Whether you were born and raised in Maryland or recently relocated there for work, the state can be a beautiful place to live.
The majority of Maryland residents get their health insurance through their employers. A relatively small number — just 6% of the population, or nearly 750,000 people — are uninsured.1 That low rate is partially due to decreasing costs. Maryland’s insurance rates under the Affordable Care Act dropped 10.3% in 2020, the second consecutive year rates decreased.2
Health insurance options in Maryland
Insurance premiums in Maryland tend to be relatively low. There are only 16 states that have lower average premiums than Maryland. In the state, the average premium is $552. For those who qualify for the advanced premium tax credit — a subsidy that can make health insurance premiums more affordable — the average monthly premium dropped to just $191.3
The implementation of the Affordable Care Act — often known as Obamacare — made a big impact in Maryland. Between 2013 and 2016, the number of uninsured individuals dropped by 38.8%.4
As part of healthcare reform under the Affordable Care Act (ACA), Maryland also expanded Medicaid to include adults under the age of 65 with incomes at or below 138% of the federal poverty level, or about $1,468 per month for a household of one person for 2020.5 Thanks to those changes, over 300,000 more people became eligible for Medicaid.6
In Maryland, your insurance options and monthly premiums are dependent upon your age, income and family size.
The Affordable Care Act/Individual Coverage
If you don’t get coverage through your employer or are self-employed, you can get health insurance through Maryland Health Connection — Maryland’s version of healthcare.gov.7 All plans other than catastrophic policies cover essential benefits under and offer free preventative services, including:8
- Doctor visits
- Maternity and newborn care
- Prescription drugs
- Laboratory tests
- Mental health care
- Substance abuse treatment
To get coverage, you must sign up for a policy during the open enrollment period, which runs from November 1 until December 15. If you miss that window, you can only enroll if you qualify for special enrollment. To be eligible, you need to have undergone a major life change, such as getting married, losing your coverage, or having a baby.
You can get a cost estimate for a plan at MarylandHealthConnection.com.
Due to the coronavirus pandemic, Maryland reopened insurance enrollments for qualified uninsured residents. Residents who currently have coverage cannot apply. Policies take effect on April 1. Residents can purchase coverage during the special enrollment period until April 15.
Plans within the Affordable Care Act are broken into four categories, called metal tiers. There are bronze, silver, gold, and platinum plans. The categories are based on how much you and your plan split the costs of your care:
- Bronze: You pay 40%, and the insurance company pays 60%
- Silver: You pay 30%, and the insurance company pays 70%
- Gold: You pay 20%, and the insurance company pays 80%
- Platinum: You pay 10%, and the insurance company pays 90%
Bronze plans have the lowest monthly premiums, but the highest costs when you need care. By contrast, platinum plans have the highest month premiums, but the lowest costs if you need care, making them a good choice if you have chronic or ongoing health conditions.9
You may be surprised by how affordable your premiums can be. In 2020, a 40 year old would pay $397 for the second-lowest-cost silver plan, known as the benchmark plan. That monthly premium is $22 less than it cost in 2019, when the monthly premium was $419 per month.10
How much you’ll pay in month premiums is dependent on what tier of coverage you choose. The average premiums by tier are below:11
|Average Lowest-Cost Bronze Premium||Average Lowest-Cost Silver Premium||Average Lowest-Cost Gold Premium|
Depending on your income, you may be eligible for subsidies that can make your health insurance more affordable. There are two possibilities:
- Advanced Premium Tax Credit: When you apply for coverage, you can use the amount of the tax credit to lower your health insurance premiums. For example, the average premium before the subsidy in Maryland was $552 in 2019. But after taking advantage of the advanced premium tax credit, the average premium was just $191.12
- Cost-Sharing Reduction: Some people may also qualify for a cost-sharing reduction (CSR). The CSR is a discount that reduces how much you have to pay for deductibles, copayments, and coinsurance.13
Maryland Easy Enrollment Health Insurance Program
In 2020, Maryland launched a pilot program to help uninsured and low-income individuals get health insurance.
When residents file their state tax return, they can indicate directly on their return if they’d like the Maryland Health Benefit Exchange to estimate their eligibility for coverage and see if they qualify for free or low-cost insurance.
To participate in the program, file your state tax return by the file deadline and check the box that says you authorize the Comptroller of Maryland to share information from your tax return with the Maryland Health Benefit Exchange.14
If you’re low-income
If you don’t have a large income, you might consider skipping health insurance to save money. However, doing so can be a costly mistake. According to The Commonwealth Fund, 41% of Americans have issues with medical bills or are paying down medical debt.15 One illness or accident can deplete your savings, leaving you scrambling to cover the cost.
Fortunately, there are several programs in place that can help you get coverage.
Depending on your income and family size, you or members of your family may qualify for free or low-cost health insurance through Medicaid. Through Medicaid, you can access preventive care, pregnancy care, prescription medications and emergency services.16
In May 2013, the governor of Maryland signed a law into effect that expanded Medicaid in the state. Adults under the age of 65 with incomes at or below 138% of the federal poverty level can qualify for Medicaid coverage.17 As of 2020, the following income guidelines apply:18
|Family Size||138% of the Poverty Guideline|
As of December 2019, over 1.1 million people in Maryland enrolled in Medicaid.20
2. Maryland Children’s Health program
If you have uninsured children under the age of 19, they may be eligible for the Maryland Children’s Health Program (MCHP).
Your children can qualify for coverage if your household income is at or below 211% of the federal poverty level. For a family of four in 2020, that means your income must be at or below $4,608 per month.
Even if your income is over the threshold, you could still get coverage through MCHP Premium. Under this plan, you pay a small premium for insurance. Premiums for children under MCHP Premium are based on household rather than per child, helping you save money. Depending on your income, the monthly premium is either $57 or $71.
You can qualify for MCHP Premium if your income is at or below 322% of the federal poverty guideline. For a family of four, that means your income can’t exceed $7,032 per month.21
As of December 2019, nearly 140,000 individuals are enrolled on MCHP.22
Alternative health insurance
If you miss the open enrollment window and still need insurance, you can get coverage with a short-term insurance policy. These policies provide coverage while you’re in between plans. While their monthly costs tend to be low, they usually have high deductibles. They can be a good option if you’re young and relatively healthy, and they’re better than going without any coverage at all.
In Maryland, you could qualify for coverage through National General for as little as $90 per month.
If you are under the age of 65, you can qualify for Medicare if you have been entitled to Social Security benefits or Railroad Retirement Board disability benefits for the past 24 months, have Lou Gehrig’s Disease or are a kidney dialysis or kidney transplant patient.23 Under Medicare Part A, hospital care lab tests and surgeries are covered.24
If you’ve reached age 65, you’re eligible for Medicare. If you or your spouse worked and paid Medicare taxes for at least 10 years, you’re eligible for premium-free Medicare Part A. That means you can get health insurance without paying any monthly premiums.
If you didn’t pay Medicare taxes while you worked, you still may be able to buy into the system.
You may also opt to add Medicare Part B coverage.The monthly premium for this add-on is deducted from your Social Security, Railroad Retirement or Civil Service Retirement checks.25 To find out if you’re eligible for Medicare and to get an estimate of what your premium would be, you can use the Medicare Eligibility Calculator.
There are three other options to consider, as well:
- Medicare Supplement: Also known as Medigap, Medicare Supplement coverage can help you pay for your copayments and deductibles.26
- Medicare Advantage: Private insurance companies sometimes offer Medicare Advantage coverage, which are bundled plans that combine Medicare Part A and medicare Part B. They usually also include Medicare Part D — prescription drug coverage.27 In Maryland, 118,000 people enrolled in Medicare Advantage plans in 2018.28
- Medicare Part D: You can also enroll in Medicare Part D — stand-alone prescription drug coverage. As of 2018 — the last available data — over 500,000 people had enrolled in Medicare Part D in Maryland.29
Private health insurance
If you have a small income, you could qualify for tax credits or cost-sharing reductions to make health insurance through the Maryland Health Connection more affordable for you. In fact, nine out of 10 Maryland residents who enrolled qualified for financial assistance.30
If you’re unemployed
Whether you lost your job or simply have a few months to wait until your new start date, getting health insurance in the meantime is essential for your financial security. There are three options to consider:
If you leave your job or are laid off, you can continue to get health insurance through your current plan thanks to the Consolidated Omnibus Budget Reconciliation Act (COBRA). You can extend your coverage for up to 18 months. However, you are responsible for paying the full cost of your monthly premiums, which can be very expensive.31
Private health insurance
If you lost your coverage, you can apply for an insurance policy through Maryland Health Connection.
Short term health insurance
If you’re in the middle of job searching or are waiting for your new employer’s coverage to go into effect, a short-term insurance policy can make a lot of sense. It can provide you with insurance during the gap until you get new coverage, protecting you in cases of major illnesses or accidents. You can usually cancel a short-term insurance policy at any time without paying a penalty.
Maryland’s rules regarding short-term plans are strict. The maximum period they are allowed is three months, and they are non-renewable. While they tend to be cheaper than plans offered under the Affordable Care Act, you can be denied on the basis of a pre-existing condition, and short-term plans do not have to meet minimum essential coverage requirements under federal law.32
Applying for health insurance in Maryland
Regardless of your family size, income, and age, there are a number of health insurance options available to Maryland residents. By doing your research, you can find a plan that works for your medical needs and your budget.