At EIMA Health Insurance, we understand these challenges. We serve insurance customers nationwide and our commitment to excellence extends to residents throughout Maryland. We are dedicated to simplifying this process, guiding you through every step of your insurance journey to ensure you understand your options and secure the coverage that best fits your unique needs, whether you’re a senior, a growing family, an individual, or a business owner. you’re a senior, a growing family, an individual, or a business owner.
Understanding Maryland’s Health Landscape: Key Statistics and Trends
Maryland has experienced steady population growth, with a 0.74% increase in 2024, bringing the total to over 6.26 million residents. This growth, particularly in the Baltimore-Washington metropolitan area, creates diverse healthcare demands.
Maryland has a relatively low uninsured rate compared to the national average, thanks in part to its proactive approach to health coverage. As of 2023, approximately 6.3% of Maryland residents were uninsured, one of the lowest rates in the country. However, even with this progress, disparities persist: Hispanic Marylanders had the highest uninsured rates (23.6%), followed by Black (6.6%), Asian/Pacific Islander (5.7%), and mixed-race residents (4.3%). This underscores the ongoing need for targeted outreach and accessible resources for all communities. [Source: HealthJournalism.org – Maryland]
These statistics highlight the vital role that Medicare, Medicaid, and the ACA play in providing essential health coverage and a robust safety net for millions of Marylanders.
Medicare: Securing Your Golden Years in Maryland
For Marylanders aged 65 and older, or those with certain disabilities, Medicare is the cornerstone of health coverage. As of August 2024, over 1.1 million Maryland residents were enrolled in Medicare, representing about 17% of the state’s population. While many states see a higher proportion of beneficiaries in Medicare Advantage plans, Maryland has a higher-than-average enrollment in Original Medicare. [Source: Healthinsurance.org – Medicare in Maryland]
How Medicare Benefits Maryland Seniors:
- Financial Protection: Medicare substantially reduces the financial burden of healthcare costs in retirement, covering a significant portion of hospital stays, doctor visits, and preventive care.
- Access to Care: It ensures seniors have access to a vast network of healthcare providers across Maryland and the U.S.
- Choice of Pathways: Maryland seniors can choose between Original Medicare (often supplemented by Medigap and Part D) or a Medicare Advantage plan, tailoring coverage to their specific needs.
Medicare FAQs for Maryland Residents:
What are the current costs for Original Medicare (Parts A & B) in Maryland for 2025?
Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance).
Resource: For official Medicare information and current costs, visit Medicare.gov.
- Part A covers inpatient hospital stays, skilled nursing facility care, and some home health care. Most Marylanders don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes for enough years. The Part A deductible for an inpatient hospital stay in 2025 is $1,676 per benefit period.
- Part B covers doctor’s services, outpatient care, and preventive services. The standard Part B premium for 2025 is $185.00 per month, and the annual deductible is $257. After your deductible, you typically pay 20% of the Medicare-approved amount for most services.
Does Maryland have a “Birthday Rule” for Medigap policies?
Yes, Maryland has a beneficial “Birthday Rule” for Medicare Supplement (Medigap) policies, enacted on July 1, 2023. This rule grants Medicare Supplement policyholders a once-yearly Open Enrollment Period that includes their birthday and the 30-day period following it. During this time, they can switch to a different Medigap policy of equal or lesser benefits from any carrier without medical underwriting. This allows Maryland seniors to shop for potentially lower premiums or a more suitable plan without being denied due to pre-existing conditions. [Source: Maryland Insurance Administration – Consumer Advisory]
How many Medicare Advantage plans are available in Maryland, and do they include prescription drug coverage?
For 2025, there are 64 Medicare Advantage plans available in Maryland, with all residents having access to a plan, including those with $0 premiums. While only about 19% of Maryland Medicare beneficiaries were enrolled in Medicare Advantage plans as of August 2024 (lower than the national average), these plans are gaining traction. Most MA plans are MAPD plans, meaning they bundle prescription drug coverage (Part D) along with Part A and Part B benefits, and often include extra benefits like routine dental, vision, hearing, and gym memberships. [Source: Healthline – 2025 Medicare Plans in Maryland, Healthinsurance.org – Medicare in Maryland]
How do I get prescription drug coverage with Medicare in Maryland?
You can get prescription drug coverage in one of two ways in Maryland:
- Enroll in a Medicare Advantage Plan (MAPD) that includes prescription drug coverage. Most MA plans offered in Maryland include this benefit.
- If you have Original Medicare (and/or a Medigap policy), you’ll need to enroll in a separate Medicare Part D Prescription Drug Plan (PDP). For 2025, there are 14 stand-alone Part D plans available in Maryland, with premiums starting as low as $0 per month.
Medicaid: A Vital Lifeline for Marylanders
Maryland’s Medicaid program, known as HealthChoice, provides essential health coverage to eligible low-income individuals and families. Maryland was one of the first states to embrace Medicaid expansion under the Affordable Care Act, significantly broadening eligibility for adults. This expansion has been a key factor in Maryland’s low uninsured rate.
How Medicaid Benefits Maryland Residents:
- Comprehensive Coverage: HealthChoice provides extensive medical, dental, vision, and behavioral health care for eligible low-income individuals, children, pregnant individuals, parents, and adults with disabilities.
- Reduced Uninsured Rate: Medicaid expansion has played a crucial role in providing access to care for vulnerable populations, significantly contributing to Maryland’s low uninsured rate.
- Support for Families: HealthChoice includes comprehensive children’s health coverage (Maryland Children’s Health Program – MCHP and MCHP Premium), ensuring more young residents have access to vital services.
Medicaid FAQs for Maryland Residents:
Who is eligible for HealthChoice (Medicaid) in Maryland?
Eligibility in Maryland is primarily based on income and specific categories. Thanks to Medicaid expansion, eligibility extends to:
- Adults with monthly income up to approximately $1,801 for a household of 1 (138% of the Federal Poverty Level for 2025).
- Children with monthly income up to approximately $4,202 for a household of 1 (up to 300% FPL for MCHP).
- Pregnant individuals, parents and caretakers, and individuals with disabilities also have specific income thresholds.
Resource: For detailed and updated income guidelines, refer to Maryland Health Connection – Medicaid Coverage Fact Sheet (effective March 1, 2025).
How do I apply for HealthChoice (Medicaid) in Maryland?
You can apply for HealthChoice through Maryland’s state-based health insurance marketplace, Maryland Health Connection. You can apply:
- Online: Visit MarylandHealthConnection.gov.
By Phone: Call the Maryland Health Connection Call Center at 1-855-642-8572 (TTY: 1-855-642-8573).
- In Person: Visit your local health department or local Department of Social Services office.
Resource: Learn more about the application process at MarylandHealthConnection.gov – How to Enroll.
What services are covered by Maryland HealthChoice?
HealthChoice provides comprehensive coverage for a wide range of medically necessary services, including:
- Transportation to medical appointments (in some cases)
- Doctor visits, hospital stays, and emergency services
- Prescription drugs
- Mental health and substance use disorder services
- Dental and vision care (especially for children)
- Preventive care and screenings
- Lab tests and X-rays
Can children of undocumented immigrants qualify for health coverage in Maryland?
Yes, as of January 1, 2024, all children under age 19, regardless of immigration status, are eligible to enroll in Medicaid or the Maryland Children’s Health Program (MCHP) if they meet income and residency requirements. Maryland is one of a few states offering this broad coverage for children.
The Affordable Care Act (ACA): Expanding Access and Affordability
For Marylanders who don’t have access to employer-sponsored insurance, including the self-employed, gig workers, and those working for small businesses that don’t offer coverage, Maryland Health Connection is the state’s official health insurance Marketplace. Maryland operates its own state-based marketplace, allowing for tailored programs and enhanced affordability. For the 2025 plan year, nearly a quarter-million Marylanders (247,243) enrolled through Maryland Health Connection, marking the seventh consecutive year of enrollment increases. This includes a 21% increase in young adults (18-37) and significant growth among Black (23%) and Hispanic (25%) consumers. [Source: Maryland Health Connection – Enrollment Press Release_01172025]
How the ACA Benefits Maryland Individuals, Families, and Small Businesses:
- Exceptional Affordability: Maryland residents qualify for significant financial help. Thanks to a combination of federal (American Rescue Plan Act and Inflation Reduction Act extended through 2025) and state subsidies (such as the young adult subsidy program, which Maryland made permanent and extended to age 40 in 2025), many Marylanders receive substantial premium assistance. The average after-subsidy premium for 2025 was $113/month nationally, with many qualifying for plans well below that.
- No Pre-Existing Condition Denials: Insurers cannot deny coverage or charge more due to pre-existing health conditions. This is a fundamental consumer protection.
- Essential Health Benefits: All plans offered through Maryland Health Connection cover the 10 essential health benefits mandated by the ACA, providing comprehensive care from preventive services to emergency care.
- “Family Glitch Fix”: The “family glitch” was addressed in 2023, allowing family members of workers who are offered “unaffordable” employer coverage (even if the employee’s individual portion is affordable) to qualify for Marketplace subsidies, opening up new affordable options for thousands of Maryland families.
Affordable Healthcare FAQs for Maryland Residents:
How do I qualify for financial help (subsidies) on Maryland Health Connection?
You qualify for premium tax credits (subsidies) and potentially cost-sharing reductions based on your household income and family size. Maryland’s state-specific programs, like the young adult subsidy (made permanent and extended to age 40 in 2025), provide additional savings. Incomes up to 150% of the FPL may qualify for $0 premium plans, while others may pay no more than 8.5% of their income for a benchmark plan. [Source: Healthinsurance.org – Maryland ACA Health Insurance Marketplace, Maryland Health Connection – Enrollment Press Release_01172025]
What is the “Maryland Easy Enrollment Health Program”?
This innovative Maryland program allows residents to indicate on their state income tax returns (or unemployment insurance applications) that they need health insurance. The Office of the Comptroller then shares this information with Maryland Health Connection, which proactively reaches out to help eligible individuals enroll. Over 15,000 have enrolled through the tax form program since its inception in 2020. [Source: Maryland Health Connection – Enrollment Press Release_01172025]
When is the Open Enrollment Period for ACA plans in Maryland for 2025?
The annual Open Enrollment Period for 2025 plans in Maryland was November 1, 2024 – January 15, 2025. This is the primary time to enroll or change your plan for the upcoming year.
Can undocumented immigrants get health coverage through Maryland Health Connection?
Yes, Maryland has taken steps to allow undocumented immigrants to enroll in health coverage through Maryland Health Connection. Starting in 2026, the state plans to allow undocumented immigrants to enroll via Maryland Health Connection and potentially obtain state-funded subsidies, pending legislative allocation. This initiative highlights Maryland’s commitment to broader health equity. [Source: Healthinsurance.org – Maryland ACA Health Insurance Marketplace]
The EIMA Health Advantage: Your Partner in Maryland Healthcare
For many Marylanders, navigating the intricacies of Medicare, Medicaid, and the ACA can feel like deciphering a complex puzzle. The thought of comparing plans, understanding eligibility criteria, and completing lengthy applications can be overwhelming, leading some to postpone or avoid securing vital coverage.
This is where EIMA Health Insurance excels. While we may be headquartered in Dallas, our commitment to providing clear, comprehensive, and compassionate guidance extends across the Old Line State. We are your trusted advisors, ready to:
- Demystify the Process: We translate complex insurance jargon into easy-to-understand terms, ensuring you grasp every aspect of your options.
- Offer Comprehensive Options: We work with all available carriers across Maryland’s Medicare, Medicaid, and ACA landscapes. We obtain and evaluate proposals, presenting you with a full spectrum of plans tailored to your specific needs.
- Provide Personalized Guidance: We take the time to listen to your unique circumstances as a family, individual, or business owner in Maryland. Our goal is to find the perfect plan that aligns with your health needs, budget, and preferences.
- Walk You Through Every Step: From initial eligibility checks and detailed plan comparisons to seamless application submission and ongoing support throughout your coverage, we are with you at every stage of your insurance journey.
Don’t let the complexity of healthcare prevent you from securing the coverage you deserve. Contact EIMA Health Insurance today for a complimentary consultation. Let us empower you with the information and support you need to make informed decisions about your health and financial future in Maryland.
Useful Local Resources for Maryland Residents:
- Maryland Health Connection: The state’s official Health Insurance Marketplace. https://www.marylandhealthconnection.gov/
- Maryland Department of Health (MDH): For HealthChoice (Medicaid) information. https://health.maryland.gov/
- Maryland Insurance Administration (MIA): For consumer guidance on insurance and to find licensed agents. https://insurance.maryland.gov/
- Medicare.gov: The official U.S. government site for Medicare. https://www.medicare.gov/
- 2-1-1 Maryland: A statewide helpline for health and human services. Dial 2-1-1.