Maryland Health Insurance
Shopping for health insurance in the state of Maryland might seem like a daunting task. Thankfully, there are many options open to residents who are uninsured or underinsured. Whether you've always been healthy or have experienced health issues in the past, this page will provide you with valuable information for obtaining health coverage. Read on to learn about the difference between group and individual coverage. If you're healthy enough to obtain coverage on the individual market or if you have a small business and qualify for small group, Health Plan One can help. If not, review the information on this page about MD Medicaid, MCHP, Family Planning, the Primary Adult Care program, and the high risk pool. All of these government programs can help those who are medically uninsurable or who cannot afford private insurance to obtain basic health coverage.
What Every Maryland Resident Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.
Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through Health Plan One. Simply visit our Short-Term information page for your free quotes.
What If I'm Between Jobs?
It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.
Because it is important not to have a break in coverage, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through Health Plan One. With individual coverage you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in Maryland so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs a plan on the individual market through Health Plan One could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Maryland each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.
If you're healthy and are unhappy with the health insurance offered by your employer, are between jobs, or are not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.
Small Group Plans
If you are self-employed, you could qualify for a small group plan in Maryland. You must have 2 or more eligible employees who each work at least 30 hours. There is no standard amount of time in business required prior to applying for coverage, but this varies by carrier as some carriers require one month of payroll. All carriers in Maryland do medically underwrite for small group plans. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. Health Plan One can help you by quoting plans for small groups. Simply call us at (877) 567-5267.
If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.
Visit our Maryland Small Business Group page for more information
Medicaid and Medicare in Maryland
Medicaid is a program meant to help low-income individuals acquire a basic level of health care coverage. The program pays the medical bills of residents who are below a certain income level and who meet several other requirements. Those who are eligible meet at least one of the following criteria. They are: at least 65 years old, disabled, blind, under 21 years old, caring for a related child in their home, pregnant, or the parents of an unmarried child under 21. The program covers medical bills for such things as doctor's visits, hospital stays, dental and vision care. For more information on the specific benefits of the program, click here: http://www.dhmh.state.md.us/mma/Eligibility/MAelig-2006Q&A.html For more specific eligibility information, see this pagehttp://www.dhmh.state.md.us/mma/Eligibility/medcareprog/html/MCP-program.html
HealthChoice is Maryland's mandatory managed care program which provides health care to about 75% of Medicaid recipients. To learn more about managed care and to see if you'd be in that 75%, click here:http://www.dhmh.state.md.us/mma/healthchoice/index.html
Income guidelines for all MD medical care programs are available in this pdf:http://dhmh.md.gov/mma/html/pdf/2009/Income_Asset_Guidelines_4-09_2.pdf
Click here for information about Maryland Medicare.
The Maryland Children's Health Program (MCHP) is the state's implementation of the federal SCHIP legislation. The program provides full health benefits to children under age 19 and pregnant women of any age whose income falls below a designated ceiling. MCHP enrollees also obtain their care from one of the managed care organizations through the HealthChoice program. MCHP is meant to cover children who are not eligible for Medicaid but whose income is at or below 200% of the federal poverty level. Pregnant women are eligible if their income is at or below 250% FPL. To qualify you must be uninsured. However, in some instances children with insurance may still qualify, so it's best to apply anyway and discuss your situation with the MCHP case manager. Benefits of the program include doctor visits, hospital care, lab work, dental and vision care, immunizations and prescriptions. For more information on the benefits associated with this program, and information on how to apply click here: http://www.dhmh.state.md.us/mma/mchp/
The Maryland Family Planning and Reproductive Health Program is in place to reduce unintended pregnancy and improve pregnancy outcomes by assuring that comprehensive contraception and reproductive services are accessible to Maryland citizens in need. This program is important because it works to prevent abortions and is a leading strategy in reducing low-birth weights and fetal/infant mortality. The types of family planning services available include preconception health, teen pregnancy prevention, reproductive health, colposcopy, birth control methods (including emergency contraception), and STD screening and treatment. For information on the specific benefits of the program as well as eligibility requirements, visit http://fha.maryland.gov/mch/fp_home.cfm
Primary Adult Care Program (PAC)
The PAC program which began in July 2006, offers health services to residents of Maryland 19 and over who make under a certain income ceiling each year. PAC has replaced the Maryland Pharmacy Assistance Program (MPAP) and the Maryland PrimaryCare Program. Participants in PAC will receive free visits to a family doctor, free outpatient visits to a counselor or psychiatrist for mental health services, and lower-priced or no-cost prescription drugs (plus a copay). Unfortunately the PAC program is not comprehensive care; it will not pay for hospital stays, emergency room visits, or specialty care. PAC will however cover all of the services described above for the MD Family Planning program (except sterilization). For full eligibility requirements and information on how to apply visit the PAC website athttp://www.dhmh.state.md.us/mma/pac/index.htm
Maryland Health Insurance Plan - MD High Risk Pool
The Maryland Health Insurance Plan is the state's high risk pool. This is a state-managed program for residents of Maryland who are unable to obtain health insurance on the group and individual markets. The program offers guaranteed-issue access to some BCBS CareFirst plans if you meet the following requirements:
- Have a qualifying medical condition
- Been denied insurance for medical reasons in the last 6 months
- Are enrolled in or are eligible for individual health insurance that limits or restricts your coverage for a specific condition or has benefits similar to MHIP but costs more because of your condition
- Are a child who has a qualifying condition
- Are switching from a high risk pool in another state and you plan to live in MD permanently and it has been less than 63 days since your previous coverage ended.
- For extensive details on the program including plan options, benefits, and full eligibility requirements see the program's website at http://www.marylandhealthinsuranceplan.state.md.us/
For information on long term care options through the state, click here: http://dhmh.md.gov/mma/longtermcare/ For information on the Employed Individuals with Disabilities Program (EID), click here:http://dhmh.md.gov/html/hottopics_eid.htm The Maryland Medical Programs homepage is also particularly helpful:http://dhmh.md.gov/mma/index.html