federal government. Montana SHIP provides unbiased, one-on-one counseling through a network of trained volunteers and staff located across the state. Counselors help beneficiaries compare Original Medicare, Medigap, and Medicare Advantage options; understand Part D drug plans; apply for Medicare Savings Programs and Extra Help; and resolve billing disputes. Given that most Montanans use Original Medicare with a Medigap supplement, Montana SHIP counselors are particularly knowledgeable about comparing Medigap plan options and helping beneficiaries choose the right supplement coverage for their situation.

To reach Montana SHIP, call 1-800-332-2272. Local SHIP counselors are available across Montana, including in rural communities and frontier areas where in-person access to insurance guidance is otherwise limited. Montana SHIP conducts outreach at senior centers, hospitals, and community events throughout the year, and is especially active during the Annual Enrollment Period (October 15 – December 7) when beneficiaries can review and update their Part D drug plan coverage.