Maryland health insurance

As a result of the coronavirus pandemic, uninsured residents have until December 15 to enroll in health insurance in Maryland

Health insurance in Maryland

No longer employed given coronavirus-related business shutdowns? Turning 65 soon? Going through other changes in your life – like getting married, having a baby, starting a new job? Sorting through your options for health insurance coverage can be challenging. The terminology can be confusing, and coverage is often costly.

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

Maryland’s health insurance marketplace

Maryland operates a state-run health insurance marketplace – 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 implemented a COVID-19 / coronavirus special enrollment period that continues through December 15, 2020, and implemented a new “easy enrollment” 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 marketplace was authorized by the Affordable Care Act (ACA). States had the option to use the federal exchange,, or implement a state-run exchange. Maryland opted for a state-run exchange, which is called the Maryland Health Connection.

ACA rules require that essential healthcare benefits be covered by plans offered on the exchange. You can use the insurance marketplace to enroll in a plan and to see if your income level qualifies for subsidies or cost-sharing reductions (CSR) to help you pay for monthly premiums and other costly out-of-pocket expenses (like a deductible or copay). The health insurance marketplace is a good option for individuals or families who own a small business or are employed by an organization that doesn’t 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 need to have a qualifying event in order to enroll. But as a result of the coronavirus pandemic, Maryland Health Connection opened a special enrollment period during which uninsured residents can sign up for coverage. The special enrollment period has been extended multiple times, and is now scheduled to continue through December 15, 2020.

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 August 15, 2020 will have coverage effective August 1, 2020
  • People who enroll between August 16 and September 15 will have coverage effective September 1, 2020.
  • People who enroll between September 16 and October 15 will have coverage effective October 1, 2020.
  • People who enroll between October 16 and November 1 will have coverage effective November 1, 2020.
  • People who enroll between November 16 and December 15 will have coverage effective December 1, 2020.

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 mid-July, more than 54,000 uninsured people had signed up for coverage (some were deemed eligible for Medicaid, while others were enrolled in private qualified health plans).

Health insurers in the health insurance marketplace

In 2020, two insurers – CareFirst BlueCross Blue Shield and Kaiser Permanente – are offering individual market health insurance in Maryland through the state-run health insurance 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.

For 2021, UnitedHealthcare plans to rejoin Maryland’s health insurance exchange. And the existing insurers that offer health insurance in Maryland have proposed another overall average rate decrease for 2021.

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 the Maryland health insurance marketplace.

Short-term health insurance in Maryland

Maryland HB1782 – enacted in 2018 – limits short-term plan duration to three months and prohibits renewal. So the current 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.

Medicare coverage and enrollment in Maryland

Medicare covers people who are age 65 or older, certain people with disabilities, and people with end stage renal disease (ESRD). Medicare terminology can be confusing. Here is a simplified explanation of some common Medicare-related terms:

  • Medicare Part A covers inpatient 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 services you receive.
  • Medicare Part C, also called Medicare Advantage, is the “all-in-one” option. Through Medicare Advantage, you can chose from one of several private health plans in your state, and the federal government pays the plan for the services you receive

Medicare Advantage plans are required to provide all the services covered under original Medicare, and they often include prescription drug coverage, too. Individual Medicare Advantage programs may offer additional services – like dental or vision coverage – with no increase in premium and keeping your costs down. 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 helpful discussion of Medicare options.

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

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.

Medicaid expansion in Maryland

Medicaid in a health insurance option available for people with little or very low income or people who have a disability. Medicaid is a joint state and federal program. The federal government defines broad requirements, and the state determines eligibility levels and operates the program. Some people qualify for both Medicaid and Medicare.

Maryland expanded Medicaid coverage under the ACA, and enrollment in the state’s Medicaid and CHIP coverage has increased by 56 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 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 additional information about the insurers that offer Medicaid plans in the state.

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.

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. Since then, Maryland Health Connection has been a successful state-run marketplace.

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.

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.

Maryland health insurance resources

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.

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