As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how Montana’s regulations and policies are likely to affect your bottom line.
How does Montana determine eligibility for Medicare Savings Programs?
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Montana, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
MSP asset limits: Montana uses the federal asset limits for QMB, SLMB and QI – which are $9,090 if single and $13,630 if married.
Who's eligible for Medicaid for the aged, blind and disabled in Montana?
Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits.
Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for those additional services if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
In Montana, Medicaid ABD covers extensive dental care, including preventive care, diagnostic services, anesthesia and dentures. Medicaid ABD also covers one eye exam and one pair of eyeglasses every 12 months.
Income eligibility: The income limit is $914 a month if single and $1,371 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
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Medicaid spend-down for Medicaid for the aged, blind and disabled in Montana
Applicants who are over-income for Medicaid for the aged, blind and disabled can qualify for Medicaid by enrolling in Montana’s Medicaid spend-down program.
When an applicant is approved for the spend-down, Medicaid calculates the portion of their monthly income above the program’s income limit – which is known as “excess income.” Enrollees activate their spend-down coverage by submitting medical bills equal to this amount. In Montana, the Medicaid spend-down is usually approved for one month increments, with the submission of additional medical expenses required for further coverage.
In Montana, the Medicaid spend-down does not cover Long Term Services and Supports (LTSS).
Income eligibility: The income limit is $525 a month for both single and married applicants.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Federal assistance with prescription drug costs in Montana
Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) will receive Extra Help. This program lowers Medicare Part D prescription drug costs. When beneficiaries apply for this program themselves, the income limit is $1,843 a month for singles and $2,485 a month for couples. The asset limit is $16,660 for individuals and $33,240 for spouses.
How does Montana regulate long-term services and supports (LTSS)?
Medicare beneficiaries increasingly rely on long-term care, and the portion of seniors needing these services will keep rising as the population ages. However, long-term care is mostly not covered by Medicare. While Medicaid fills the gap in Medicare coverage for long-term care, its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Medicaid nursing home coverage
Income limits: The applicant’s income must be less than the cost of nursing home care. Usually only the income of the spouse who needs nursing home care is counted.
However, nursing home enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $50 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If only one spouse requires Medicaid, the other spouse can keep up to $148,620.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Enrollees also can’t have more than $688,000 in home equity.
Home and Community Based Services (HCBS) waivers
Every state’s Medicaid program covers community-based long-term care services. Programs that pay for this care are called Home and Community Based Services (HCBS) waivers. Recipients continue living in the community, rather than entering a nursing home.
Income limits: The income limit is $914 a month if single. If a married couple is applying, the combined income limit is $1,828 a month (each spouse is allowed up to $914 a month).
Asset limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If only one spouse requires Medicaid, the other spouse can keep up to $148,620. HCBS enrollees can’t have more than $688,000 in home equity.
Spousal impoverishment protections in Montana
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying.)
Spousal impoverishment rules allow community spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income.
In Montana in 2022, these spousal impoverishment rules allowed community spouses to keep:
Medicaid home equity limit in Montana
Federal law requires states to limit eligibility for Medicaid nursing home care and HCBS to applicants with a home equity interest below a specific dollar amount. States set these home equity levels based on a federal minimum of $688,000 and maximum of $1,033,000 in 2023.
Montana requires applicants for Medicaid LTSS to have no more than $688,000 in home equity.
Penalties for transferring assets in Montana
The high cost of long-term care means that some individuals attempt to “impoverish themselves” by giving away or transferring assets to qualify for Medicaid. To curb these asset transfers, federal law requires states to have a penalty period for applicants for Medicaid nursing home care who give away or transfer assets for less than their value. States can also have an asset transfer penalty for HCBS. Medicaid will not pay for LTSS during this period.
Montana has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60-month lookback period prior to receiving Medicaid (or entering a nursing home). The length of the penalty is calculated by dividing the amount of money transferred or given away by the cost of nursing home care (which is $271.47 a day in Montana in 2023).
Estate recovery in Montana
A state’s Medicaid agency is required to recover what it paid for long-term care related costs while an enrollee was 55 or older. States can choose to also pursue estate recovery for costs that are unrelated to LTSS (and for enrollees who didn’t receive LTSS). This is called estate recovery.
Montana has chosen to recover the cost of all Medicaid benefits paid for enrollees beginning at the age of 55. This means the state pursues estate recovery against enrollees who did not receive LTSS. However, the state does not use estate recovery to recoup costs for Medicaid expansion enrollees. This is important, as Montana expanded Medicaid under the ACA as of 2016, and more than 86,000 people — including many who are 55 or older — were enrolled under the expanded eligibility guidelines as of August 2020.
When an enrollee’s Medicaid coverage was administered by a Managed Care Organization (MCO) (ie, a private insurer with which the state contracts to administer Medicaid benefits), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. This means the state might pursue large recoveries from enrollees who used little medical care.
Montana appears to delay its estate recovery for enrollees who are outlived by a spouse or a child who is under 21 or disabled. The state would recover from the estate once the spouse died, or the child turned 21 (or was no longer considered disabled).
The state may also grant a hardship exemption from estate recovery under certain other circumstances.
Where can Medicare beneficiaries get help in Montana?
Montana State Health and Insurance Assistance Program (SHIP)
Free volunteer Medicare counseling is available by contacting the Montana State Health and Insurance Assistance Program (SHIP) at 1-800-551-3191.
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The SHIP’s website has more information on the services it offers.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature beneficiaries can use to find an elder attorney locally.
Montana Area Agencies on Aging (AAAs)
Medicare beneficiaries in Montana can receive assistance from an Area Agency on Aging (AAA). These organizations can provide counseling about services that help with aging or living with a disability, and with planning for long-term care needs. Here is a list of AAAs in Montana.
Where can I apply for Medicaid in Montana?
Medicaid is administered by the Department of Public Health and Human Services (DPHHS) in Montana. Seniors and people with disabilities can learn about applying for Medicaid on this website or by calling the Senior and Long Term Care Division at (406) 444-4077.
