PacificSource Health Plans offers this marketplace health insurance plan (Plan ID 23603MT0320002) 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.
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.
Standard High On Exchange 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.
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.
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).
Variant 23603MT0320002-01 (Standard On Exchange Plan) currently displayed.
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Benefits
Covered services & limitations
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
20.00% Coinsurance after deductible
Tier 1 in-network20.00% Coinsurance after deductible
Out-of-network20.00% Coinsurance after deductible
Composite, resin, or similar restoration per tooth surface per 24 months. Periodontal scaling and root planing or curettage 1 per quadrant (8 or fewer teeth in one arch) per 24 months. Full mouth debridement 1 every 24 month only if no prophylaxis in the prior 24 months and an exam cannot be performed due to obstruction.
Major Dental Care - Child
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
Complicated oral and periodontal surgery are covered. Pulp capping only payable when pulp is exposed. Pulpotomy only for deciduous teeth. Crowns and other restorations 1 per tooth every 60 months. Replacement of existing prosthetic only when unserviceable and in place at least 60 months. Cast partial, full, and immediate dentures, or overdenture limited to cost of standard full or cast partial denture. Benefits for relines provided once per 12 months. Surgical placement and removal of implants 1 per tooth space per 60 months.
Tier 1 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
Basic Dental Care - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Dental Check-Up for Children
No Charge
Tier 1 in-networkNo Charge
Out-of-networkNo Charge
Limit: 2.0 Visit(s) per Year
Periodic exams 2 per year. Comprehensive exams covered. Full mouth, cone beams, or panorex x-rays 1 per 60 months. Bitewing x-rays 1 set per 6 months. Prophylaxis or periodontal maintenance 2 per year. Fluoride applications 4 per year. Sealants 1 per permanent molar and bicuspid in a 36 month period. Athletic mouth guards 1 per lifetime. Brush biopsies to aid in diagnosis of oral cancer are covered. Space maintainers are covered.
Major Dental Care - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
Medically necessary orthodontia requires a predetermination and a treatment plan.
Exclusions: Coverage for orthodontia services are excluded unless medically necessary.
Routine Dental Services (Adult)
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
1
First Tier Utilization
100%
Import Date
10/15/2025
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
Medical EHB Deductible, Combined In/Out of Network, Family Per Group
$150 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person
$50 per person
Medical EHB Deductible, Combined In/Out of Network, Individual
$50
Medical EHB Deductible, In Network (Tier 1), Family Per Group
per group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Person
per person not applicable
Medical EHB Deductible, In Network (Tier 1), Individual
Not Applicable
Medical EHB Deductible, Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person
per person not applicable
Medical EHB Deductible, Out of Network, Individual
Not Applicable
Plan Effective Date
1/1/2026
Plan Expiration Date
12/31/2026
Plan Type
Indemnity
QHP/Non QHP
Both
Source Name
SERFF
Plan ID
23603MT0320002
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?
Kids Dental Choice 0-20-50 (23603MT0320002) is a High Indemnity from PacificSource Health Plans 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 Kids Dental Choice 0-20-50 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 Kids Dental Choice 0-20-50 HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental add-ons: Child.
Vision coverage is not listed for this plan.
Does Kids Dental Choice 0-20-50 support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for Kids Dental Choice 0-20-50?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency care only
Does Kids Dental Choice 0-20-50 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: This plan covers eligible services when performed by an eligible provider.
How do I enroll in or manage payments for Kids Dental Choice 0-20-50?
Use the issuer portal https://ipay.pacificsource.com/FFM/ to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.
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.
