Residents of Maryland looking for cheap health insurance have several options. These options range from purchasing insurance on Maryland’s Health Connection (Maryland’s equivalent to Healthcare.gov), to being eligible for Medicare or Medicaid.

This guide examines how each option works, potential costs, eligibility requirements, and how you enroll in, join, or purchase an affordable health insurance plan.

What to know about insurance in Maryland

  • Marketplace plans: Any adult between the ages of 19 and 64 can enroll in or purchase a health care plan in Maryland. This includes plans purchased on the Maryland Health Connection or off-exchange plans purchased through a broker, an insurance agent, or a health care company.
  • Open enrollment: If you want to purchase a plan on the Maryland Health Connection you must pick a plan during the open enrollment period of November 1 through January 15. If you don’t sign up during open enrollment, you’ll need a qualifying event to enroll. Getting married or divorced, having a child by birth or adoption, becoming a U.S. citizen or a permanent resident/legal alien, or moving to Maryland are all qualifying events.
  • Maryland Health Connection: The Maryland Health Connection is the state government’s website that allows residents to enroll in Affordable Care Act plans. All ACA plans guarantee affordable, quality health coverage. These plans are also eligible for tax credits and financial assistance.
  • Off-marketplace plans: If you don’t want to purchase a plan on the Health Connection, you can purchase a plan through a broker, an insurance agent, or a health insurance company. Under the ACA, all full health care plans are required to provide coverage for pre-existing conditions and mental health care. The difference between plans purchased on the Health Connection and off-exchange is ACA plans offer tax credits and benefits.
  • Coverage types: Around 55% of Maryland residents receive their health care coverage through an employer. An additional 18.7% receive Medicaid, and 13.3% are enrolled in Medicare. Non-group insurance, which includes plans bought off-exchange and short-term insurance policies, constitutes 5.4%. The U.S. Military provides health coverage for 1.9% of Marylanders. Currently, the state has a low uninsured rate of 5.9%.

How do I enroll in Maryland’s health insurance marketplace?

Maryland is one of a handful of states with its own ACA exchange, the Maryland Health Connection. Like Healthcare.gov, your first step is to create an account. You’ll be asked for certain personal information including your address, your phone number, and your household income. Once you’ve created your account, the Maryland Health Connection will direct you to the appropriate coverage for your eligibility, whether it’s Medicare, Medicaid, or a marketplace plan.

You’ll be able to view several affordable health insurance plans simultaneously to judge which plan best suits your health care needs, those of your family, and your budget.

Four companies offer health care plans on the Maryland Health Connection in 2022:

  • Aetna
  • CareFirst Blue Cross Blue Shield
  • Kaiser Permanente
  • United Healthcare

How do I enroll in Maryland’s individual and family insurance?

If you don’t wish to use the Maryland Health Connection you can purchase plans through a broker, an insurance agent, or a private company. When purchasing an off-exchange plan, there are some important considerations when shopping for individual coverage, whether for yourself or for multiple people. These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Maryland

If you’re healthy and make few trips to the doctor and don’t require many prescriptions, your best bet is to look at a plan that has a low monthly premium but high deductibles. This will help you keep your health care costs to a minimum.

On the other hand, if you have a chronic health condition requiring regular visits to a doctor or a specialist, and many medications, the best plan for you will likely be one with a higher monthly premium but lower deductibles. This will help you reduce your out-of-pocket expenses.

Health companies offer several different kinds of plans.

  • With a Health Maintenance Organization (HMO) plan, you’ll have lower overall costs, but there are restrictions on how you receive your health care. You’ll need to get a referral to see a specialist, as well as name a primary care physician. You can only use that plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan costs more, but you’ll have fewer restrictions. You won’t need to name a primary care physician or obtain referrals to see a specialist. You can also visit out-of-network providers, although it will cost more than using in-network providers.
  • A Point of Service Plan (POS) allows you to see out-of-network providers, but you’ll still need to get a referral if you want to see a specialist.

Insurance for families in Maryland

Concerns about which health plan is the right one become more complicated when you’re thinking about an entire family. Your children may be healthy, but if you or your spouse have a chronic illness such as high blood pressure, asthma, or hypertension, you’ll need to balance your family’s overall health needs with your budget.

An HMO plan that can help reduce your overall costs may be the best option for a healthy family. If you or a family member have a chronic health issue, a PPO plan or a POS plan may be the best option since both plans allow you to visit out-of-network providers.

The main difference between an off-exchange plan and one offered on the Maryland Health Connection is the premium tax credits available to you if your income is between 100% to 400% of the Federal Poverty Level (FPL). Off-exchange plans do not offer these benefits. Plus, if you choose a silver plan on the Maryland Health Connection, you may be able to lower your out-of-pocket costs through cost-sharing reductions (CSRs).

How much does health insurance cost in Maryland?

The Maryland Health Connection works with a similar structure of metal tiers as Healthcare.gov. Available plans fit into categories: Bronze, Silver, Gold, or Platinum. However, don’t think that if you choose a Bronze plan, you’re selecting a lower level of coverage than if you picked a Gold one. There are no differences in the quality of care in any ACA-compliant plan. The difference comes in how you choose to pay for that plan.

Average premium in Maryland 2018 2019 2020 2021 2022
Most affordable Bronze plan $321 $298 $266 $222 $221
Most affordable Silver plan $448 $404 $388 $342 $319
Most affordable Gold plan $456 $408 $333 $327 $296

 

  • Bronze plans are a good option if you’re generally healthy. They have low monthly premiums and higher deductibles. There’s also 40% coinsurance every time you use a medical service. It’s a good plan if you don’t want to pay a lot for health care but want a solid level of coverage if needed. The most affordable Bronze plan in Maryland costs $221 a month.
  • Silver plans are often the most attractive option for those who purchase a  health care plan on the Maryland Health Connection. It costs a bit more than a Bronze plan, but it has lower deductibles and a lower coinsurance payment of 30%. What makes a Silver plan more attractive are the tax credits and CSRs available if you’re eligible. The most affordable Silver plan in Maryland, before any possible savings through tax benefits or CSRs, is $319 a month.
  • Gold and Platinum plans are for those who have chronic health issues; the plans have the lowest deductibles and coinsurance fees (20% for a Gold plan, 10% for a Platinum plan) of any plan. While these plans have higher-cost monthly premiums, the low deductibles and coinsurance help you save more in out-of-pocket costs if you require regular medical care. In 2022, the most affordable Gold plan in Maryland costs $296 a month.

Can you get cheap health insurance in Maryland?

As part of a health care reform enacted by Maryland in 2018, the state expanded Medicaid (also known as Medical Assistance or MA) to cover nearly all adults between the ages of 19 and 64 with incomes at or below 138% of the federal poverty level. Nearly 1.5 million people are enrolled in Maryland Medicaid and MCHP (the Maryland Children’s Health Program).

Medicaid in Maryland

To be eligible for Medicaid in Maryland, you need to live in the state, be a U.S. citizen, national, permanent resident, or legal alien who needs health care or insurance assistance, and have a low or very low income.

You must also meet one of the following criteria:

  • Be pregnant, regardless of age
  • Have responsibility for a child or children 17 years of age or younger
  • Have a disability or have a family member in your household who has a disability

You must also meet certain income and resource requirements to be eligible for Medicaid in Maryland. These income and resource requirements are different for different categories of individuals.

If you’re between 19 and 64, you have a financial limit of $17,774 a year, while a household of three people has a financial limit of $30,305. If your household has more than eight people in it, you can add $4,540 for each additional person.

Asset or resource limits depend on how Medicaid is being used. For nursing home care, you can’t have assets greater than $3,000, while a couple can’t have assets of more than $6,000, and this drops to $5,000 after six months, with each spouse having no more than $2,500 in their name.

Maryland Children’s Health Program (MCHP)

MCHP provides health benefits for uninsured children up to 19 and pregnant women of any age who meet income guidelines. For children, adjusted family income must be at or below 211% of the federal poverty level. In 2021, for a family of four, this amounted to about $4,600 a month.

Uninsured children receive health benefits which include doctor’s visits, lab work and tests, immunizations, prescription drugs, hospitalizations, dental and vision care, transportation to medical appointments, and mental health services.

You can apply for MA or the Maryland Children’s Health Program through the Maryland Health Connection.

What are Maryland’s Medicare options for seniors and people with disabilities?

Medicare is the federal government’s health care insurance program that covers you if you’re 65 and older or have a qualifying disability.

  • Original Medicare is the basic form of Medicare. It consists of two parts: Part A (hospitalizations, nursing home care, hospice care, home health care) and Part B (medical services, durable health equipment, mental health care). Original Medicaid doesn’t cover prescription drugs, so you’ll need a Medicare Part D plan to pay for medications. There are no out-of-pocket limits under Original Medicaid.
  • An alternative to Original Medicare is a Medicare Advantage Plan. It is an individual plan approved by Medicare. It offers dental, vision, and hearing coverage, with many of these plans also providing access to fitness programs and prescription drug coverage. There are four types of Medicare Advantage Plan: HMO, PPO, Private Fee-For-Service, and Special Needs. Each plan is oriented towards different health care needs and will have different monthly premiums and deductibles. In 2022, there are 29 Medicare Advantage Plans available in Maryland. However, you may only choose a Medicare Advantage Plan available in the county in which you live.

If you’re concerned about out-of-pocket costs with Original Medicare, you can cover some of these expenses with a Medicare Supplemental Insurance plan. It covers deductibles, co-pays, and coinsurance fees. However, it doesn’t cover vision, dental, hearing, or long-term care. One advantage to a Medicare Supplement Insurance Plan is that many plans will provide health coverage if you travel outside the United States. Currently, you cannot purchase a Medicare Supplemental Insurance Plan if you have chosen a Medicare Advantage Plan.

Eligibility

  • A U.S. citizen, national, or a permanent resident who has resided in the country for the past five years
  • At least 65 or have a qualifying disability, regardless of age
  • Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

The Maryland State Health Insurance Assistance Program (SHIP) provides free, unbiased, and confidential counseling to you, your family, or your caregivers. This counseling includes guidance on all aspects of Medicare, including Original Medicare, Medicare Advantage, Medicare Part D, billing issues, Medicare fraud, and how to appeal denials. None of the certified, trained volunteers works for a health insurance company, nor will they ever try to sell you a plan.

Are there short-term health insurance plan options in Maryland?

Yes, but a short-term insurance operates under specific rules. In 2018 the state enacted legislation that limits a short-term plan to three months with no renewals. In 2019, a new law required short-term health insurance to cover mental health care, including substance abuse disorders. A short-term plan also needs to provide a level of coverage for inpatient room and board, hospital care, emergency room care, diagnostic services, surgical care, doctor’s visits, and outpatient treatment.

Maryland Insurance FAQs

Does Maryland require health insurance?

Although the Affordable Care Act requires you to have health insurance, changes in Congress and federal court rulings repealed the original mandate’s tax penalty. While some states have enacted their own health care law, Maryland is not one of them.

Do I have to use the Healthcare Marketplace in Maryland?

No, you can also purchase health care in Maryland through a broker, an insurance agent, or a health insurance company.

What types of alternative health insurance plans (like cost-sharing plans) are available in Maryland?

The most common kind of cost-sharing plan in Maryland is a faith-based plan. In a faith-based plan, members share health costs with other members. You don’t need to belong to a particular denomination or follow any religious tradition to take part in a plan. Since these plans aren’t regulated by the federal government or Maryland, they’re not required to provide coverage for pre-existing conditions or other essential health care benefits. Before you purchase a faith-based plan, make sure it provides coverage for any health conditions that affect you or your family.

Do I need health insurance in Maryland if I have HSA/FSA?

Most likely. It’s difficult, if not impossible, for you to save enough money in an HSA/FSA plan to pay your bills if a serious illness or injury occurs. HSA/FSA plans work best when you use them to cover out-of-pocket costs like deductibles, copays, or dental or vision care.

Do I need short-term disability coverage in Maryland if I have health insurance?

Do you have a dangerous job? If you answer yes, then it would be wise to obtain some form of disability coverage that pays for household expenses like groceries, utilities, or mortgage payments if you’re injured and unable to work. Health insurance will not cover these types of expenses.

Do I need long-term disability coverage in Maryland if I have health insurance?

It depends on how dangerous your job is. If you work in an industry like construction, purchasing a long-term disability plan is a good idea. Health insurance will not pay for household expenses like groceries, utilities, or mortgage payments.

What does MCHP in Maryland cover?

Uninsured children receive health benefits that include doctor’s visits, lab work and tests, immunizations, prescription drugs, hospitalization, dental and vision care, transportation to medical appointments, and mental health services.

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Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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