In Maryland, access to healthcare and health insurance is above average, and the state consistently ranks well for these measures. With a state-based health insurance exchange and Medicaid expansion under the Affordable Care Act, the number of Marylanders who go uninsured has declined substantially.
This guide provides an overview of the healthcare landscape in Maryland, including public health rankings, ACA implementation, legislation, and other factors. Use the following links to see how Maryland is moving on specific health measures, and read how efforts around healthcare reform might be pushing the state in a positive direction.
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.
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 for more details.
The Old Line State also placed 18th in United Health foundation’s America’s Health Rankings for 2015. Again, the state fared well in measures related to access to healthcare. It placed ninth for lack of health insurance, second for primary care physicians, and eight for dentists. Disparity in health status and violent crime were Maryland’s lowest-ranking measures – 42nd and 43rd.
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.
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 Gallup, Maryland’s uninsured rate was 12.9 percent in 2013. It dropped 5.1 percentage points to 7.8 percent by the end of 2014, making Maryland one of the 10 states with the largest reduction in percentage uninsured that year.
By late-2015, Maryland’s uninsured rate dropped slightly more to 7.5 percent – the uninsured rate among all states that both created a state-run or partnership exchange and expanded Medicaid at that time was about 7.8 percent. Nationally, it was 11.7 percent.
2017 open enrollment rates and carriers
With the exception of UnitedHealthcare, which is exiting the individual market at the end of 2016, all carriers that participated in Maryland’s state-based exchange will continue to do so in 2017. These carriers and their proposed average rate increases are as follows:
- CareFirst Blue Choice (HMO): 12 percent
- CareFirst Blue Cross Blue Shield: 16 percent
- Cigna: 30 percent
- Evergreen: 8 percent
- Kaiser Permanente: 25 percent
CareFirst Blue Choice has had the bulk of the market share for plans sold on Maryland Health Connection.
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.
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.
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 is moving to the platform successfully used by Connecticut.
Medicaid expansion is a key ACA strategy for reducing the uninsured rate, and Maryland joined 25 other states and the District of Columbia in implementing this measure. As detailed below, Maryland saw significant Medicaid enrollment during the open enrollment period on the marketplace. Medicaid signup continues year-round, so enrollment totals change monthly.
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 saw a 43 percent increase in Medicaid enrollment from 2013 to June 2016, with monthly enrollment reaching 1.2 million. Since Medicaid expansion under the ACA, Maryland has seen the 13th biggest change in Medicaid enrollment nationwide.
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.
Other ACA reform provisions
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.
Evergreen did not attract many consumers during 2014 open enrollment, in part due to the problems with Maryland Health Connection. Nevertheless, while many CO-OPs had closed or announced their closures, as of September 2016, Evergreen remained in operation. The CO-OP was profitable in first quarter 2016 and grew its enrollment by 10,000 people between 2015 and 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) has 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
Here’s a summary of recent state-based legislation related to healthcare reform: