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.

What You Should Know About Medicare Advantage Plans in Maryland

  • Many plans available: There are 29 Medicare Advantage Plans available in Maryland as of 2022.
  • Location dependent: Where you live determines how many Medicare Advantage Plans are available to you.
  • Shop your options: Medicare Advantage Plans can vary in cost, coverage, and benefits, although all plans provide at least as much coverage as Medicare Part A and Part B.

Is Medicare Advantage Right for You?

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.
Note:

  • You can’t have both a Medicare Advantage Plan and a Medicare Supplement Plan.
  • You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan.

How to Compare Medicare Advantage Plans in Maryland

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:

  • Monthly premium: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
  • Plan network: You may need to use doctors and providers who are within a plan’s network. Before choosing a Medicare Advantage Plan, think about the doctors and facilities (including pharmacies) you prefer to use, then check if the plan offers coverage at those locations. Some plans may provide out-of-network coverage, but this usually comes at a higher cost.
  • Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles, and these may change only once per year on January 1.
  • Copayments and coinsurance: Copayments or coinsurance are how much you pay for each service or doctor’s visit, such as $20 per doctor visit. Each Medicare Advantage Plan sets its copayment or coinsurance amount that can differ from what you would pay through Original Medicare.
  • Out-of-pocket maximum: Each Medicare Advantage Plan sets a yearly limit on the maximum amount you’d be responsible for paying for services covered by Medicare. Once you reach this limit, you won’t have to pay anything for the services you receive covered by Part A and Part B in that year.
  • Additional coverage: Most Medicare Advantage Plans also provide prescription drug coverage and often include additional benefits that Original Medicare won’t cover, such as vision, dental, and hearing. Plans may provide even more benefits, like discounted gym membership or transportation to doctor’s visits. Medicare Advantage Plans can also tailor their benefits to the specific needs of particular chronically ill beneficiaries.

About Medicare Advantage Plans in Maryland

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
29
  • Local HMO
  • Local PPO
  • MSA
  • Aetna HMO
  • Aetna PPO
  • Cigna HMO
  • Kaiser HMO
  • Sierra HMO
  • Sierra POS
  • Sierra PPO
  • UnitedHealthcare PPO

Understanding Medicare Advantage Plan Types:

  • HMO: Health Maintenance Organization plans generally provide coverage only at in-network providers except in medical emergencies. You usually need to have a primary care physician who can give you a referral to see specialists. Most HMO plans include prescription drug coverage.
  • HMO-POS: HMO-POS plans are HMO plans with a Point of Service benefit for out-of-network providers. In these plans, you may be able to use out-of-network providers for certain services but may pay more for your care if you do.
  • PPO: Preferred Provider Organization plans have a network of healthcare providers and facilities where your care will cost less. You can use out-of-network providers as well, but your care will cost more. You usually do not need a primary care doctor to get referrals to see specialists or receive treatment. Most PPO plans include prescription drug coverage.
  • PFFS: Private Fee-for-Service plans allow you to use any Medicare-approved provider. Some PFFS plans have networks of providers where you can receive lower-cost care. You don’t need referrals to see specialists in PFFS plans, but prescription drugs are not always covered.
  • SNPs: Special Needs Plans are for beneficiaries with specific diseases or characteristics. These plans tailor benefits and providers to the special needs of the group they serve. You are generally limited to the network of providers the plan offers and need a primary care doctor and get referrals to specialists. All SNP plans include prescription drug coverage.

Enrollment and Eligibility for Medicare Advantage Plans in Maryland

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:

  • You’ve received Social Security Disability Insurance or Railroad Board Disability Annuity for 24 months
  • You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
  • You have End-Stage Renal Disease

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.

  • Your IEP begins three months before the month you turn 65 and extends for three months after the month you turn 65. During this period, you can enroll in a Medicare Advantage Plan. If you join before the month you turn 65, your coverage will begin the first day of the month you turn 65. If you enroll in the three months after turning 65, your coverage will begin the first day of the month after you enroll.
  • If you miss your IEP, you can sign up for Medicare during the General Enrollment Period from January 1 to March 31.
  • After you enroll in Medicare, you can enroll in or make changes to your Medicare Advantage Plan coverage during the Medicare OEP from October 15 and December 7 of each year. During this time, you can change from Original Medicare to Medicare Advantage, switch to a different Medicare Advantage Plan, or change from Medicare Advantage back to Original Medicare.

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.

Medicare Enrollment Periods

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

Maryland Medicare Advantage Plans With Prescription Drug Coverage

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.

Getting Help with Medicare Advantage Plans

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
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Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

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