GET A QUOTE
Select a Product

Zip Code

Maryland Health Insurance Guide

Maryland Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes

As a Maryland resident you have a variety of private health insurance plans to choose from including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Maryland State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA. 

Maryland is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health, gender, age and lifestyle habits. If you are accepted, the insurer has the right to impose an exclusionary period up to 24 months for any pre-existing conditions. Maryland HMOs are not allowed to set a pre-existing exclusion period, Maryland does allow insurance companies a 24-month exclusion period for pre-existing conditions and an 84-month look-back period n all other types of individual health insurance policies. In Maryland, you are only entitled to credit for prior coverage if you are exercising your HIPAA group-to-individual portability rights. Maryland also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions, body systems and body parts. Mary does not enforce any restrictions on the premium you can be charged for an individual health insurance policy; rates are typically based on the plan you choose, your age, health and sex.

Maryland is a guarantee issue state for group health plans issued to small businesses. If your Maryland health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. Neither can the insurer impose any exclusionary period or look-back period for pre-existing conditions. However, you employer may have a waiting period for eligibility for new hires.  Premiums for small group health insurance are determined by location and age, with a permissible rate adjustment factor of 40%.

Maryland is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.

 

Maryland Mandated Health Benefits
Maryland laws require private health insurance policies to cover several state-mandated benefits. These currently include:

  • Alcoholism and Drug Abuse Treatment
  • Alzheimer’s
  • Autism
  • Blood Products
  • Bone Mass Measurements
  • Breast Reconstruction
  • Cervical Cancer and HPV Screening
  • Chlamydia
  • Cleft Palate
  • Clinical Trials
  • Colorectal Cancer Screening
  • Contraceptives
  • Dental Anesthesia
  • Diabetes Supplies and Self Management
  • Hair Prostheses
  • Hearing Aids
  • Home Health Care
  • Hospice Care
  • In Vitro Fertilization
  • Long Term Care
  • Mammography
  • Mastectomy Stays
  • Maternity and Maternity Stays
  • General and Parity Mental Health
  • Minimum Testicular Cancer Stays
  • Morbid Obesity Treatment
  • Newborn Hearing Screening
  • Off Label Drug use
  • Orthotics and Prosthetics
  • PKU/Formula
  • Prostate Cancer Screening
  • Second Surgical Opinion
  • TMJ Disorder
  • Well-Child Care
  • Coverage for newborns under parent's policy
  • Coverage for adopted children under parent's policy
  • Coverage for handicapped and continuation/dependents under parent's policy
  • Coverage for dependent students under their parent’s policy
  • Coverage for continuation/employees
  • Coverage for grandchildren

 

 

Types Health Insurance Plans Available in Maryland
The following major medical health insurance plans are generally available in Maryland. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.

  • Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.

  • Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.

  • Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care.  Non-emergency services out of network are usually not reimbursed.

  • Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists.  Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.

 

 

Alternative Health Programs in Maryland

  • The Maryland Health Insurance Plan (MHIP) MHIP is the state-sponsored high-risk pool that offers health insurance to state residents who have been unable to secure coverage from private insurers because of pre-existing conditions.  To be eligible, you must live in Maryland and have been denied health insurance within the past six months because of a pre-existing condition, or have lost your employer-provided group coverage, or have exhausted COBRA and are not eligible for Medicare. There are five different medical insurance plans to choose from including an HMO Plan with no deductable, a PPO Plan with $500 deductible, a PPO with $1,000 deductible, a High Deductible Plan with $2,500 combined medical and pharmacy deductible, plus an MHIP+ Plan for people with limited income. Plan benefits, coinsurance and out-of-pocket costs vary per plan. Premiums are based on plan and age, but can be no less than 100% and no higher than 150% of the standard rate risk.  All MHIP plans have a $2 million lifetime maximum benefit. There is no exclusion for pre-existing conditions with proof of creditable coverage. Pregnancy is not subject to any waiting period.

  • Maryland Children’s Health Insurance Program (MCHP)
    MCHP is the state-sponsored program providing health insurance for eligible resident children up to age 19 and pregnant women of any age who do not have other coverage and cannot afford Medicare. Eligibility is based on family size and income.  Waiting periods of up to six months can be waived in certain instances. Coverage is comprehensive. Enrollment must be renewed every 12 months. Health plans options are offered through a variety of Managed Care Organizations. Premiums are based on income.

 

Regulating Agency
The Maryland Office of Insurance is responsible for regulating Maryland’s health insurance industry.

Get access to Maryland health insurance quotes from http://www.einsurance.com/health-insurance.

Maryland Insurance Administration
200 St Paul Place, Ste 2700
Baltimore, MD  21202
(410) 468-2000 or (800) 492-6116
http://msa.maryland.gov/msa/mdmanual/25ind/html/47insur.html

Maryland Health Insurance Plan
10455 Mill Run Circle
Mail Stop RR-291
Owings Mills, MD  21117-9185
(443) 738-0667 or (888) 444-9016
http://www.marylandhealthinsuranceplan.state.md.us

Maryland Children’s Health Program (MCHP)
(800) 456-8900
https://mmcp.dhmh.maryland.gov/chp/pages/Home.aspx

(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/

Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/