Maryland Health Insurance

Overview

If you live in Maryland and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for Maryland

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 855-642-8572 or go to the Maryland Health Connection website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on Maryland's new insurance marketplace, called Maryland Health Connection. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on Maryland's new insurance marketplace, called Maryland Health Connection. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the Maryland Health Connection website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on Maryland Health Connection will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The Maryland Health Connection website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 855-642-8572 or go to the Maryland Health Connection website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Maryland. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to apply for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty. Note that a new state policy allows for all Marylanders who called by March 31 and try to enroll will be able to be covered, even if they can't finish enrollment by that date.

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Maryland’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in Maryland must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

Maryland's Official Marketplace

Maryland Health Connection is Maryland’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Maryland Health Connection, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Maryland Health Connection website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on Maryland Health Connection

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a Maryland Health Connection plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Maryland Health Connection plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

All Savers Insurance. All Savers is part of United Healthcare, a division of United Health Group, the largest U.S. insurance company. Its national network includes 726,500 doctors and 5,600 hospitals.  

CareFirst BlueChoice. The parent company of CareFirst of Maryland, this nonprofit health-services company is the largest health insurer in the mid-Atlantic with over 3.4 million members. CareFirst is an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. CareFirst serves residents in Maryland, Washington, D.C. and northern Virginia.

CareFirst Blue Cross Blue Shield of Maryland. A subsidiary of CareFirst BlueChoice, CareFirst of Maryland is also an independent licensee of the Blue Cross and Blue Shield Association. It offers insurance plans in every Maryland county.

Evergreen Health Cooperative. This new, nonprofit, member-governed, co-op offers Maryland residents exchange plans in Bronze through Gold tiers. A searchable provider directory as well as its drug formulary are available.

Group Hospitalization and Medical Services. GHMSI is a CareFirst company and is affliated with the Blue Cross and Blue Shield Association. GHMSI serves Maryland as well as Washington, D.C. and northern Virginia. Maryland residents who buy a GHMSI exchange plan may not have access to the entire GHMSI network of doctors and hospitals.

Kaiser Foundation Health Plan. A part of Kaiser Permanente, one of the largest nonprofit health insurance companies, the Kaiser Foundation Health Plan serves Maryland as well as Washington, D.C. and northern Virginia. It has over 481,700 members.

Need More Help?

If you need help choosing a health insurance plan or filling out your application, Maryland has trained nongovernment groups to guide you through the process. Sometimes called “Navigators,” these groups can answer technical questions on insurance, Medicaid, and tax credits (called a subsidy) . Navigators also specialize in assisting non-English speaking populations. For more information, contact the Maryland Health Connection call center at 855-642-8572. The center is open seven days a week, Monday through Friday from 8:00 a.m. to 8:00 p.m., on Saturdays from 8:00 a.m. to 6:00 p.m., and on Sundays from 8:00 a.m. to 2:00 p.m. 

The Maryland Health Education and Advocacy Unit exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 410-528-1840 or emailed at consumer@oag.state.md.us. Residents can file an insurance complaint online.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01