Maryland Health Connection, the state-run marketplace, is dramatically improved over the version that launched in the fall of 2013. The state abandoned its old website technology and replaced it with Connecticut’s proven system, fired contractors, implemented new call center technology, and implemented a staggered launch to the second open enrollment period.
The extensive overhaul, which cost about $40 million according to the Washington Post, has Maryland Health Connection working smoothly. Nearly 52,000 people signed up for health insurance through Maryland Health Connection between Nov. 15 and Dec. 5. About 30,000 people selected private health insurance, while about 22,000 qualified for Medicaid.
Phase-in to 2015 open enrollment pays off
Maryland used a staggered start to limit traffic in the first several days of 2015 open enrollment.
Consumers were able to browse anonymously starting on Nov. 9. This is a major improvement over last year, when consumers were unable to browse plans until after they had created an account with the exchange.
Consumers could sign up for coverage at enrollment fairs beginning on Nov. 15 and through the call center on Nov. 16. Several more days of increasing access were planned. However, with the site running smoothly, the exchange was opened to all users two days early on Nov. 17.
Re-enroll for 2015 to get subsidies
People who enrolled in private plans through the Maryland Health Connection in 2014 need to re-enroll during the 2015 open enrollment period. The transition to new software means that subsidy eligibility will need to be redetermined.
People who don’t re-enroll will be able to keep their existing health insurance policy, but not their subsidy. Since most enrollees received a subsidy in 2014, the exchange is encouraging everyone to re-submit their financial information to determine subsidy eligibility for 2015.
The Maryland Insurance Administration announced 2015 premiums in late August.
For 2015, eight carriers are offering individual policies through Maryland Health Connection, with a total of 61 plans available (an increase from 45 in 2014).
Three of the six carriers that offered 2014 individual policies have lowered premiums for their 2015 policies, while the other three raised their rates. The increases for those three companies are lower than what they requested, thanks to careful review by the Maryland Insurance Administration.
2014 enrollment recap
Despite all of the problems in 2014, Maryland exceeded its enrollment goal of 260,000. Through September 2014, the Maryland exchange had enrolled more than 458,000 people: 81,553 in private health plans, and another 376,850 in Medicaid.
Six insurers offered 45 individual plans through Maryland Health Connection for the 2014 plan year. The vast majority of those enrolling in QHPs selected plans offered by one of the three CareFirst BlueCross BlueShield companies that participated in the marketplace. The CareFirst options captured nearly 94 percent of enrollees during the first open enrollment period, followed distantly by Kasier with about 5 percent, Evergreen Health Cooperative with 0.7 percent, and All Savers (part of UnitedHealthcare) with 0.4 percent.
Small business exchange
Maryland launched its Small Business Health Options (SHOP) exchange in April 2014. More than 90 plans from 11 insurers were available for the 2014 plan year. For the 2015 plan year, small employers can choose from among 11 insurers offering 110 health plans.
Difficulties in 2014
Severe technical problems plagued the Maryland Health Connection website in 2014. Some consumers who were unable to sign up for private insurance were temporarily enrolled in the state’s high-risk insurance program, at the state’s expense. Problems with determining who qualifies for Medicaid means the state may make about $20 million in unnecessary payments over two years. Maryland fired its prime contractor, Noridian Healthcare Solutions, and hired Deloitte Consulting to adapt Connecticut’s successful technology for use by Maryland. Consultants put the cost of rebuilding the Maryland Health Connection website at up to $60 million.
Maryland Health Connection was criticized for its lack of transparency. News outlets informally complained about inadequate disclosure of website problems, and the Kent County News filed a formal complaint with the state’s Open Meetings Compliance Board. Industry experts, state and federal legislators, and the state comptroller all questioned the mostly closed-door meetings during which exchange officials decided to rebuild the state’s website rather than transition to the federal site.
In addition, the Maryland Health Benefit exchange, which oversees the marketplace, repeatedly delayed the launch of the Small Business Health Options Program (SHOP). Work on the SHOP website was put on hold in February, and the launch date pushed back until Jan. 1, 2015. As of April 2014, small businesses could purchase policies and receive tax credits by working directly with insurers or through brokers or third-party administrators (TPAs).
Maryland Health Connection History
Maryland was an early adopter of the health insurance marketplace envisioned by the Affordable Care Act (ACA). While many other states waited to see the outcome of the Supreme Court challenge to the ACA, Maryland moved ahead. The Maryland Health Benefit Exchange (MHBE) was signed into law in April 2011, with additional legislation passed in May 2012. The MHBE was later rebranded as the Maryland Health Connection. In December 2012, the Maryland Health Connection was among the first six state-based exchanges to be approved by the federal government.
Maryland Health Connection is overseen by a nine-member board. On June 25, 2014, Carolyn Quattrocki was named to a one-year term as executive director of the board. She began serving in that role on an interim basis in December 2013 following the resignation of Rebecca Pearce.
Maryland Health Connection functions as a clearinghouse, meaning any QHP can sell policies on the exchange. Any health plan with significant market share in the state is required to participate in the marketplace. After two years of operation, the exchange has the option to adopt an active purchaser model. Health plans are limited to selling four benefit packages per metal level (platinum, gold, silver, and bronze).
Maryland health insurance exchange links
Maryland Health Connection
Maryland Health Benefit Exchange (MHBE)
Information about exchange planning and development
State Exchange Profile: Maryland
The Henry J. Kaiser Family Foundation overview of Maryland’s progress toward creating a state health insurance exchange.
Health Education and Advocacy Unit, Office of the Attorney General
Serves residents and other consumers who receive health care from a Maryland health care provider or health insurance provider.