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 individual/family health coverage runs from November 1 through January 15 in Maryland.
To enroll or change plans outside of the open enrollment period, a qualifying life event is necessary.
In Maryland, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (Maryland Health Connection). During the open enrollment period for 2023 coverage, 76% of the people who enrolled in private plans through Maryland Health Connection qualified for premium subsidies.
Marylanders may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Maryland.
For Maryland residents who aren’t eligible for premium subsidies or Medicaid short-term health insurance is a lower-cost coverage option. In Maryland, two insurers offer short-term plans.
For 2023, there are three insurers that offer exchange plans in Maryland, with varying coverage areas:
- CareFirst (including BlueChoice HMO and CareFirst of Maryland PPO)
- Kaiser Permanente
- UnitedHealthcare (Optimum Choice)
For 2023, average premiums for individual/family health coverage in Maryland increased by 6.6% (calculated before any subsidies were applied). And for 2022, average full-price premiums in the state’s individual market increased by 2.1%.
But Maryland has also debuted a new state premium subsidy for young adults (age 18 – 34), which reduces the amount that these enrollees have to pay for their health coverage. And the American Rescue Plan’s subsidy enhancements are still in effect nationwide, making coverage more affordable than it used to be.
Thanks to the state’s reinsurance program, average pre-subsidy (full price) premiums in Maryland’s individual market decreased by an average of 13% in 2019, by another 10% in 2020, and decreased by nearly 12% for 2021.
During the open enrollment period for 2023 coverage, 182,166 people enrolled in private plans through Maryland’s exchange, which was a new record high for the state.
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 95% 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% in 2018 (it remained at 6% 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% in 2013, and 8.9% 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 late 2022, more than 1.1 million 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.