Maryland Health Insurance

Health insurance in Maryland

● Maryland's state health insurance exchange is Maryland Health Connection. 

● Open enrollment for 2021 health plans will run out from November 1 to December 15, 2020.

● Two insurers offer coverage for 2020 in Maryland's individual market, and UnitedHealthcare will be back on the market for 2021.

● Short-term health plans are available in Maryland with initial plan terms of up to three months.

● More than a million Marylanders are enrolled in Medicare.

● Maryland adopted the ACA's Medicaid expansion in 2014; since then, enrollment has grown by 56%.

● Maryland's Evergreen Health Cooperative, a CO-OP created by ACA, went bankrupt in 2017.

Is it no longer used in view of coronavirus-related business arrests? At 65 soon? Go through other changes in your life - how to get married, have a baby, start a new job? Ordering options for health insurance coverage can be challenging. Terminology can be confusing and coverage is often expensive.

This website was created to provide consumers with a useful resource for health insurance options, and this particular page is a resource for Maryland-specific information. You will find information about the many types of health insurance coverage available. You can find the basics of Maryland's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Maryland; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Maryland residents. The health insurance market (also called exchange), Medicare, and Medicaid all include coverage for medical expenses and prescription drugs.

Maryland's health insurance marketplace

Maryland operates a state-run health insurance market - Maryland Health Connection. Maryland has implemented Medicaid expansion under the Affordable Care Act and has rules that strictly limit short-term health insurance plans.

Maryland has implemented a special COVID-19/coronavirus enrollment period that continues until December 15, 2020 and implemented a new "easy registration" program in 2020 that helps people get medical insurance in Maryland based on information from their state tax returns.

Maryland open enrollment period and special enrollment dates

The health insurance market has been authorized by the Affordable Care Act (ACA). States had the ability to use the federal exchange, Healthcare.gov or implement a state-run exchange. Maryland opted for a state-run exchange called the Maryland Health Connection.

ACA rules require essential health benefits to be covered by the plans offered in the event of an exchange. You can use the insurance market to sign up for a plan and see if your income level is eligible for grants or cost-sharing reductions (CSR) to help you pay monthly premiums and other expensive out-of-pocket expenses (such as a deductible or copay). The health insurance market is a good option for individuals or families who own a small business or are employed by an organization that does not provide health insurance coverage.

Open enrollment in Maryland for 2021 health insurance coverage will begin on November 1, 2020. Outside of open enrollment, residents normally must have a qualifying event to register. But as a result of the coronavirus pandemic, Maryland Health Connection has opened a special enrollment period during which uninsured residents can sign up for coverage. The special enrollment period has been extended several times and is now expected to continue until December 15, 2020.

And although actual dates are normally always after a person's enrollment date, this special enrollment period has different rules in an attempt to cover as many uninsured people as possible:

● People who sign up by August 15, 2020 will have coverage starting August 1, 2020

● People who sign up between August 16 and September 15 will have coverage starting September 1, 2020.

● People who sign up between September 16 and October 15 will have coverage starting October 1, 2020.

● People who sign up between October 16 and November 1 will have coverage starting November 1, 2020.

● People who sign up between November 16 and December 15 will have coverage starting December 1, 2020.

This special sign-up window is designed to reduce the number of uninsured residents in the state during the COVID-19 pandemic. The exchange reported that by mid-July, more than 54,000 uninsured people had enrolled in coverage (some were considered eligible for Medicaid, while others were enrolled in qualified private health plans).

Health insurers in the health insurance marketplace

In 2020, two insurers - CareFirst BlueCross Blue Shield and Kaiser Permanente - offer individual marketplace health insurance in Maryland through the state-run health insurance exchange. Thanks to the state's reinsurance program, premiums fell by an average of 13% in 2019 and another 10% in 2020.

By 2021, UnitedHealthcare plans to rejoin Maryland's health insurance exchange. And existing insurers offering health insurance in Maryland have proposed another overall decrease in the average rate for 2021.

158,934 people enrolled in private plans through the Maryland exchange during the open enrollment period for 2020 coverage, which was the highest enrollment since 2016, when more than 162,000 people enrolled.

Short-term health insurance in Maryland

Maryland HB1782 - enacted in 2018 - limits the duration of the short-term plan to three months and prohibits renewal. So current short-term federal rules allowing extended short-term plans do not apply in Maryland.

The state also requires the inclusion of various benefits in short-term plans sold in Maryland.

Medicare coverage and enrollment in Maryland

Medicare covers people over the age of 65, some people with disabilities, and people with end-stage kidney disease (ESRD). Medicare terminology can be confused. Here's a simplified explanation of some common terms related to Medicare:

● Medicare Part A covers hospital care.

● Medicare Part B covers medical services.

● Medicare Part D covers prescription drugs.

● Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for the services you receive.

● Medicare Part C, also called Medicare Advantage, is the "all-in-one" option. Through Medicare Advantage, you can choose between one of the many private health plans in your state, and the federal government pays for the plan for the services you receive 

Medicare Advantage plans are necessary to provide all services covered by the original Medicare and often also include coverage of prescription drugs. Individual Medicare Advantage programs can offer additional services, such as dental or vision coverage, without any premium increase and keeping costs low. You can change Medicare Advantage plans or move between Medicare Advantage and traditional Medicare each year during the open enrollment period. This article provides a useful discussion about Medicare options.

1,052,496 Maryland residents were enrolled in Medicare in mid-2020. The annual Medicare enrollment period for private Medicare (Part D and Medicare Advantage) plans runs from October 15 to December 7, with coverage starting January 1.

Medicaid expansion in Maryland

Medicaid in a health insurance option available to people on low or very low incomes or people with disabilities. Medicaid is a joint state and federal program. The federal government defines broad requirements and the state determines eligibility levels and manages the program. Some people qualify for both Medicaid and Medicare.

Maryland has expanded Medicaid coverage under the ACA, and enrollment in the state's Medicaid and CHIP coverage has increased by 56% since 2013. The federal government pays 90% of the cost of Medicaid expansion, while the state pays the remaining 10%.

Visit the Maryland Department of Health website to learn more about the state's Medicaid program. Like most states, Maryland uses private insurers to administer managed care plans for many of the state's Medicaid enrollees. Maryland's health insurance exchange has more information about insurers offering Medicaid plans in the state.

Maryland CO-OP failed, went into receivership in 2017

The Consumer Operated and Oriented Plan (Co-Op) was created through the ACA to stimulate the creation of consumer-run nonprofit health insurance companies. Evergreen Health Cooperative in Maryland was one of 24 CO-POs to receive a federal loan.

But as with most CO-PO, Evergreen no longer offers coverage. They offered small-group coverage for 2017, but not individual market coverage.

They had planned to switch to a for-profit entity and start offering individual market coverage again for 2018, but by the summer of 2017 the state announced that private investors who planned to buy co-op had withdrawn from the agreement and CO-OP went into receivership.

Maryland and the Affordable Care Act

Maryland's politics are dominated by Democrats at the state and federal levels, and the Affordable Care Act has broad support among Maryland leaders. Governor Larry Hogan is a Republican, but he has shown a willingness to work across the aisle to implement health reform measures in the state, including a reinsurance program and the "easy enrollment" program that uses tax return data to help ensure residents have the health care for which they are eligible.

When the ACA was passed in 2010, both Maryland Senator Benjamin Cardin and Barbara Mikulski voted in favor of the law, as did all but one of the eight U.S. representatives. Mikulski has since been replaced by Chris Van Hollen, who is also a Democrat and supporter of the ACA.

The Maryland Legislature approved a state-run health insurance market, and then-Gov. Martin O'Malley signed the bills in 2011. The state market, called the Maryland Health Connection, was one of the first approved by the federal government.

Despite the initial start of the state, its market worked poorly. So bad, in fact, that the state abandoned its technological infrastructure and purchased the platform that Connecticut had successfully used. Since then, Maryland Health Connection has been a successful state market.

Medicaid expansion is a key ACA strategy to reduce the uninsured rate, and Maryland was among the states that expanded Medicaid as soon as that option became available, with actual coverage in January 2014.

Maryland has seen a significant drop in its uninsured rate since the ACA's individual mandate took effect. According to U.S. Census data, 10.2% of Maryland residents were un insured in 2013, and this had fallen to 6% in 2018. Nationally, the average uninsured rate was 14.5% in 2013 and 8.9% in 2019.

Does Maryland have a high-risk pool?

In the individual health insurance market before 2014, applications were signed from the medical reference point in nearly every state, including Maryland. Because medical history has been used to determine suitability for coverage, people with pre-existing conditions have often found themselves unable to purchase full plans in the private market.

The Maryland Health Insurance Plan (which has now been phased out) provided coverage since 2003 for people who had been denied plans in the private market due to pre-existing conditions, or offered only plans that excluded their pre-existing conditions.

According to the ACA, medical history is no longer an eligibility factor for private health insurance. The need for high-risk pools has therefore been largely eliminated, but some risk pools are still operational.

In 2013, MHIP published a plan for the transition of their members to the exchange. But Maryland's exchange was one of the most technologically challenged during the first open enrollment period and in December 2013, MHIP's board voted to extend the MHIP Standard plans until the end of 2014 and MHIP Plus plans until the end of March 2014. In January 2014, MHIP also became a temporary insurer for Maryland residents who were unable to secure coverage in the Maryland exchange due to website issues during the early months of 2014 of open enrollment. MHIP has stopped providing coverage as of January 1, 2015.

Maryland Health Insurance Resources

● Maryland Health Connection

● Maryland Department of Health (Medicaid Information)

● Maryland Health Education and Advocacy Unit

● Access to health care in Maryland

● Maryland Senior Health Insurance Program