En Español | Most Marylanders are eligible to buy health insurance through Maryland Health Connection, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Maryland Health Connection’s open enrollment period begins Nov. 1 and lasts through Jan. 15, 2022, but you may be able to switch to a marketplace plan if you get married, have a baby or experience another qualifying life event.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of its household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible:
- Most Marylanders, including non-U.S. citizens with worker or student visas, regardless of whether they are currently insured.
- You may also qualify for Maryland’s Medicaid program, which offers free or low-cost coverage to low-income people and families and to those who live in skilled nursing facilities or have certain disabilities. Noncitizens with qualified immigration status and pregnant women and children under age 21 are eligible for some Medicaid coverage.
When can I enroll?
- Maryland’s open enrollment runs from Nov. 1–Dec. 15. Coverage starts Jan. 1.
- You can enroll anytime if you experience a qualifying event. In most cases, you have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
- Enrollment in Medicaid and the Maryland Children’s Health Program is available any time of year.
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. To apply and enroll:
- 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’ll 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-Friday from 8 a.m.–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 free of charge.
- In person: Due to the COVID-19 pandemic, most in-person help is temporarily unavailable. Representatives called “navigators” and “brokers” are available to help you and your family understand your options and determine if you qualify for financial assistance. Call Maryland Health Connection’s customer service center at 855-642-8572.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your household income and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Maryland Health Connection plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Maryland Health Connection plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a silver-level plan to get this assistance.
If you received or are eligible to receive unemployment benefits at any point in 2021, even if it was just one week, you can enroll in a plan with monthly premiums of nearly $0. All types of unemployment compensation qualify, including regular state-paid benefits or emergency or extended unemployment provided through the federal government. Changes related to receiving unemployment benefits expire Dec. 31, 2021.
What plans are available?
Maryland Health Connection plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on whether you qualify for a basic plan or an enhanced silver plan for lower-income households. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
Maryland residents age 30 and younger can apply for a catastrophic plan, which covers emergency medical care for an individual or family for low monthly premiums. You must apply for an exemption to show that other coverage options are unaffordable.
You can shop, compare plans and see if you’re eligible for financial assistance with Maryland Health Connection’s online “Get an Estimate” tool.
What if I already have health insurance?
If you have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Maryland Health Connection. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you may be able to save money by switching to a Maryland Health Connection plan during a 60-day special enrollment window. Be sure to apply and select your Maryland Health Connection plan before your COBRA coverage ends to make sure there's no gap. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker.
Will I need to get a new doctor?
That depends. Major insurance providers, including CareFirst BlueCross Blue Shield, Kaiser Permanente and UnitedHealthcare, offer Maryland Health Connection plans, but not all doctors accept them. You can talk to your primary care physician or use the online “Get an Estimate” tool to see whether a certain doctor or practice will accept a marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Such families may choose to enroll separately and still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.