Maryland is a small state nestled in the Mid-Atlantic region, known for the City of Baltimore, being located near the nation’s capital, and making an abundance of delicious crab cakes. The residents of Maryland have access to the Atlantic Ocean, the Chesapeake Bay and many other outlets of water traffic for industrial and recreational purposes. If you are a resident of Maryland looking for a health insurance policy, you have some of the safest insurers in the nation to choose from.
East Coast Health Insurance can connect you to the best companies in Maryland health insurance, including Aetna, Coventry, Blue Cross Blue Shield of Maryland, Kaiser Permanente and UnitedHealth Care. For pricing and available plans specific to your city or town, enter your zip code below and compare rates on your own, or call one of our licensed Maryland agents for personal guidance through the process of selecting a plan at 888.803.5917.
The state of Maryland has an improving level of overall health, so congratulations! While there is still work to be done on making the population of Maryland healthier, there are several positives to make note of, including a decreasing number of smoking adults. Over the past ten years, smoking has decreased from 20.5 to 15.2 percent of the adult population – which still means there are 672,000 people over 18 who have yet to quit. Other good qualities include a low level of binge drinking, a high percentage of high school graduates, and a great number of primary care doctors throughout the state, increasing access to health care.
Some areas that need help are the number of overweight and obese adults in Maryland, which has increased over the past ten years. Diabetes has also become more prevalent in adults, now affecting 9.3% of all adults in the state. Air pollution is also high throughout the state, which leads to respiratory and other health complications. The number of children in poverty has also seen an elevation, increasing rapidly over the past year – from 12.3 to 13.6% of all Maryland residents under age 18. Many of these health problems can be improved upon by getting and using a health insurance plan, using state-funded programs, eating better and finding a physical activity that suits you. Making lifestyle changes can keep Maryland on the rise in terms of health.
Health Insurance Plans
- PPO Value plans in Maryland give you access to Aetna’s preferred network of providers, as well as the freedom of using non-network providers. Plans come in deductibles of $2,500, $3,500, $5,000, $7,500 and $10,000 for individuals in-network. The monthly premiums on Value plans are the most affordable of any PPO plan from Aetna, and cost sharing is higher in return. For most medical services, you will pay a percentage of coinsurance which varies based on the type of care. Doctor’s office visits are available for a $30 copay, specialist visits are $50, and prescription drugs are also covered for a copay.
- PPO High Deductible plans are available with either a $3,000 or $5,000 annual deductible for individuals (double for families), and the capability to open a health savings account. Using funds from a health savings account helps you gain a better sense of control over your medical bills, and also give you tax advantages. These plans have a high level of coverage, with just about every type of medical service available for no cost after you have met the deductible. Preventive care such as immunizations, well-child care and physical exams can be used at any time after your plan starts, covered at 100%.
CareFirst Blue Cross Blue Shield
- BlueChoice HMO Open Access plans are HMO plans without the need for referrals to see in-network providers. While a primary care doctor coordinates routine care and other types of treatment, even directing you to specialists, a referral is not required like a normal HMO. Preventive care is covered at 100% from the start of your plan, including routine exams and well-child services. There is also coverage on various tiers of prescription drugs available as soon as your plan is purchased. The HMO network is comprised of over 26,000 primary care physicians and 55 hospitals in the area, so there is always a quality option for care. There is also the option of opening a health savings account at certain deductible levels.
- BlueChoice HMO (Referral-based) plans are standard HMOs that require a referral from your primary care physician in order to use a specialist or other type of provider within the network. These plans are convenient, as there are no claims to file, and preventive care is covered in full as soon as your plan starts. A discount on dental care of up to 40% is available for plan members, in addition to health education programs, disease management for individuals with asthma, diabetes and heart conditions. Despite the need for referrals, there is still access to a large HMO network throughout the region. Some of these plans are qualified for use with a health savings account.
- HealthyBlue plans give you the freedom to choose providers from the CareFirst BlueChoice network, or any non-network provider you like. These plans do not require referrals for any type of care, and no claims when seeking care in-network. Preventive care and wellness services are available immediately, which includes immunizations, women’s health care, men’s health care, and well-child care in addition to annual physicals. Doctor’s office visits and prescription medications are covered from the start of your plan. These plans also have an incentive program to gain benefits as a result of participating in wellness programs. Some can be connected to an HSA.
- POS plans are available in several types: BlueChoice Advantage, BlueChoice Opt-Out Open Access and Maryland Point of Service. These plans do not require you choose a PCP, and you have the ultimate freedom to select a provider from the network or outside of the network. Costs will be lower when using providers from the BlueChoice network, which has a large number of providers throughout the state. Prescription drugs are covered from the day your plan starts, and additional benefits are offered such as BlueVision, a discount program for discounts on glasses, contacts, and eye exams.
- PPO plans through CareFirst are available in three variations: BluePreferred, PPO and Select PPO. These plans give you the option of using the BluePreferred network of provider for lower rates on health care or seeking out-of-network care at your discretion. Preventive care is covered at 100% immediately, which includes well baby/child care, immunizations, screenings for various diseases and cancers, routine physicals and more. These cover a large number of medical services after meeting the deductible, including inpatient hospital care, surgery, emergency room care, maternity care, lab work, medical supplies and home health care.
- 80% Choice PPO plans have the widest variety of deductibles, from $500 to $5,000 for individuals, and double the amount for families. These plans offer 80% coverage on many health care services after meeting the deductible, which leaves you responsible for 20% coinsurance on inpatient and outpatient hospital services, emergency care and urgent care. After a $25 copay, primary care visits are covered at 100%, which also includes preventive care such as immunizations, mammograms, GYN exams, well child visits and annual physicals. These plans also cover prescription drugs, starting at a $10 copay for generics.
- 500, 1000, 15000 plans are available in these three deductible options, which are twice as much for families. The out-of-pocket maximum for these plans is $2,000 coinsurance in addition to your deductible, and the lifetime maximum is $2 million. These plans cover doctor’s office visits in full after a $20 copay, and preventive care services are no cost from your plan’s start date. Prescription coverage is included with a $150 deductible, which gives you $5 generics and $25 brand name formulary drugs. After meeting the deductible, inpatient hospitalizations, lab work, diagnostic tests, surgery, urgent care and other major medical care are no cost to you.
- 2500 plans provide 70/30 coverage, with a deductible of $2,500 for individuals and $5,000 for families. Physician office visits are covered in full by your plan after a $20 copay for primary care doctors and $35 for specialists. Prescription drugs are covered with a $10 copay for generics. Once you have met the deductible, your plan will pay for 70% of outpatient care, hospital stays, X-rays, testing, medical equipment, home health care and more when using in-network providers.
- 5000 plans are very basic and easy to use, offering 100% coverage on medical costs after you meet the deductible. These plans have no out-of-pocket maximum, and provide primary care visits for no cost after a $20 copay. Specialist visits are available for a $35 copay, and preventive care in-network is covered at 100%. This includes vaccinations and screenings for various conditions and diseases, GYN exams, routine physicals and more. There is also affordable prescription drug coverage, with a $10 copay for generics.
- Copay plans in Maryland have either a $3,500 or $4,000 deductible for individuals, $7,000 or $8,000 for families, and health care costs at a predetermined rate. Doctor’s office visits are $25/$35 for primary care, and $40/$50 for specialists. Other services are available for a copay, including outpatient surgery, inpatient hospital care, maternity services, emergency and urgent care, and diagnostic labs. Prescriptions are covered for a copay once you have met the $100 deductible.
- Deductible plans are available in many levels of deductibles ranging from $750 to $8,000. Each of these plans offer primary care care visits for a $30 copay, specialist visits for $40, and emergency care for $150 copay (waived if admitted), regardless of the deductible. Preventive care is covered in full as soon as your plan begins, which includes yearly physicals, well-child care, GYN exams, vaccinations and more. After you meet the deductible, you will either pay 20 or 30% coinsurance on major medical costs.
- HSA-Qualified Deductible plans have deductibles of $1,250 or $2,500 and give you the capability of opening a health savings account (HSA), which gives you a better handle on your health care expenses. With an HSA, you can pay for medical services as dictated by your plan, both in and out-of-network, and receive tax benefits simultaneously. These plans cover either 80% or 100% of all covered medical costs after deductible, including outpatient surgery, hospitalization, professional visits, lab work and more. Maternity care is covered in full, doctor’s office visits are a $20 or $30 copay and specialist visits are $30 or $40.
- Copay plans in Maryland from UnitedHealthOne are convenient and simple for individuals who want to pay a predictable rate for health care services. These plans are similar to group plans from an employer, but you have the freedom to choose in-network or out-of-network providers. When your plan becomes effective, you have the ability to receive preventive care such as cancer screenings, vaccinations, well-child care and other exams for no charge. Prescription drugs are available for a rate of $15 for generics, and $30-40 for brand names through Copay 100 and 80 plans. These plans have high deductibles, and once it has been met, you can use network or non-network providers for care though the network offers better prices.
- High Deductible plans are available in three types, including Plan 80, Saver 80 and Plan 100, which means you can either have your plan cover 80 or 100% of your health care costs after deductible. Plan 100 is the most comprehensive coverage option, with more services available for no cost after you meet your deductible in exchange for higher premiums. Plan 100 and Plan 80 cover physician and specialist visits and prescriptions drugs, while the Saver plan does not, due to its low premiums. High deductible plans all cover preventive care at 100% before deductible.
- Health Savings Account plans come with 100% in-network coverage on most major medical services after having met your deductible, and the ability to pair your plan with an HSA. Funds from the HSA can be used to pay for qualified health care costs, including your deductible, coinsurance, and other cost-sharing. Premiums are lower due to the high deductible, and preventive care is available for no charge from the start date of your plan. Most medical services are covered, as these are very comprehensive plans, including inpatient and outpatient hospital care, emergency room visits, home health care and more.
Public Health Options
For Maryland residents who have special medical needs or cannot afford to purchase health insurance, there is a handful of state-funded alternatives. Assistance with medical care, prevention of disease, family planning, and being able to maintain good health regardless of your current condition are all available through programs and services administered by your state government. Frequently used public programs include Medicaid and the Maryland Children’s Health Insurance Program, which provide medical assistance to low-income families, pregnant women, and other individuals with health needs. For a full list of programs in Maryland, visit the Maryland Department of Health & Mental Hygiene site, as well as the Maryland Department of Human Resources. The following is a selection of some of the important public health options to know about in Maryland.
- Medicaid: health care coverage for individuals with low income, disabilities, children, or have certain medical needs.
- Maryland Children’s Health Insurance Program: residents under the age of 19 who are not eligible for Medicaid can receive coverage on many medical services.
- Primary Adult Care (PAC) Program: a health care program for Maryland residents over age 19 who earn a low income, featuring free primary care visits and hospital care.
- Employed Individuals with Disabilities Program: medical assistance for disabled adults between ages 18 – 65 who want to return to work.
Health Insurance Laws
In Maryland, health insurance regulations exist for the purpose of keeping health insurance companies as well as insured individuals protected. In some cases, one party feels a loss and compromise, but laws are about to change due to the Affordable Care Act. For the individual, the ACA will bring more protections, especially in regards to having a pre-existing condition. In many states, those with such conditions are rejected by insurers, charged more, or are given a clause to their plan stating the insurer will not cover expenses related to the condition.
Maryland has already begun to make care more equal, by defining pre-existing conditions by the objective standard, determined by a condition for which someone has actually received care in the past. Though an insurer still has the right to deny you a plan, they cannot legally issue an elimination rider, so they must pay for care related to your pre-existing condition at a certain point. Exclusion periods are allowed, so if you are accepted for a plan and have a pre-existing condition, the insurance company can decide not to pay for treatment for up to 12 months.
Under the ACA, early 2014 will bring all adults of any health status the ability to receive a plan from a private health insurer. Those with pre-existing conditions will no longer be denied or charged any more than a normal, healthy adult. In the meantime, there is an alternative for adults with pre-existing conditions called the Pre-Existing Condition Insurance Plan. With a PCIP, you can receive health care as you would from a health insurance company for a monthly premium, though it is administered by the state. If you have a pre-existing condition according to an insurance company in Maryland, you are eligible for a PCIP.
Due to HIPAA regulations, health insurers have to follow the guaranteed renwability provision. This law retains the right of the insured individual to keep their health plan regardless of acquiring an illness during the course of their term. It also states that the insurance company must offer to renew the same plan at the end of a term, unless the insured person has outstanding premium payments, has committed fraud, or broken the agreement associated with their policy in another way. Being a responsible, paying policy-holder will guarantee you the right to receive more care for a longer period of time in Maryland and throughout the U.S..