Maryland health insurance
State will seek federal funding for reinsurance, and will impose insurer fee that is being suspended at the federal level for 2019
- Louise Norris
- Individual health insurance and health reform authority; broker
- April 6, 2018
Maryland health insurance overview
Open enrollment in Maryland’s exchange for 2018 coverage began on November 1, 2017, and continued until December 22, 2017. This was a one-week extension, announced in mid-December. Open enrollment had previously been scheduled to end December 15, but Maryland Health Connection ultimately joined most of the other state-run exchanges in issuing an extension. All plans purchased during open enrollment were effective January 1, 2018. By the end of open enrollment, 153,571 people had enrolled, which was about 2.6 percent lower than the year before — not surprising, given the shorter open enrollment period and the sharp increase in premiums for the minority of enrollees who don’t qualify for premium subsidies.
In 2018, under the terms of the Contraceptive Equity Act, Maryland began requiring all fully insured plans (ie, not including self-insured group plans) to fully cover vasectomies, with no cost-sharing for the patient. This is similar to the federal requirement that all plans cover female contraception in full, but coverage for male contraception is not addressed in federal regulations (so under federal rules, female sterilization, which is more expensive than male sterilization, is covered in full, but vasectomies do not have to be covered at all). This was welcome news for consumer advocates, but it also meant that HSA-qualified plans in Maryland might no longer be in compliance with IRS rules, since the IRS mandates that HSA-qualified plans cannot provide any benefits before the deductible, with the exception of preventive care — and the IRS doesn’t consider vasectomies to be preventive care. To get around this issue, lawmakers in Maryland passed HB135/SB137 in 2018, to exempt HSA-qualified plans from the requirement to cover vasectomies.
In Maryland, access to healthcare and health insurance is above average, and the state consistently ranks well for these measures. With a state-based health insurance exchange and Medicaid expansion under the Affordable Care Act, the number of Marylanders who go uninsured has declined substantially — from 10.2 percent in 2013, to 6.1 percent in 2016, according to US Census data.
This guide provides an overview of the healthcare landscape in Maryland, including public health rankings, ACA implementation, legislation, and other factors. Use the following links to see how Maryland is moving on specific health measures, and read how efforts around healthcare reform might be pushing the state in a positive direction.
Maryland health ratings
In the Commonwealth Fund’s 2015 Scorecard on State Health System Performance, Maryland ranked 18th based on scoring for five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity. But in the 2017 ranking, Maryland tied with New York for 10th place.
Access was Maryland’s highest-scoring category (fifth place) due to lower than average uninsured rates, few adults who went without a routine doctor visit, few adults who went without healthcare due to cost, and only 1 percent of individuals under age 65 with high out-of-pocket medical costs relative to their annual household income. See the most recent Maryland scorecard (2017 version) for more details.
The Old Line State placed 18th in United Health Foundation’s America’s Health Rankings for 2015, and climbed slightly, to 16th place, in 2017. Again, the state fared well in measures related to access to healthcare, and to healthy behaviors.
For more even information about health in Maryland, see Key Health Data About Maryland from the 2016 edition of Trust for America’s Health.
Finally, the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin break down public health rankings at the county level.
How has Obamacare helped Maryland?
Maryland experienced a significant drop in its uninsured rate after the ACA’s individual mandate went into effect. According to US Census data, 10.2 percent of Maryland residents were uninsured in 2013, and that had fallen to 6.1 percent in 2016. Nationwide, the average uninsured rate was 14.5 percent in 2013, and had fallen to 8.6 percent by 2016.
2018 enrollment rates and carriers
CareFirst and Kaiser are continuing to offer coverage in Maryland’s exchange for 2018, but Cigna withdrew from the exchange at the end of 2017 (they only had about 700 members, so their exit did not have a substantial effect). Evergreen Health, an ACA-created CO-OP, did not offer individual market plans in Maryland for 2017, but they had planned to start offering exchange plans again for 2018. That plan did not come to fruition, however, as Evergreen was placed in receivership and is no longer offering coverage at all.
So CareFirst and Kaiser are the only two insurers offering plans through the Maryland exchange for 2018. But they already had by far the bulk of the market share for plans purchased through the exchange.
Maryland enrollment in qualified health plans
Despite the challenges of a malfunctioning website, as was the case for many exchanges early on, 67,757 Marylanders enrolled in qualified health plans (QHPs) through Maryland Health Connection during 2014 open enrollment. More than 90 percent of those enrolling in QHPs for 2014 coverage selected plans offered by CareFirst BlueCross BlueShield. By August 13, 2015, effectuated enrollment in QHPs through Maryland’s exchange was substantially improved at 123,673 with 94 percent receiving financial assistance.
In 2016, Maryland Health Connection launched a pilot program in which customers who called the exchange were transferred to brokers for assistance. The program was intended to reduce call-center hold times and allow customers to receive plan selection advice, which only licensed agents and brokers can provide. If deemed successful, the program will return with additional brokers for the 2017 open enrollment period, which begins November 1, 2016.
A total of 162,177 people enrolled in QHPs through Maryland Health Connection during 2016 open enrollment – Maryland allowed those who began the enrollment process by January 31 to finish by February 5 if they were unable to finish on time due to a snowstorm that struck the area. This was a 35 percent increase over 2015 – the third highest percentage nationwide. Maryland had also enabled online browsing of 2016 exchange plans one month ahead of open enrollment, and once open enrollment began, within the first nine days, 89 percent of enrollees had returned to the exchange to actively renew their coverage or switch plans.
For 2017 coverage, 157,832 people enrolled in plans through Maryland Health Connection. For 2018 coverage, open enrollment was much shorter than it had been in prior years, ending on December 22 instead of January 31. By the end of open enrollment, 153,571 people had purchased coverage for 2018.
Maryland and the Affordable Care Act
Maryland politics are dominated by Democrats at the state and federal level, and the Affordable Care Act has broad support among Maryland leaders.
When the ACA was passed in 2010, both Maryland Sens. Benjamin Cardin and Barbara Mikulski voted in favor of the law, as did all but one of the state’s eight U.S. Representatives. Mikulski has since been replaced by Chris Van Hollen, who is also a Democrat and supporter of the ACA.
The Maryland legislature approved a state-run health insurance marketplace, and Gov. Martin O’Malley signed the bills into law in 2011. The state marketplace, called the Maryland Health Connection, was one of the first approved by the federal government.
Despite the state’s early start, its marketplace performed poorly. So poorly, in fact, that the state abandoned its technological infrastructure and purchased the platform that Connecticut had been successfully using.
Medicaid expansion is a key ACA strategy for reducing the uninsured rate, and Maryland joined 30 other states and the District of Columbia in implementing this measure. As detailed below, Maryland has seen significant Medicaid enrollment since expansion was implemented. Medicaid signup continues year-round, so enrollment totals change monthly.
At the beginning of 2014, the Kaiser Family Foundation estimated that 756,000 nonelderly Marylanders were uninsured. When the state decided to expand Medicaid, 302,400 residents qualified for coverage through the program.
The state saw a 52 percent increase in Medicaid enrollment from 2013 to October 2017, with total enrollment reaching nearly 1.3 million. Nationwide, the average increase in Medicaid enrollment is 29 percent, so Maryland’s enrollment has increased by far more than the national average.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program was created through the ACA to spur the creation of nonprofit, consumer-run health insurance companies. Evergreen Health Cooperative in Maryland was one of 24 CO-OPs to receive a federal loan.
But as was the case with most of the CO-OPs, Evergreen is no longer offering coverage. They offered small group coverage for 2017, but not individual market coverage. They had planned to switch to a for-profit entity and begin offering individual market coverage again for 2018, but by the summer of 2017 the state announced that the private investors who had planned to purchase the CO-OP had pulled out of the deal, and the CO-OP was placed in receivership.
Does Maryland have a high-risk pool?
In the individual health insurance market prior to 2014, applications were medically underwritten in nearly every state, including Maryland. Because medical history was used to determine eligibility for coverage, people with pre-existing conditions often found themselves unable to purchase comprehensive plans in the private market.
The Maryland Health Insurance Plan (which has now been phased out) had been providing coverage since 2003 for people who were denied plans in the private market because of pre-existing conditions, or offered only plans that excluded their pre-existing conditions.
Under the ACA, medical history is no longer an eligibility factor for private health insurance. The need for high-risk pools has thus been largely eliminated, but some risk pools are still operational.
In 2013, MHIP released a plan for transitioning their members to the exchange. But Maryland’s exchange was one of the more technologically challenged during the first open enrollment period, and in December 2013, the MHIP board voted to extend MHIP Standard plans until the end of 2014, and MHIP Plus plans until the end of March 2014. In January 2014, MHIP also became a temporary insurer for Maryland residents who were unable to secure coverage in the Maryland exchange because of website problems during the first few months of 2014 open enrollment. MHIP stopped providing coverage as of January 1, 2015.
Medicare enrollment in the state of Maryland
Maryland Medicare enrollment reached 930,088 in 2015 – about 16 percent of the state’s population. Nationally, 17 percent of the population is enrolled in Medicare. The state is among those with a smaller percentage of Medicare enrollees who qualify due to disability (14 percent). Eighty-six percent of Maryland Medicare recipients qualify based on age alone.
Medicare spends about $9,190 annually per Maryland enrollee and, as of 2009, the state ranks 17th in overall spending with $8.8 billion per year.
Marylanders who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. A relatively small percentage of Maryland Medicare beneficiaries choose Medicare Advantage plans; in 2015, only 8 percent had done so, compared with 31 percent nationwide.
The state sees far more enrollees in Medicare Part D plans, which provide stand-alone prescription drug coverage. About 52 percent of Maryland Medicare recipients have Part D plans, while 43 percent of Medicare recipients nationwide have such Rx coverage.
State-based health reform legislation
Scroll to the bottom of this page for a summary of recent state-based legislation related to healthcare reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
More Maryland coverage
News, history, and enrollment info for your state marketplace
Maryland Health Insurance
Health Ranking: #16
State Health Department Web Site: http://www.dhmh.state.md.us/
While Maryland has historically had a low percentage of uninsured individuals, it is among the states that saw the greatest reduction percentage of uninsured from 2013 to 2014 when Obamacare’s key provisions took effect and subsidies became available.
Maryland is among the states that both operates its own state-based Obamacare exchange and expanded Medicaid. The state’s health insurance landscape also includes ACA-compliant individual and family health insurance plans sold in the private marketplace, such as those available through HealthCare.org.
Maryland and the Affordable Care Act
Maryland Health Connection is the state-based Health Insurance Marketplace. When individuals and families obtain coverage through this exchange, they may qualify for income-based financial assistance in the form of premium tax credits and cost-sharing subsidies.
Those who are not eligible for tax credits and subsidies may explore ACA-compliant health plans available in the private marketplace. Health insurance quotes are available at HealthCare.org, where consumers can also buy short term health insurance, supplemental health insurance, dental insurance and Medicare supplement plans.
Maryland employers with 50 or fewer full-time employees can offer healthcare benefits through its Small Business Health Options Program (SHOP) and may be eligible for tax credits to help pay employee premium costs.
Medicaid expansion in Maryland
Maryland has expanded Medicaid to single, low-income adults ages 19 to 64 that earn up to 138 percent of the federal poverty level. More information about Medicaid is available at https://www.marylandhealthconnection.gov/en/medicaid-basics-benefits/.
The Maryland Children’s Health Insurance Program provides health insurance benefits to eligible children up to age 19.
The United Health Foundation ranked Maryland in 2014 as the 16th healthiest state in the US. This state has been making great improvement when it comes to its health within the past five years. Some of the decisive factors that have helped Maryland this year to be right in the middle of the list (you could say it’s a middle-point, when compared to the rest of the country) .The state’s work to raise the percentage of immunization coverage for its children and decrease in the violent crime rate have helped the state in 2008.
Right now, Maryland is a good please to live in terms of Health. Health Care is accessible and efficient, and obtaining Health Insurance is not as complicated as it is in other states of the US. If this state is able keep the good health habits they currently are enforcing and watch out for possible health issues (such as lowering the percentage of obese residents, and keeping the incidence of cardiovascular and cancer-related death low). Overall, Maryland is a healthy place to live.
Your guide to buying individual health insurance
Thanks to special enrollment periods, millions of Americans can still buy ACA-compliant plans. And short-term plans will also be easier to buy.
- Louise Norris
- Individual health insurance and health reform authority; broker
- August 1, 2018
How to buy health insurance outside of open enrollment
- Open enrollment has ended, but you can still enroll if you’re eligible for a special enrollment period.
- Consumers are still required to have ACA-compliant coverage.
- Premium and cost-sharing subsidies are still available – andkey to affordability.
- For millions who can’t afford ACA-compliant coverage, short-term coverage that could provide a temporary safety net.
- New Trump administration short-term health insurance rules have expanded consumers’ access to the plans.
The Trump Administration has finalized rules that will expand consumer access to short-term health plans and lengthen the duration of that coverage. Read more.
With all of the hype about the importance of ACA’s annual open enrollment, it’s easy to understand why many Americans believe their opportunity to buy affordable health coverage has passed. But for millions, that’s simply not the case.
Millions can buy outside of open enrollment
There’s actually a fairly long list of opportunities to enroll in ACA-compliant coverage outside of open enrollment. So before you give up hope on compliant coverage – and coverage that may very well include a subsidy – you should review our Insider’s Guide to Obamacare’s Special Enrollment.
The list of qualifying events that could result in a special enrollment period for you at any point during the year including:
Your reasons to enroll haven’t changed
If you’re wondering whether it still makes sense to enroll, consider this:
- You’re still required by law to have ACA-compliant health coverage. If you don’t, you could face the individual mandate penalty. Yes, the GOP tax bill included repeal of the individual mandate penalty, but that doesn’t take effect until 2019. People who are uninsured in 2018 will still face a penalty. Calculate your penalty.
- Coverage is stillguaranteed-issue, regardless of pre-existing conditions.
- Premiums for older enrollees are still capped at no more than three times the premiums for younger enrollees.
- All new major medical plans are still required to cover essential health benefits.
- And the financial assistance provided by the ACA is still available, with premium subsidies that are larger than ever in most areas of the country.
Subsidies can still greatly reduce your plan costs
Depending on your household income, you may still be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies).
- Premiums subsidies are still available in the exchange for people with income up to 400 percent of the poverty level. (For 2018 coverage, a single person can earn up to $48,240 and be eligible for the premium tax credit, and a family of four can earn up to $98,400). Calculate your subsidy. In 2017, 84 percent of exchange enrollees received premium subsidies that covered an average of two-thirds of the total premiums.
- The only thing that has changed about premium subsidies for 2018 is that they’re larger than they were in 2017 in most areas, since average premiums increased and the subsidies grow to keep up with premiums.
- Cost-sharing subsidies are also still available in 2018, even though the Trump Administration has eliminated funding for cost-sharing reductions. People with income up to 250 percent of the federal poverty level still have access to Silver plans with reduced out-of-pocket costs.
A few reminders about affordable coverage
Given the premium increases that took effect in most areas for 2018, it’s essential for anyone who is eligible for premium tax credits – or who might be eligible with an income fluctuation later in the year – to enroll through the exchange if and when they have a special enrollment period. Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.
In general, the only people who should be enrolling off-exchange are those who are 100 percent certain that there is no way they will qualify for a premium tax credit during the year – keeping in mind that the premium tax credits are available well into the middle class and are larger in 2018 than they were in 2017 in order to offset the higher premiums. (A family of four earning $98,400 is eligible for premium subsidies in 2018.)
Remember that you have an option to either have the premium tax credit paid directly to your insurer each month to offset the amount you have to pay in premiums, or you can pay full price for your coverage each month and claim the full premium tax credit when you file your tax return.
But either way, it’s only available if you enroll in a plan through the exchange. If you buy your plan off-exchange, there’s no way to claim the tax credit at the end of the year, even if your income ultimately ends up at a level that would have been subsidy-eligible.
Short-term health insurance as a temporary safety net
The Affordable Care Act has delivered health insurance for millions who were unable to find affordable coverage on the individual market in the past. And, while we strongly encourage our readers to take advantage of the comprehensive ACA-compliant coverage, we do recognize that there is a segment of the individual market population that is facing daunting rate increases. We realize that their coverage options may be limited.
Many consumers face unaffordable premiums – perhaps because they’re in the coverage gap or because their incomes make them ineligible for subsidies. The good news is that there’s a wide range of short-term health coverage available that could provide a temporary safety net until you can find less expensive comprehensive coverage.
New rule will make longer short-term coverage easier to buy
Consumers who are unable to afford ACA-compliant coverage may soon be able to purchase short-term coverage with a much longer duration. Federal regulation changes finalized this summer and announced this month will make it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for three years.
Availability of those plans will vary from one area to another – and the rules won’t take effect until October 2018.
A guide to individual and family health insurance
As much as we love the Affordable Care Act, we know as well as anyone that the individual health insurance market continues to be a source of confusion for many consumers.
Since 1994, this web site has been a guide for consumers seeking straightforward explanations about the workings of individual health insurance – also known as medical insurance. Within this site, you’ll find hundreds of articles loaded with straightforward explanations about health insurance – and the health law – all written by a team of respected health insurance experts.