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Maryland Health Connection


The Maryland Health Benefit Exchange, also known as Maryland Health Connection, is a state-run organization created under the Affordable Care Act to provide individuals, families and small businesses access to affordable insurance. Marylanders can compare and contrast health plans with a variety of benefits and purchase coverage that can keep them safe from high medical costs and the individual mandate tax. One of the major perks of Maryland Health Connection is its budget-friendly price tag. While coverage on the exchange costs about the same as a plan purchased off the exchange, only health plans purchased through Maryland Health Connection qualify for subsidies to reduce your premiums and even cost sharing, depending on your income. Subsidies are government-issued tax credits that help you pay for coverage if you can’t afford to buy it yourself.

You can shop for Maryland Health Connection plans with a licensed agent such as the marketplace-certified staff at East Coast Health Insurance, or apply directly through the exchange’s website. Plans are specifically for individuals and families who don’t have access to coverage elsewhere, like an employer or Medicaid. For small businesses, the SHOP exchange provides coverage options for employers with less than 50 workers who want a cost-effective way to insure their workers. If an individual qualifies for Medicaid, they can also apply for coverage through the Maryland Health Connection site.

Living in Maryland, you have the benefit of a state-run marketplace, which means your own local officials, insurers, health care providers and community members administer coverage and decide what’s best for the population, rather than the federal government. It’s a bit more personalized as Maryland residents have set up the program, which is a storefront for the products of commercial carriers.

Not sure if you’re eligible for the marketplace? Here’s how to determine whether you qualify for the exchange.

Maryland Health Connection

Marketplace Eligibility for Individuals and Families

If you’re a legal resident of Maryland who doesn’t get coverage from your employer, or your job-based coverage doesn’t cover at least 60% of covered medical expenses after deductible, you can enroll. Additionally, you must not be eligible for Medicaid, which means you earn less than or equal to 133 percent of the federal poverty level, which is about $15,282 per year for an individual and $31,322 for a family of four. If you are age 65 or older, you do not need to shop on the marketplace, either, as you’re covered by Medicare.

Subsidies

Maryland residents who earn between 133 and 400% FPL may qualify for the premium tax credit, which is money provided by the government to help make insurance more reasonable. The less you have, the more assistance you’ll be given, as subsidies are calculated by the cost of coverage in relation to your income. The amount you would pay for the second least expensive silver plan in your area cannot exceed a certain percentage of your income, and the subsidy will compensate for the difference between your income and the actual premium rate.

 

Individual and Family Plans

To meet ACA standards, each health insurance policy sold through Maryland Health Connection must have the same selection of covered services, called essential health benefits (EHBs), regardless of actuarial value, deductible, or cost. The ten categories of EHBs as defined by the health care law are:

  • Preventive and wellness services and chronic disease management
  • Prescription drugs
  • Maternity and newborn care
  • Pediatric services, including dental and vision
  • Hospitalization
  • Ambulatory patient services
  • Emergency care
  • Rehabilitative and habilitative services and devices
  • Mental health and substance abuse disorder care
  • Laboratory testing

While provider networks and premiums vary from one insurer to the next, you can be sure each of these types of services is covered when you purchase any plan on the exchange.

Enroll in Marketplace Coverage

Plan Tiers

Cost sharing and monthly rates vary between health plans, but each carrier on the exchange sells the same four “metallic” coverage tiers with the same actuarial values. Deductibles can vary, which will adjust premium costs also, but every insurer sells bronze, gold, silver and platinum plans, which represent the amount of coverage you receive after the deductible is met. Here’s a general breakdown of the coverage tiers:

 

Bronze Plan

Covers 60% of qualified medical care after deductible. You pay 40% of the total bill.

Higher cost sharing and lower premiums.

 

Silver Plan

Covers 70% of approved health services after deductible. You pay 30% coinsurance.

A good balance of cost sharing and premium cost for overall affordability.

 

Gold Plan

Plan pays 80% of covered care after deductible. Your share of costs is 20%.

Less cost sharing for a higher premium.

 

Platinum Plan

90% of medical expenses covered. You’re responsible for 10% of costs.

The least coinsurance for the highest premium.

 

For explanations of health insurance and ACA terms such as coinsurance, deductibles and actuarial value, please refer to our Glossary.

 

Additional Plans

On top of the comprehensive coverage offered in these four tiers, Maryland Health Connection also offers catastrophic plans and dental coverage. With more than 80 total plans to choose from, the marketplace is anything but limiting.

Catastrophic Plans

Designed for younger, healthier Marylanders who don’t use too much health care, these policies provide a few essentials while helping individuals avoid the penalty tax. Catastrophic plans cover 4 doctors office visits for a copay, emergency care subject to deductible, and free preventive care. There are three catastrophic policies to choose from on the exchange.

 

Participating Carriers

Individual coverage is sold by eight different Maryland health insurance companies on the marketplace. Your choice depends on what doctors and hospitals you’d like in your network, the most affordable rate provided, and the plan design that best fits your needs. Some insurers are smaller, regional companies, while others are large national brands. Regardless of size, they each meet the federal criteria for a qualified health plan. For help choosing a plan, call one of our licensed agents at 888 803 5917.

 

Visit Maryland Health Connection or contact us for more details on getting coverage in your area.

 

Compare Maryland Health Connection Plans

Use the tool below to compare rates and find out which health plans serve your county. You can also view an estimate of your subsidy applied to premium rates on the marketplace. To purchase a plan, call an agent at 888.803.5917.

 

*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.

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