Know your options for Medicare Advantage Plans in Maryland and find out how to enroll.
TABLE OF CONTENTS
There are two primary ways you can get Medicare coverage. The first (and typically default) way is through Original Medicare. This includes Medicare Part A for hospital insurance, which most people receive premium-free, and Part B for medical insurance, which you’ll generally have to pay for. Many Original Medicare beneficiaries add on Medicare Part D for prescription drug coverage or use Medicaid or a Medigap or employer plan to supplement their coverage.
The other option for getting Medicare coverage is through a Medicare Advantage Plan, also called Medicare Part C. These are bundled plans that provide an all-in-one alternative to Original Medicare. Medicare Advantage Plans offer the same coverage as Medicare Parts A and B and frequently include even more benefits, like prescription drug coverage, hearing, dental, and vision.
Plans can vary by state and location, which is why it’s important to understand the Medicare Advantage Plans offered in your state. Here is what you should know about Medicare Advantage Plans in Maryland.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
With 29 Medicare Advantage Plans available in Maryland, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
Maryland residents have access to 29 Medicare Advantage Plans available in 2022. This includes local HMO and PPO plans and MSA plans. Maryland has no PFFS plans.
The most plan availability is in the counties of Baltimore, Montgomery and Frederick, followed by Baltimore City, Calvert, Carroll, Charles, and Prince George’s counties.
Of all the Medicare Advantage Plans offered in Maryland, seven of them were rated 3.5 or higher for plan year 2019 to 2020 by NCQA. This included HMO, PPO and POS plans.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Maryland Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
Maryland-wide Medicare Advantage Resources
|Resource||Contact||How they help|
|Maryland Department of Aging||Phone: 800-243 3425||The Maryland Department of Aging helps establish Maryland as an attractive location for all older adults through vibrant communities and supportive services that offer the opportunity to live healthy and meaningful lives|
|Maryland Health Connection||Phone: 855-642-8572||Maryland Health Connection is Maryland’s new health insurance marketplace that will make it easier for Marylanders to shop, compare, and enroll in quality health coverage|
|Maryland Medicare Savings Program||Phone: 800-638-3403.||The Maryland Medicare Savings Program helps connect low-income individuals who buy-in to Medicare with Medicare Savings Programs|
|Maryland State Health Insurance Assistance Program||Phone: 800-243 3425||The State Health Insurance Assistance Program (SHIP) helps meet the most universal needs of Medicare beneficiaries, such as understanding their health insurance benefits, bills, and rights|
|Maryland’s Medicaid Program||Phone: 855-642-8572||Medicaid covers doctor visits, pregnancy care, prescription drugs, hospital and emergency services, and more, at no cost|
|Maryland Insurance Administration||Phone: 800-492-6116||The agency strives to increase public understanding of the vital role insurance plays in the daily lives of Maryland residents and businesses|
Local Medicare Advantage Resources
|Resource||Contact||How they help|
|Allegany County Department of Human Services||Phone: 301-784-7000||The Maryland Department of Human Services (DHS) is the state’s primary social service provider, serving people in economic need, provide preventive services, and protect vulnerable children and adults in each of Maryland’s 23 counties and Baltimore City|
|Anne Arundel Transportation for Elderly/Disabled||Phone: 410-222-0022
email: [email protected]
|Anne Arundel County Office of Transportation (OOT) provides two types of service: complementary American with Disability Act (ADA) and General Paratransit (GPT) throughout Anne Arundel County|
|Baltimore County Department of Aging||Phone: 410-887-2059
email: [email protected].
|Baltimore County’s State Health Insurance Program (SHIP) office provides objective education and assistance to individuals eligible for Medicare, a health insurance for people 65 and over, as well as for people with 24 months of Social Security Disability|
|Calvert County Health Department||Phone: 410-535-5400||The Calvert County Health Department seeks to promote and protect the health of all county residents by preventing illness and eliminating hazards to health|
|Calvert County Office on Aging||Phone: 410-535-4606||The mission of the Calvert County Office on Aging is to enable senior citizens to avail themselves of a full range of services and programs in order to maintain the best possible quality of life|
|Caroline County Health Department||Phone: 410-479-8030||The Caroline County Health Department, a local office of the Maryland Department of Health, is dedicated to the preservation and advancement of the lifelong Health and Wellness of our County’s residents and environment|
|Charles County Department of Social Services||Phone: 301-392-6400||Charles County Department of Social Services works diligently to meet the needs of Charles County residents through more than two dozen family support and financial assistance programs|
|Carroll County Bureau of Aging & Disabilities||Phone: 410-386-3800||The Carroll County Bureau of Aging & Disabilities is dedicated to providing the highest quality of services, programs, and assistance to promote choice, dignity and independence for older adults, individuals with disabilities, Veterans, and those who care for them|
|Frederick County Health Care Connection||Phone: 301-600-3124||Health Care Connection is your link to information regarding Medical Assistance (Medicaid) and other state health insurance programs (Qualified Health Plans) and services|
|Harford County Medicare and Medicaid||Phone: 410-638-3000||A guide to Medicare and Medicaid programs in Hartford county|
|Howard County Medicare Information||Phone: 410-313-2200
email: [email protected]
|A guide to Medicare in Howard county|
|Prince George’s Aging and Disabilities Resource Center||Phone: 301-265-8450||Prince George’s County’s Aging and Disabilities Services Division provides and supports a broad range of services and programs for older adults, persons with disabilities, family members, and other caregivers who want to plan for future needs|
|Montgomery County Department of Health and Human Services||Phone: 240-777-0311||A guide to Medicare in Montgomery county|
|Somerset County Department of Human Services||Phone: 410-677-4200||The Maryland Department of Human Services (DHS) is the state’s primary social service provider, serving people in economic need, provide preventive services, and protect vulnerable children and adults in Somerset county|
|Wicomico County Department of Human Services||Phone: 410-713-3900||The Maryland Department of Human Services (DHS) is the state’s primary social service provider, serving people in economic need, provide preventive services, and protect vulnerable children and adults in Wicomico county|
|Worcester County Department of Human Services||Phone: 410-677-6800
email: [email protected]
|The Maryland Department of Human Services (DHS) is the state’s primary social service provider, serving people in economic need, provide preventive services, and protect vulnerable children and adults in Worcester county|
Federal Medicare Advantage Resources
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||N/A||A guide to managing Medicare appeals and grievances|
|CMS Medicare Managed Care Eligibility and Enrollment||N/A||A guide to managing Medicare eligibility and enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||N/A||A guide to managing your Medicare prescription drug coverage|
|Medicare.gov||Phone: 800-633-4227||This is the main website for applying for (or making changes to) your Medicare coverage|
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.