Living in Maryland doesn’t mean you should have to struggle in order to find the health insurance you and your family need. but what do you do when you’re lost, and have nowhere to turn? Being the long-standing experts in the insurance market that we are, we understand how complicated and confusing the process can be – but we also understand what you as a consumer need to know to make the best decision for yourself and your household. Below, we’re going to talk about all of the most convenient and affordable insurance options available to residents of Maryland. We hope you learn something that can help you make a beneficial decision about your health insurance needs.
Major Medical Insurance in Maryland
It may not feel like it’s been very long, but the Patient Protection and Affordable Care Act that passed back in 2010 is about to celebrate its tenth anniversary this year. Ever since it was signed into law, it has helped people who struggle to find affordable insurance get the affordable healthcare options they need and want. But since this legislation is still in its relatively early years, it is changing constantly – and you might be unaware of recent changes that could finally make health insurance affordable for you and your loved ones.
In Maryland, your first stop should be the website of your state Health Insurance Marketplace: MarylandHealthConnection.gov. Instead of applying online at HealthCare.gov, applying through your state’s healthcare exchange ensures that you get tax credits and other discounts which are unique and specific to you as a Maryland resident. Open Enrollment typically starts on November 1st and extends until December 15th, but you should contact your state exchange and ask them about qualifying life events which could make you eligible for a special enrollment period.
Some people may be reading this and wondering what’s so special about health insurance coverage through Maryland’s state exchange. For one, the insurance plans sold there are what is known as “guaranteed issue” policies. When a policy is guaranteed issue, it means that you cannot be rejected for coverage for any reason if you apply for coverage. It also means that you cannot be charged higher monthly premiums based on pre-existing conditions. As a matter of fact, the four factors below are the only things your insurance company can use to justify charging a higher premium:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Major medical coverage offered through the Maryland state exchange is also more comprehensive than any of the other options you’ll read about on this page. Each plan comes with the 10 guaranteed Essential Health and Wellness Benefits that the ACA legislation mandates major medical coverage to have. No matter what your medical needs may be right now, you can be sure to get the comprehensive and preemptive care you need to manage your healthcare at an affordable rate:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
One good thing about applying for coverage in the state of Maryland is that the state adopted the ACA Medicaid expansion recommendation many years ago. This means that as long as you make at least 100% of the federal poverty level, you can qualify for a generous tax credit that makes your monthly premiums more affordable. The chart below can help give you an idea of whether or not your household income qualifies you and your family for one of these tax credits. Households making more than 400% of the federal poverty level are generally not offered income-based tax credits, because it is assumed they have the resources necessary to pay their premiums.
|Household Size||Annual Income (100% of the FPL)|
If you make less than 100% of the federal poverty level, then you might want to apply for Medicaid instead. Qualifying for Medicaid in Maryland is actually much easier than it is in other states. Much like the tax credits from the Health Insurance Marketplace, all you need is proof of your household size and income to qualify for Medicaid. To learn more about Medicaid in Maryland and to apply quickly and easily online, be sure to visit the Medicaid Basics and Benefits Maryland Health Connection website.
Short Term Health Insurance in Maryland
The good news is that short-term health insurance is available in Maryland. But purchasing short-term health insurance isn’t without its caveats. For starters, in 2018, Maryland enacted new legislation that limits short-term plans to 3 months of coverage. The law also prohibits renewal of that specific plan. Does this mean you could hop around from one insurance plan/company to the next in order to stay covered for longer than 3 months if you can’t get access to qualifying coverage? Potentially, but you will have to undergo medical underwriting with every insurance policy you sign up for. And since this is short-term health insurance and not major medical coverage through the ACA, you won’t have any protection against being charged more or denied coverage based on pre-existing conditions or your recent medical history.
Another important change in the law in Maryland is the fact that short-term health insurance plans must now offer extra benefits, including mental health care and treatment for substance abuse. This requirement is great for people who need the coverage and otherwise wouldn’t have access to it; but it can make short-term health insurance more expensive. This is on top of the fact that in exchange for lower monthly premiums, short-term health plans usually compensate by charging consumers higher out-of-pocket costs. This transfer of financial responsibility usually shows up in the form of a high deductible ($5,000 or more on average), caps on annual benefits, and lifetime benefit caps, but no caps on your total out-of-pocket expenses.
Christian Health Plans/Health Share Plans in Maryland
Health sharing ministries have been around in some form or another for a while – but they did experience an explosion in popularity during the early days of the Affordable Care Act. During the first few years that the law and the Health Insurance Marketplace were active, the individual mandate required every citizen who filed taxes to either purchase qualifying major medical coverage or to pay a tax penalty. Although the benefits offered by Christian health plans don’t qualify them as major medical coverage, their religious nature did award people and exemption to the individual mandate. They are also comparably affordable when compared to short-term health insurance, which made them a more financially attractive option for people who couldn’t qualify for a tax credit Through the ACA.
These days, some people may think it’s easier and cheaper just simply not to purchase coverage at all rather than choose a Christian health plan. But like short-term health insurance, it can be a huge financial benefit to have some sort of coverage “just in case” rather than to risk going without. Christian health plans also have the following in common with short-term health insurance:
- Not guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
However, don’t get comfortable thinking these plans are identical just because they have so much in common. There are many differences between short-term health insurance and health share plans, both big and small. For one, your “monthly share amount” takes the place of your monthly premium, and you will pay for your co-payments, deductible, and coinsurance by paying “unshared amounts” or “personal responsibility amounts” to your Christian health plan provider. You won’t have a legal contract between you and your health share plan; therefore, if they ever deny you benefits for any reason, you won’t have legal recourse to get the money you are owed. we should also mention the participation guidelines which Christian Health Plans impose on their members. These guidelines could be something as simple as choosing a (usually Christian) faith and immediately ending tobacco use; some plans, however, could have very detailed participation guidelines which mandate that you adhere to a very biblical style of life. But if that lifestyle dovetails well with your own, and if you find a Christian health plan that gives you the benefits you need at a price you and your family can afford, it can be worth it in the long run.
Fixed Indemnity Plans in Maryland
Fixed indemnity plans help pay a fixed portion of your medical expenses instead of splitting the cost on a percentage basis the way major medical coverage does. The way a fixed indemnity plan pays out your benefits will likely be either on a per day, per week, per month, per incident, or per visit basis. The most popular Indemnity plans are hospital indemnity plans, because these bills tend to be the most expensive (and hence people need the most assistance with them); but you may also be able to find doctor indemnity plans or even dental indemnity plans in your area.
But if you are looking for legally qualifying coverage to replace an ACA plan, fixed indemnity plans cannot offer you that (unfortunately). However, they are excellent for supplementing the major medical coverage you already have and lowering your out-of-pocket costs. But if you don’t have major medical coverage right now, fixed indemnity plans can at least help in the interim. You will still have some pretty substantial out-of-pocket costs for whatever your fixed indemnity plan doesn’t cover, and you will likely face annual and lifetime benefit limits; but it’s still better for most people then paying 100% of their medical bills out-of-pocket. Whether you currently have major medical coverage or not, there are a variety of different consumers out there who can benefit from fixed indemnity plans.
Discount Cards in Maryland
A medical discount card is a membership program you can join voluntarily in order to receive discounts on common medical care and purchases. These programs usually work something like the AARP or the AAA auto club: you pay a membership fee, either on a monthly or annual basis, and they send you a discount card in the mail. Then you present that discount card wherever it is that you buy prescription drugs, receive certain medical services, and more in order to get a discount right there at the register. You don’t have to worry about filing claims or waiting for reimbursements. That being said, medical discount cards are certainly not a legally qualified substitute for major medical coverage. A good medical discount card might help take some of the sting out of your out-of-pocket costs – but they don’t come anywhere close to offering you the benefits and the comprehensive coverage that a Health Insurance Marketplace plan will.
The truth is, though, that not all medical discount cards are created equal. You have to take a very close look at the medical discount card company you wish to purchase a membership from in order to make sure that they offer the discounts they say they offer, as well as work with the providers they claim they work with. Not all discount card companies are as honest and forthcoming as they should be about the services you will get in return for purchasing a membership. But all it takes is a little digging and a few calls and you can figure out whether a discount card offer can help you with your out-of-pocket costs. For more information about medical discount cards in Maryland, you can check out the Frequently Asked Questions Page of the Maryland Insurance Administration’s official website.