Maryland Insurance: Low-Income Exclusive?

Maryland offers a range of health insurance options for its residents, including marketplace insurance through the Maryland Health Connection. This is the state's Affordable Care Act (ACA) marketplace, where most Marylanders are eligible to purchase health insurance. While low-income individuals and families can benefit from free or low-cost coverage options like Medicaid and the Maryland Children's Health Program, marketplace insurance is not restricted to only those with low incomes. In fact, Maryland Health Connection plans cater to a diverse range of residents, including self-employed people, early retirees, and workers at small businesses without health benefits.

Maryland Health Connection: the state's ACA marketplace for insurance coverage

Maryland Health Connection is the state's official health insurance marketplace, where residents can shop for and enroll in health coverage plans. It is the state's Affordable Care Act (ACA) marketplace, allowing most Marylanders to buy health insurance during open enrollment.

The ACA Marketplace, also known as Obamacare, is an affordable option for many. Maryland operates its own state-run exchange, which follows an active purchaser model. This means the state negotiates with insurance companies to decide which plans will be available for purchase.

Maryland Health Connection offers four categories of plans: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premiums and the highest deductibles and copays, covering around 60% of care costs. Silver plans have moderate premiums, deductibles, and copays, covering 70-94% of costs. Gold plans have higher monthly premiums and lower deductibles and copays, covering about 80% of costs. Platinum plans have the highest premiums and lowest deductibles and copays, covering around 90% of costs.

Maryland Health Connection also offers a catastrophic plan for residents aged 30 and younger, covering emergency medical care for low monthly premiums. Additionally, Maryland has a reinsurance program that has kept full-price premiums lower than they would otherwise be.

The state's Medicaid program offers free or low-cost coverage to low-income individuals and families, those living in skilled nursing facilities, and those with certain disabilities. Non-citizens with qualified immigration status, pregnant women, and children under 21 are also eligible for some Medicaid coverage.

Maryland Health Connection provides an online tool, "Get an Estimate," to help residents shop for plans, compare prices, and see if they are eligible for financial assistance. The website also provides information on essential benefits covered by all plans, including emergency services, maternity and newborn care, mental health services, and chronic disease management.

Maryland Health Connection is committed to making health insurance accessible and affordable for its residents, offering a range of plans and financial assistance options to meet diverse needs.

Medicaid in Maryland: free or low-cost coverage for low-income people, families, pregnant women and children

Maryland's Medicaid program offers free or low-cost health coverage to low-income people and families, as well as to those living in skilled nursing facilities or with certain disabilities. Non-US citizens with qualified immigration status, pregnant women, and children under the age of 21 are also eligible for some Medicaid coverage.

Medicaid is available to individuals and families with limited income and resources. To qualify for Medicaid, your monthly income must be up to a certain amount, depending on your household size. If you are pregnant or have children, you may earn more and still qualify.

Medicaid covers doctor visits, including regular check-ups and specialists, family planning and birth control, hospital and emergency services, and primary mental health services through your doctor, all at no cost.

Enrollment in Medicaid and the Maryland Children's Health Program (MCHP) is available all year round. The MCHP provides full health benefits for children up to the age of 19. Pregnant women and children who meet income guidelines can receive free or low-cost health insurance under the MCHP. Non-citizen pregnant women can also get free health care for themselves and their baby from the start of pregnancy through four months postpartum.

To apply for Medicaid, you can go to the Maryland Health Connection website, apply via the state exchange's mobile app, or call the Maryland Health Connection customer service center. Representatives called "navigators" and "brokers" are also available to help you understand your options and determine your eligibility for financial assistance.

Marketplace health insurance: available for self-employed people, early retirees, and workers without health benefits

Marketplace health insurance is available to self-employed people, early retirees, and workers without health benefits.

Self-employed people

If you are self-employed, you can purchase qualified health coverage through the Marketplace for individuals and families. This is known as an Individual Marketplace plan. You can find coverage for yourself and your family and access premium tax credits and other savings if you qualify. To qualify for savings, you will need to provide an estimate of your household income to the Marketplace for the year you are seeking coverage.

Early retirees

If you retire before the age of 65 and lose your job-based health plan, you can use the Health Insurance Marketplace to buy a plan. Losing health coverage qualifies you for a Special Enrollment Period, meaning you can enroll in a health plan outside of the usual Open Enrollment Period. If you are 65 or older but not eligible for Medicare, you may be able to buy insurance in the Marketplace and get lower costs on monthly premiums and out-of-pocket costs based on your household size and income.

Workers without health benefits

If you work part-time and cannot get job-based health insurance, you can buy health insurance in the Health Insurance Marketplace. You may qualify for savings based on your income. If your employer does offer health insurance to part-timers, you can still buy insurance through the Marketplace instead, but you may not qualify for a premium tax credit and other savings based on your income.

The Marketplace offers health insurance plans for people in a variety of situations, including those who are self-employed, early retirees, and workers without health benefits.

Medicare: federal insurance for over 65s, those with certain disabilities, and people with End-Stage Renal Disease

Maryland residents can purchase health insurance through the Maryland Health Connection, the state's Affordable Care Act (ACA) marketplace. This is a federal and state-funded insurance program that helps make health insurance more affordable for low- and middle-income residents.

Maryland's Medicaid program offers free or low-cost coverage to low-income people and families, as well as those who live in skilled nursing facilities or have certain disabilities.

Now, onto Medicare. Medicare is a federal insurance program for:

• People aged 65 or older
• People under 65 with certain disabilities
• People of any age with End-Stage Renal Disease (ESRD)

Medicare consists of four types of coverage, known as "parts." There are three enrollment periods for Medicare, and it is important to sign up as soon as possible to avoid penalties or gaps in coverage. You can sign up for Medicare Part A and Part B through Social Security.

Medicare covers a range of services, including prescription drugs, mental health services, and substance use disorder treatments. It also helps with the cost of hospital and nursing home stays.

State Health Insurance Assistance Programs (SHIPs) are available to help people with Medicare and their families make informed healthcare decisions and understand costs and coverage.

Health Insurance Marketplace Open Enrollment: when uninsured Marylanders can apply for coverage

Maryland's Health Insurance Marketplace is called the Maryland Health Connection. It is a state-run exchange that follows an active purchaser model, which means the state negotiates with insurance companies to decide which plans will be available for purchase.

Who is eligible for Marketplace coverage?

To qualify for Marketplace coverage in Maryland, you must:

• Be a U.S. citizen, national, or lawfully present in the U.S.
• Not be enrolled in Medicare
• Not have access to affordable health coverage through an employer
• Not be eligible for Medicaid or CHIP
• If married, you must file a joint tax return (with limited exceptions)
• Not be able to be claimed as a tax dependent by someone else

Open Enrollment Period

The open enrollment period for individual and family health plans in Maryland runs from November 1 to January 15. Enrollment by December 31 will mean coverage starts from January 1 the following year. Enrollment between January 1 and January 15 will mean coverage begins from February 1.

Special Enrollment Periods

Outside of the open enrollment period, a special enrollment period allows you to enroll in a plan if you experience a qualifying life event. This could include:

• Losing coverage
• Getting married or divorced
• Having a child, adopting a child, or placing a child for adoption or in foster care
• Moving to Maryland, or within the state
• COBRA coverage ending
• Change of citizenship or immigration status
• Incarceration or release
• Change in status as an American Indian/Alaska Native
• Getting pregnant (you have 90 days to enroll from the time the pregnancy is confirmed)
• Gaining or losing a dependent
• Losing other health coverage, such as insurance through your job
• Turning 26 and aging out of your parent's plan

How to Enroll

There are several ways to enroll in a Marketplace plan in Maryland:

• Online: Go to the Maryland Health Connection website and click "How to Enroll" to get started. You can also apply via the state exchange's mobile app on Apple or Android devices. You will need to create an account to begin the enrollment process.
• By phone: Call the Maryland Health Connection customer service center at 855-642-8572, Monday through Friday from 8 a.m. to 6 p.m., and follow the prompts. Multilingual agents are available in dozens of languages, including Spanish, Arabic, Chinese, Farsi, and French. Relay services for the deaf or hard of hearing are offered for free.
• In person: Representatives called "navigators" and "brokers" are available to help you and your family understand your options and determine whether you qualify for financial assistance. Find a navigator in Maryland counties to help you apply in person or check the events section of the Maryland Health Connection website. You can also call customer service at 855-642-8572 to find locations.

Maryland Health Connection plans are organized into four categories:

• Bronze plans have the lowest monthly premiums and the highest deductibles and copays, covering roughly 60% of care costs.
• Silver plans have moderate monthly premiums, deductibles, and copays. They cover 70% to 94% of care costs, depending on whether you qualify for a basic plan or an enhanced silver plan for lower-income households.
• Gold plans have higher monthly premiums and lower deductibles and copays, covering roughly 80% of care costs.
• Platinum plans have the highest monthly premiums and the lowest deductibles and copays, covering roughly 90% of care costs. These plans are for people with significant healthcare needs who are willing to pay the highest premiums.

No, Maryland Marketplace Insurance is not just for low-income people. However, low-income people may qualify for Maryland's Medicaid program, which offers free or low-cost coverage. Maryland also offers state-funded subsidies for young adults aged 18-37 to help make coverage more affordable for this demographic.

Frequently asked questions