Medicare in Maryland

More than a million people in Maryland have Medicare coverage. Most are enrolled in Original Medicare.

At a glance: Medicare health insurance in Maryland

Medicare enrollment in Maryland

2020 Medicare enrollment datesThe number of Maryland residents with Medicare coverage surpassed one million as of April 2018. By November 2018, it stood at 1,014,267. That’s less than 17 percent of the state’s population, compared with a little more than 18 percent of the United States population enrolled in Medicare.

86 percent of Maryland’s Medicare beneficiaries are eligible based on their age (ie, they are at least 65 years old), while the other 14 percent are eligible due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability.

Medicare Advantage in Maryland

Nationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2017. 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.

The availability of Medicare Advantage plans varies from one county to another. In St. Mary’s County, Maryland, there is just one Medicare Advantage plan available in 2019. But in Baltimore County and Montgomery County, there are 23 plans available.

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). And as of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch 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 2019, there are 49 insurers that offer 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 enroll in 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 (and Plan C, if the insurer offers that plan) 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. This requirement 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 switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C.

Medicare Part D in Maryland

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.

For 2019 coverage, insurers are offering 25 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.

526,518 MarylandMedicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug plans in Maryland as of November 2018. Nationwide, about 43 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.

Most Medicare Advantage plans include Part D coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare is higher than average in Maryland, which is why enrollment in stand-alone Part D plans is also higher than average. In addition to the people with stand-alone Part D coverage, more than 100,000 Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage.

Medicare spending in Maryland

In 2016, Original Medicare spent an average of $9,560 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 $9,533 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 $11,399, while Hawaii had the lowest, at $6,441.

You can read more about Medicare in Maryland in our state Medicare guide. You can also contact the Maryland Senior Health Insurance Program if you have questions related to Medicare coverage in Maryland.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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