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Maryland health insurance

Two insurers are offering individual-market exchange plans for 2019; premiums decreased by 13.2 percent on average.

Health insurance in Maryland

Maryland’s health marketplace

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 during subsequent open enrollment periods.

Open enrollment for 2019 ended on December 15, but enrollment is still possible for residents who have qualifying events.

In 2018, 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, 2019 rates are decreased an average of 13.2 percent.

Maryland enrollment in qualified health plans

Despite the challenges of a malfunctioning website – as was the case for many exchanges early on – 67,757 Marylanders enrolled in qualified health plans (QHPs) through Maryland Health Connection during 2014 open enrollment. More than 90 percent of those enrolling in QHPs for 2014 coverage selected plans offered by CareFirst BlueCross BlueShield. By August 13, 2015, effectuated enrollment in QHPs through Maryland’s exchange was substantially improved at 123,673 with 94 percent receiving financial assistance.

In 2016, Maryland Health Connection launched a pilot program in which customers who called the exchange were transferred to brokers for assistance. The program was intended to reduce call-center hold times and allow customers to receive plan selection advice, which only licensed agents and brokers can provide. If deemed successful, the program will return with additional brokers for the 2017 open enrollment period, which begins November 1, 2016.

A total of 162,177 people enrolled in QHPs through Maryland Health Connection during 2016 open enrollment – Maryland allowed those who began the enrollment process by January 31 to finish by February 5 if they were unable to finish on time due to a snowstorm that struck the area. This was a 35 percent increase over 2015 – the third highest percentage nationwide. Maryland had also enabled online browsing of 2016 exchange plans one month ahead of open enrollment, and once open enrollment began, within the first nine days, 89 percent of enrollees had returned to the exchange to actively renew their coverage or switch plans.

For 2017 coverage, 157,832 people enrolled in plans through Maryland Health Connection. For 2018 coverage, open enrollment was much shorter than it had been in prior years, ending on December 22 instead of January 31. By the end of open enrollment, 153,571 people had purchased coverage for 2018.

Read more about the Maryland health insurance marketplace.

Maryland Medicaid

At the beginning of 2014, the Kaiser Family Foundation estimated that 756,000 nonelderly Marylanders were uninsured. When the state decided to expand Medicaid, 302,400 residents qualified for coverage through the program.

The state recorded a 23.5 percent increase in Medicaid enrollment from 2013 to July 2018, with total enrollment reaching nearly 1.6 million.

Maryland Medicaid signups continue throughout the year. 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 fails

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, don’t apply in the state.

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 2015 Scorecard on State Health System Performance, Maryland ranked 18th based on scoring for five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity. But in the 2017 ranking, Maryland tied with New York for 10th place.

Access was Maryland’s highest-scoring category (fifth place) due to lower than average uninsured rates, few adults who went without a routine doctor visit, few adults who went without healthcare due to cost, and only 1 percent of individuals under age 65 with high out-of-pocket medical costs relative to their annual household income. See the most recent Maryland scorecard (2017 version) for more details.

The Old Line State placed 18th in United Health Foundation’s America’s Health Rankings for 2015, and climbed slightly, to 16th place, in 2017. Again, the state fared well in measures related to access to healthcare, and to healthy behaviors.

For more even information about health in Maryland, see Key Health Data About Maryland from the 2016 edition of 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.

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 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 joined 30 other states and the District of Columbia in implementing this measure. As detailed below, Maryland has seen significant Medicaid enrollment since expansion was implemented. Medicaid signup continues year-round, so enrollment totals change monthly.

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 6.1 percent in 2016. Nationwide, the average uninsured rate was 14.5 percent in 2013, and had fallen to 8.6 percent by 2016.

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

Maryland Medicare enrollment reached 930,088 in 2015 – about 16 percent of the state’s population. Nationally, 17 percent of the population is enrolled in Medicare. The state is among those with a smaller percentage of Medicare enrollees who qualify due to disability (14 percent). Eighty-six percent of Maryland Medicare recipients qualify based on age alone.

Medicare spends about $9,190 annually per Maryland enrollee and, as of 2009, the state ranks 17th in overall spending with $8.8 billion per year.

Marylanders who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. A relatively small percentage of Maryland Medicare beneficiaries choose Medicare Advantage plans; in 2015, only 8 percent had done so, compared with 31 percent nationwide.

The state sees far more enrollees in Medicare Part D plans, which provide stand-alone prescription drug coverage. About 52 percent of Maryland Medicare recipients have Part D plans, while 43 percent of Medicare recipients nationwide have such Rx coverage.

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