Montana health plan · 2026

Blue Focus Silver POS℠ Standard · 30751MT0670028

Blue Cross Blue Shield of Montana offers this marketplace health insurance plan (Plan ID 30751MT0670028) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: POS CSR: 94% AV Level Silver Plan Issuer: Blue Cross Blue Shield of Montana
Telehealth Data pending HSA eligible No Dental Not listed Vision Child

CMS AV Calculator output: 94.11% (5.89% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$443 – $1736

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$2,200

$4400 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $10.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand $15.00

View formulary tiers

$606 / mo before subsidies

≈ $7275 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1921 / mo before subsidies

≈ $23055 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2327 / mo before subsidies

≈ $27922 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1479 / mo before subsidies

≈ $17744 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00%

Durable Medical Equipment

25.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Montana). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 94% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00%

Durable Medical Equipment

25.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Montana 4704
PCPs in Montana 439
Telehealth support Data pending
Nationwide providers 259485
4,704 doctors statewide 439 PCPs 25 OB/GYN
Providers Montana All US states
All 4704 259485
PCP 439 975
Allergy N/A 3
OB/GYN 25 44
Dentists 240 99351

Drug coverage overview

3,947 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,307
SPECIALTY 899
NON-PREFERRED-BRAND 741
Prior authorization Drugs
Required 940
Not Required 3,007
Step therapy Drugs
Required 28
Not Required 3,919
Quantity limits Drugs
Has Limit 1,663
No Limit 2,284

Customer highlights

What stands out for members

  • Issuer: Blue Cross Blue Shield of Montana · Plan ID 30751MT0670028 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 30751MT0670028-06 (94% AV Silver Plan ) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

25.00%

Diabetes Education

25.00%

Home Health Care Services

25.00%

Laboratory Outpatient and Professional Services

25.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$10.00

Preventive Care/Screening/Immunization

0.00%

Primary Care Visit to Treat an Injury or Illness

$0.00

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00

Rehabilitative Speech Therapy

$0.00

Specialist Visit

$10.00

Urgent Care Centers or Facilities

$5.00

X-rays and Diagnostic Imaging

25.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

25.00%

Delivery and All Inpatient Services for Maternity Care

25.00%

Dialysis

25.00%

Durable Medical Equipment

25.00%

Emergency Room Services

25.00%

Emergency Transportation/Ambulance

25.00%

Hospice Services

No Charge

Inpatient Hospital Services (e.g., Hospital Stay)

25.00%

Inpatient Physician and Surgical Services

25.00%

Mental/Behavioral Health Inpatient Services

25.00%

Mental/Behavioral Health Outpatient Services

$0.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

25.00%

Outpatient Rehabilitation Services

No Charge

Outpatient Surgery Physician/Surgical Services

25.00%

Radiation

25.00%

Skilled Nursing Facility

25.00%

Substance Abuse Disorder Inpatient Services

25.00%

Substance Abuse Disorder Outpatient Services

$0.00

Transplant

25.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Hearing Aids

25.00%

Major Dental Care - Child

Coverage details pending

Prenatal and Postnatal Care

No Charge

Routine Eye Exam for Children

No Charge

Well Baby Visits and Care

No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00

Non-Preferred Brand Drugs

$50.00

Preferred Brand Drugs

$15.00

Specialty Drugs

$150.00

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

25.00%

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

Coverage details pending

Infusion Therapy

$50.00

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

25.00%

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

Coverage details pending

Prosthetic Devices

25.00%

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

25.00%

Allergy Testing

25.00%

Bariatric Surgery

Coverage details pending

Cosmetic Surgery

25.00%

Eye Glasses for Children

25.00%

Habilitation Services

$0.00

Imaging (CT/PET Scans, MRIs)

25.00%

Infertility Treatment

25.00%

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

Coverage details pending

Reconstructive Surgery

25.00%

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

25.00%

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Variant attributes

Blue Focus Silver POS℠ Standard · Variant 30751MT0670028-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

30751MT067

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

30751MT0670028-06

Plan Marketing Name

Blue Focus Silver POS℠ Standard

Plan Variant Marketing Name

Blue Focus Silver POS℠ Standard

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

30751

Issuer Marketplace Marketing Name

Blue Cross and Blue Shield of Montana

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MTN008

Out of Country Coverage

Yes

Out of Country Coverage Description

This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Coverage outside our service area is available for Emergency and Urgent Care services. You may also obtain non-emergency care outside our service area but may be responsible for a greater portion of costs.

Service Area ID

MTS028

State Code

MT

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.9411075

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,200

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$200

SBC Scenario, Having Diabetes, Copayment

$200

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$500

SBC Scenario, Treatment of a Simple Fracture, Copayment

$30

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

25.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$4400 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$2200 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$2,200

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$17600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$8800 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$8,800

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MTF005

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Design 1

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

POS

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

30751MT0670028

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$5600 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$2800 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$2,800

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Montana?

Blue Focus Silver POS℠ Standard (30751MT0670028) is a Silver POS from Blue Cross Blue Shield of Montana in Montana for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Focus Silver POS℠ Standard support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Focus Silver POS℠ Standard HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Focus Silver POS℠ Standard support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Focus Silver POS℠ Standard?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Blue Focus Silver POS℠ Standard?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Does Blue Focus Silver POS℠ Standard cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Coverage outside our service area is available for Emergency and Urgent Care services. You may also obtain non-emergency care outside our service area but may be responsible for a greater portion of costs.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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