Health insurance in Maryland
- Maryland’s state-run health insurance exchange is Maryland Health Connection.
- COVID-related enrollment period for uninsured residents continues through August 15, 2021.
- Three insurers are offering 2021 coverage in Maryland’s individual market, including UnitedHealthcare, which has rejoined the marketplace.
- Short-term health plans are available in Maryland with initial plan terms of up to three months.
- More than a million Maryland residents are enrolled in Medicare.
- Maryland adopted the ACA’s Medicaid expansion in 2014; enrollment has grown by 56% since then.
- Maryland’s Evergreen Health Cooperative, an ACA-created CO-OP, failed in 2017.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Maryland. You’ll find information about Maryland’s health insurance exchange (Maryland Health Connection); a brief overview of Medicaid expansion in Maryland; a quick look at the state’s rules for short-term health insurance; Maryland-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.
The health insurance marketplace was authorized by the Affordable Care Act (ACA). States had the option to use the federal exchange, Healthcare.gov, 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.
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.
Maryland open enrollment period and special enrollment dates: Uninsured residents can enroll through August 15, 2021
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.
(but Maryland is still limiting enrollment — without a qualifying event — to people who are uninsured, as opposed to the more flexible enrollment windows that are being offered in other states; note, however, that there is always a special enrollment period available for people who become newly eligible for premium subsidies, which applies to many people in 2021 as a result of the American Rescue Plan).
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).
Health insurers in the health insurance marketplace
In 2020, two insurers – CareFirst BlueCross Blue Shield and Kaiser Permanente – offered 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, by another 10 percent in 2020, and by nearly 12 percent for 2021.
And for 2021, UnitedHealthcare rejoined Maryland’s health insurance exchange.
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. 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.
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) or ALS. 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 outpatient care, physician services, and various other 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. People with Original Medicare need to purchase Part D coverage and Medigap coverage separately, unless they have supplemental coverage provided by an employer or Medicaid.
- Medicare Part C, also called Medicare Advantage, is the “all-in-one” option, as most Advantage plans include Part D coverage, and all of them include a cap on out-of-pocket costs for the services that would be covered by Original Medicare. Through Medicare Advantage, you can choose from one of several private health plans in your state, and the federal government pays the plan for the services you receive. Individual Medicare Advantage programs may also offer additional services – like dental or vision coverage. 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.
1,060,444 Maryland residents were enrolled in Medicare as of October 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. 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.
Medicaid expansion in Maryland
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 63 percent since 2013. The federal government pays 90 percent of the cost of Medicaid expansion, while the state pays 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 (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.
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
- Maryland Health Connection
- Maryland Department of Health (Medicaid information)
- Maryland Health Education and Advocacy Unit
- Health Care Access Maryland
- Maryland Senior Health Insurance Program
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.