Frequently asked questions about health insurance
coverage options in Maryland
Maryland operates a state-run health insurance marketplace – Maryland Health Connection. The health insurance marketplace was authorized by the Affordable Care Act (ACA). Read more about the Maryland health insurance marketplace.
Open enrollment in Maryland for 2021 health insurance coverage ran from November 1, 2020 through December 15, 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 has, since the spring of 2020, been running a nearly-continuous special enrollment period during which uninsured residents can sign up for coverage; the current end date is August 15, 2021.
The initial special enrollment period was extended multiple times, and continued through December 15, 2020, with generous effective date rules that allowed some enrollees to have retroactive coverage. Maryland reopened its COVID-related special enrollment period as of early January 2021, with a scheduled end date of March 15, 2021. But soon after the Biden administration announced a COVID-related enrollment window on HealthCare.gov through May 15, Maryland Health Connection extended its COVID-related enrollment window again, giving uninsured residents until May 15 to sign up for coverage.
When HealthCare.gov subsequently extended its window through August 15, Maryland Health Connection again followed suit, so the state’s COVID-related enrollment window is now slated to run through August 15, 2021.
Maryland’s enrollment during this window is a bit more limited than the rules that apply in most states. For people who don’t have a qualifying event, enrollment is limited to new enrollees (including people switching from off-exchange to on-exchange coverage) and to plan upgrades. So current Maryland exchange enrollees can use the COVID/American Rescue Plan enrollment window to upgrade to better coverage, but cannot use it to switch to a plan at a lower metal level.
The exchange is continuing to use the same retroactive coverage availability rules that applied in 2020. Maryland is the only state where people can sign up for retroactive coverage during the COVID-related enrollment window, depending on the date that they enroll.
By March 2021, a year after the COVID-related enrollment window began, Maryland reported that more than 48,000 people had enrolled in private plans during the state’s nearly continuous COVID-related enrollment window, in addition to another 92,000 who enrolled in Medicaid (Medicaid enrollment is always available year-round).
Three insurers – CareFirst BlueCross Blue Shield, Kaiser Permanente and UnitedHealthcare – are offering individual-market health plans for 2021 through the Maryland exchange.
During the open enrollment period for 2020 coverage, 158,934 people enrolled in private plans through Maryland’s exchange – the highest enrollment had been since 2016, when more than 162,000 people enrolled. Enrollment hit a new record high during the open enrollment period for 2021 coverage, however, with 166,038 people selecting or renewing coverage for 2021.
Maryland has offered the nation’s longest COVID-related special enrollment period (currently slated to run through August 15, 2021), 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. Enrollment in private plans through Maryland Health Connection reached an all-time high during the open enrollment period for 2021 coverage.
Read our full overview of the Maryland health insurance marketplace.
Medicaid is 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 6% since 2013. The federal government pays 90% of the cost of Medicaid expansion, while the state pays the remaining 10%.
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.
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 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 (it remained at 6 percent in 2019, and did not experience the slight uptick in the uninsured rate that many other states saw in 2019). Nationwide, the average uninsured rate was 14.5 percent in 2013, and 8.9 percent in 2019.
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.
As of early 2021, 1,062,738 Maryland residents were enrolled in Medicare.
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. There is also an annual Medicare Advantage open enrollment period (for people who already have Advantage coverage) that runs from January 1 to March 31.
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.
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.