- Medicare enrollment in Maryland surpassed one million people as of April 2018.
- Only 11 percent of Maryland Medicare beneficiaries select Medicare Advantage plans.
- The availability of Medicare Advantage plans in Maryland ranges from one plan to 23 plans, depending on the county.
- There are 50 insurers offering Medigap plans in Maryland in 2020.
- Maryland law guarantees access to Medigap plan A for enrollees under age 65. Insurers that offer Medigap Plan D must also make it available for enrollees under the age of 65 (and Plan C, if the insurer offers it and the enrollee was eligible for Medicare prior to 2020).
- More than half of Maryland’s Medicare beneficiaries have stand-alone Part D prescription coverage.
- Per-enrollee Medicare spending in Maryland is virtually the same as the national average.
Medicare enrollment in Maryland
The number of Maryland residents with Medicare coverage surpassed one million as of April 2018. By July 2020, it stood at 1,054,500 — about 17 percent of the state’s population enrolled in Medicare.
87 percent of Maryland’s Medicare beneficiaries are eligible based on their age (i.e., they are at least 65 years old), while the other 13 percent are eligible due to a disability that has lasted at least 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to take effect). Nationwide, 85 percent of people filing for Medicare benefits are at least 65 years old, while 15 percent are under 65 and eligible due to disability.
Medicare coverage options
Residents can choose how to access their Medicare benefits. The first choice is between Medicare Advantage plans, where coverage is through private Medicare Advantage plans, or Original Medicare, where coverage is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.
Original Medicare includes Part A (also called hospital insurance, which helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center) and Part B (also called medical insurance, which helps pay for outpatient care like a doctor appointment or a preventive healthcare service, such as most vaccinations). Medicare Advantage plans bundle Parts A and B under a single monthly premium and often include other services like prescription drug and vision coverage. There are pros and cons to either option, and the “right” solution is different for each individual.
Medicare Advantage in Maryland
Nationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in Maryland, just 11 percent of Medicare beneficiaries selected Medicare Advantage plans. Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.
By mid-2020, about 13 percent of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 87 percent were enrolled in Original Medicare. At that point, total private plan enrollment among Medicare beneficiaries nationwide had grown to 40 percent, but Medicare Advantage enrollment continues to be less popular in Maryland.
The availability of Medicare Advantage plans in Maryland varies from one county to another. In St. Mary’s County, there is just one Medicare Advantage plan providing service in 2020. But in Baltimore County and Montgomery County, there are 24 plans and 20 plans available, respectively.
Medicare beneficiaries can switch back and forth from Medicare Advantage to Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7). There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can change to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
Medigap in Maryland
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.
Medigap plans are standardized under federal rules, with ten different plan options available. In Maryland in 2020, 50 insurers provide Medigap plans, although some only offer a few of the ten plan designs.
Under federal rules, Medicare beneficiaries have a six-month window, when they turn 65 and file for benefits under Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.
But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees under the age of 65. In Maryland, Medigap insurers are required to offer Plan A to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees; insurers that offer Medigap Plan C must also offer it to disabled Medigap enrollees who were already eligible for Medicare prior to 2020; under federal rules, Medigap plans C and F cannot be sold to anyone who is newly eligible for Medicare in 2020 or later). The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.
The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then change to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D. And Maryland does limit the pricing on Medigap Plan A for disabled enrollees: It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.
Medicare Part D plans in Maryland
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.
For 2020 coverage, insurers are offering 27 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.
549,075 Maryland Medicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug plans in Maryland as of July 2020. Nationwide, about 40 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.
Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D enrollment in Maryland is also higher than average. In addition to the people with stand-alone Part D coverage, nearly 114,000 Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage.
Medicare spending in Maryland
In 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, according to data that were standardized to eliminate regional differences in payment rates. The analysis was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees — but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.
The national average Medicare spending that year was $10,096 per enrollee, so Medicare spending in Maryland was virtually the same as the national average. On the extreme ends of the spectrum, Louisiana had the highest average per-enrollee costs, at $11,932, while Hawaii had the lowest, at $6,971.
How does Medicaid provide financial assistance to Medicare beneficiaries in Maryland?
Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services Medicare doesn’t cover – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Maryland includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Resources for your questions about Medicare in Maryland
If you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, try one of these resources for assistance.
- Maryland Senior Health Insurance Program: Visit the website or call your county office.
- The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.
- The Maryland Health Care Commission’s Consumer Guide to Long Term Care also provides helpful information on preparing for the cost of long-term care.
- Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.