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Maryland health insurance

As a result of the coronavirus pandemic, uninsured residents have until June 15 to enroll. And the state's "easy enrollment" program for uninsured residents has been extended until July 15.

Health insurance in Maryland

Maryland’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Maryland is one of the states fighting the hardest to preserve the Affordable Care Act’s gains. See the steps Maryland has taken.

Maryland operates a state-run health insurance marketplace – Maryland Health Connection. The initial rollout of the exchange in 2013 was a disaster, and the exchange underwent a complete overhaul in 2014, resulting in a much better user experience.

Coronavirus special enrollment period through June 15, 2020

Open enrollment for 2020 ended on December 15, 2019, but enrollment is still possible for residents who have qualifying events. And 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 was initially slated to run through mid-April, but the exchange has extended it through June 15.

And although effective dates are normally always after the date a person enrolls, this special enrollment period has different rules in an effort to get as many uninsured people covered as quickly as possible:

  • People who enroll by April 15 will have coverage effective April 1.
  • People who enroll between April 16 and May 1 will have coverage effective May 1.
  • People who enroll between May 16 and June 15 will have coverage effective June 1.

This special enrollment window is designed to reduce the number of uninsured residents in the state during the COVID-19 pandemic. The exchange reported that as of late March, more than 10,000 uninsured people had signed up for coverage (some were deemed eligible for Medicaid, while others were enrolled in private qualified health plans).

“Easy Enrollment” program continues until July 15, 2020

Maryland rolled out a new “easy enrollment” program in 2020: Uninsured residents can check a box on their tax return indicating that they’d like the state to share their data with Maryland Health Connection to determine whether they might be eligible for free or subsidized health coverage. If so, the exchange will reach out to the person and help them enroll — and they can do so right away, as the exchange will grant a 35-day special enrollment period during which the person can pick a plan (and Medicaid/CHIP enrollment run year-round).

The easy enrollment program was designed to follow the tax-filing season, which has been extended through July 15 amid the COVID-19 pandemic. Maryland has announced that the easy enrollment program has been extended through July 15 as well. By the end of March, more than 1,600 people had enrolled in health coverage via the easy enrollment program.

Maryland’s marketplace

In 2020, two insurers – CareFirst BlueCross Blue Shield and Kaiser Permanente – are offering individual-market health plans through the Maryland exchange. Thanks to the state’s reinsurance program, premiums decreased by an average of 13 percent in 2019, and by another 10 percent in 2020.

In the fall of 2015, Maryland Health Connection launched a pilot program in which customers who called the exchange were transferred to brokers for assistance. The program was designed to reduce call-center hold times and allow customers to receive plan selection advice, which only licensed agents and brokers can provide. Similar programs have since been adopted by and other state-run exchanges.

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

Read our full overview of Maryland’s health insurance marketplace.

Maryland Medicaid

Maryland expanded Medicaid under the ACA, and enrollment in the state’s Medicaid and CHIP coverage has increased by 54 percent since 2013. The federal government pays 90 percent of the cost of Medicaid expansion, while the state pay the remaining 10 percent.

Visit the Maryland Department of Human Resources website to learn more about the state’s Medical Assistance programs.

Read more about Medicaid expansion in Maryland.

Maryland CO-OP failed, was placed in receivership in 2017

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

But as was the case with most of the CO-OPs, Evergreen is no longer offering coverage. They offered small group coverage for 2017, but not individual-market coverage.

They had planned to switch to a for-profit entity and begin offering individual market coverage again for 2018, but by the summer of 2017 the state announced that the private investors who had planned to purchase the CO-OP had pulled out of the deal, and the CO-OP was placed in receivership.

Read more about ACA’s CO-OPs.

Short-term health insurance in Maryland

Maryland’s HB1782 – passed in 2018 – limits short-term plan duration to three months and prohibits renewal. Thus, new federal short-term rules allowing for extended short-term plans do not apply in Maryland.

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

Read more about short-term health insurance in Maryland.

Maryland health ratings

In the Commonwealth Fund’s 2019 Scorecard on State Health System Performance ranked Maryland 18th out of the 50 states and DC.

The Old Line State placed also ranked 18th in United Health Foundation’s America’s Health Rankings for 2019.

For more even information about health in Maryland, see Key Health Data About Maryland from the Trust for America’s Health.

Finally, the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin break down public health rankings at the county level.

Maryland and the Affordable Care Act

Maryland politics are dominated by Democrats at the state and federal level, and the Affordable Care Act has broad support among Maryland leaders. Governor Larry Hogan is a Republican, but has shown a willingness to work across the aisle to implement health care reform measures in the state, including a reinsurance program and the “easy enrollment” program that utilizes tax return data to help ensure that residents are getting the health coverage assistance for which they’re eligible.

When the ACA was passed in 2010, both Maryland Sens. Benjamin Cardin and Barbara Mikulski voted in favor of the law, as did all but one of the state’s 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 marketplace, and then-Gov. Martin O’Malley signed the bills into law in 2011. The state marketplace, called the Maryland Health Connection, was one of the first approved by the federal government.

Despite the state’s early start, its marketplace performed poorly. So poorly, in fact, that the state abandoned its technological infrastructure and purchased the platform that Connecticut had been successfully using.

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

How has Obamacare helped Maryland?

Maryland experienced a significant drop in its uninsured rate after the ACA’s individual mandate went into effect. According to US Census data, 10.2 percent of Maryland residents were uninsured in 2013, and that had fallen to 6 percent in 2018. Nationwide, the average uninsured rate was 14.5 percent in 2013, and 8.9 percent in 2019.

Does Maryland have a high-risk pool?

In the individual health insurance market prior to 2014, applications were medically underwritten in nearly every state, including Maryland. Because medical history was used to determine eligibility for coverage, people with pre-existing conditions often found themselves unable to purchase comprehensive plans in the private market.

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

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

In 2013, MHIP released a plan for transitioning their members to the exchange. But Maryland’s exchange was one of the more technologically challenged during the first open enrollment period, and in December 2013, the MHIP board voted to extend 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 because of website problems during the first few months of 2014 open enrollment. MHIP stopped providing coverage as of January 1, 2015.

Medicare enrollment in the state of Maryland

1,044,855 Maryland residents were enrolled in Medicare as of the end of 2019. You can read our overview of Medicare in Maryland for more information about Medicare Advantage and Part D availability, as well as the state’s rules for Medigap plans.

State-based health reform legislation

Scroll to the bottom of this page for a summary of recent state-based legislation related to healthcare reform.

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.