Medicare in Montana runs on federal rules, with free SHIP counseling through the Montana DPHHS and Medicare Savings Programs that can reduce your Part B premium to zero.
In This Guide
- Key Takeaways
- Original Medicare: Parts A and B
- Medicare Advantage in Montana (Part C)
- Medicare Part D: Prescription Drugs
- Medigap in Montana
- Help Paying for Medicare in Montana
- Medicare Enrollment Periods
- Free Medicare Help: Montana SHIP
- Frequently Asked Questions
About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 or Montana SHIP at 1-800-551-3191.
Original Medicare: Parts A and B
Original Medicare is run directly by the federal government. The mechanics and costs are the same in Montana as in every other state.
Part A (Hospital Insurance)
Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible applies per benefit period, not per calendar year. A benefit period starts the day you're admitted and ends 60 days after discharge; get readmitted after that gap and the deductible resets.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Routine dental, vision, and hearing are not covered.
- Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: 20% of the Medicare-approved amount for most outpatient services
Delay Part B without other creditable coverage and you'll owe a permanent 10% premium penalty for every 12-month period you could have had it.
Medicare Advantage in Montana (Part C)
Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare. They cover everything Parts A and B do, except hospice, which Original Medicare continues to cover. Most plans bundle Part D drug coverage along with extras like dental, vision, and hearing.
Montana is a large, predominantly rural state. Billings, Missoula, Great Falls, and Helena typically have some Medicare Advantage plan options. In rural counties, the choices narrow sharply, and many areas have very few or no plans available. Before enrolling, check the Medicare Plan Finder for your specific county.
How These Plans Work
- You continue paying your Part B premium ($202.90 a month) on top of any plan premium. The average Medicare Advantage plan premium is about $14 a month in 2026, and many plans charge $0 extra.
- Most plans run on HMO or PPO networks. Confirm your doctors and hospitals are in-network before you enroll.
- Plans typically require prior authorization for certain services; Original Medicare generally does not.
- Every plan caps annual in-network out-of-pocket spending at no more than $9,250 in 2026 (many plans set it lower). Original Medicare has no such cap.
In rural Montana, where MA plans are scarce or absent, Original Medicare plus a Medigap policy often provides the most predictable cost structure.
Medicare Part D: Prescription Drugs
Part D covers outpatient prescription drugs. You can add a standalone Part D plan to Original Medicare or get drug coverage built into a Medicare Advantage plan.
The Inflation Reduction Act restructured Part D. The coverage gap (donut hole) no longer exists starting in 2025. The redesigned benefit has three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
- Catastrophic: once your out-of-pocket costs reach $2,100, you pay $0 for covered drugs for the rest of the year.
The $2,100 cap is the figure that matters most in 2026 Part D. The average standalone Part D premium is about $46.50 a month, though plan premiums vary. Every plan must offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into monthly payments across the year instead of paying in full at the pharmacy.
People who qualify for Extra Help pay much less.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in Montana
Medigap policies fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, not with Medicare Advantage.
Montana offers the federally standardized plans, lettered A through N. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020. Plan G is the most common choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible out of pocket.
Your best window is the federal Medigap Open Enrollment Period: six months that begin the month you are 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate, with no medical underwriting. Outside it, Montana insurers may use medical underwriting, meaning they can review your health history, charge more, or decline you.
Montana does not have a birthday rule or other state-added Medigap guaranteed-issue protections beyond the federal standard. For rural Montanans with limited Medicare Advantage options, the Medigap open-enrollment window is especially worth protecting.
Medigap or Medicare Advantage?
You cannot hold both at the same time. Medigap means staying on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a typically higher monthly premium. Medicare Advantage means trading some of that flexibility for a plan network. For a side-by-side comparison, see our guide to Original Medicare vs. Medicare Advantage.
Help Paying for Medicare in Montana
If you have limited income and resources, two programs can cut your Medicare costs significantly.
Medicare Savings Programs
Montana administers the Medicare Savings Programs through Montana DPHHS, the state's Medicaid agency. Montana uses the standard federal income tiers and resource limits.
| Program | Individual | Couple | What it pays |
|---|---|---|---|
| QMB | Up to about $1,350 | Up to about $1,824 | Part A and B premiums, deductibles, coinsurance |
| SLMB | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
QMB is the most generous tier: it pays your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. Income figures tie to the Federal Poverty Level and update each April. Apply through Montana DPHHS, and enrolling in any of these programs automatically qualifies you for Extra Help with Part D.
Extra Help for Part D
Extra Help (also called the Low-Income Subsidy) pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone; everyone who qualifies now gets the full subsidy.
- Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
- Resource limits: $16,590 for an individual, $33,100 for a couple
- Enrollment in QMB, SLMB, or QI qualifies you for Extra Help automatically
Apply through Social Security at ssa.gov or call 1-800-772-1213.
Medicare Enrollment Periods
These deadlines are federal and the same in Montana as everywhere else. Miss one and you may face a coverage gap or a permanent penalty.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes during Annual Open Enrollment take effect January 1. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically. If not, sign up through Social Security. The General Enrollment Period runs January through March; under the BENES Act, coverage now starts the first of the month after you sign up. If you delayed Part B because you had employer coverage, you get an 8-month Special Enrollment Period after that coverage ends (COBRA and retiree coverage do not count).
Free Medicare Help: Montana SHIP
The Montana SHIP (State Health Insurance Assistance Program) is run by the Montana DPHHS Office on Aging and delivered through local Area Agencies on Aging across the state. Counselors are free, unbiased, and do not sell insurance.
Montana SHIP counselors can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans
- Apply for the Medicare Savings Programs and Extra Help
- Sort out billing questions, denials, and appeals
- Identify and report Medicare fraud
Call the statewide toll-free line at 1-800-551-3191 or visit dphhs.mt.gov/SLTC/aging/SHIP to find your local Area Agency on Aging.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the average is about $46.50 a month), and many Medicare Advantage plans charge no additional premium. Your total out-of-pocket depends on the plan you choose and the care you use.
No. Montana does not have a birthday rule or other state-added Medigap guaranteed-issue protections. The only guaranteed window is the standard federal six-month Medigap Open Enrollment Period that begins when you turn 65 and enroll in Part B. After that window closes, insurers may apply medical underwriting.
Montana uses the standard federal tiers. For 2026: QMB income up to about $1,350/month for an individual ($1,824 for a couple), SLMB up to about $1,616 ($2,184), and QI up to about $1,816 ($2,455). The resource limit is $9,950 per individual and $14,910 per couple for all three programs. Apply through Montana DPHHS.
Only in the larger metro areas. Billings, Missoula, Great Falls, and Helena typically have some options. Rural Montana, which covers most of the state's geography, generally has very few or no Medicare Advantage plans. Use the Medicare Plan Finder at medicare.gov to check your specific county.
Montana SHIP, through the DPHHS Office on Aging and local Area Agencies on Aging. Call 1-800-551-3191 for free counseling.
Learn More
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Enrollment Periods
Find personalized help with Medicare in Montana at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.