The Maryland Health Insurance Plan (MHIP) is the state’s high-risk pool for individuals with pre-existing conditions, created by state legislature in 2002 for those who cannot obtain individual coverage. Whether you have been denied a health plan due to your condition, or have been unable to receive coverage for the services you need the most due to an exclusion, MHIP is available. Though MHIP typically costs more than a regular individual health insurance plan, premiums are capped at 150 percent of standard Maryland rates. This ensures that most people can still get coverage for a reasonable enough monthly premium.
When the Pre-Existing Condition Plan was enacted in other states in 2010 as a result of the Affordable Care Act, MHIP entered into contract with the U.S. Department of Health and Humans Services in order to operate Maryland’s PCIP, known as MHIP Federal. PCIP is a federal high-risk pool for U.S. citizens and legal residents who have pre-existing conditions and have been uninsured for at least six months. There are many ways to qualify for MHIP, and it offers similar benefits to a comprehensive individual health plan on the private market. For those who have no other coverage options, MHIP is a great solution.
Qualifying for MHIP
Marylanders who are eligible for MHIP must have lived in the state for at least six months and maintain your legal residence in Maryland. One of the following requirements must be met in order to be enrolled in MHIP:
- You have been denied coverage within the past six months because of your health.
- You have access to an individual health plan that either limits, restricts, or blocks coverage for your condition, or has benefits resembling MHIP but is very costly due to your condition.
- You are a childwith a medical condition, submitting an application through a parent or caretaker.
- You have one of the following medical conditions:
Those who are eligible for Medicaid, Medicare, or group coverage through an employer are unable to receive MHIP. There are exceptions with individuals who have lost their group coverage and have exhausted their COBRA benefits, as well as those who are at least 55 years old and have a pension from the Pension Benefit Guaranty Corporation, and are not eligible for Medicare. Residents may also qualify if their job has been affected by competition from international trade, or if they are switching from another state’s high-risk pool and you plan to relocate to Maryland.
Qualifying for MHIP Federal
Those who qualify for MHIP Federal (or PCIP) must be a current Maryland resident, a citizen of the United States or legal permanent resident, and have been uninsured for the six consecutive months before applying to MHIP. Also, you must either have one of the conditions listed above; have been denied coverage in the past six months due to your condition; have access to a health insurance policy that limits or eliminates coverage for your condition or has similar benefits to MHIP but is more expensive because of your health; or are a child who wants to apply through a parent or guardian.
Coverage and payments vary based on the plan in which you are enrolled. There are several different levels of coverage, depending on whether you have a PPO, HMO, or HDP plan. MHIP, MHIP+, and MHIP Federal have different plans available and each has its own coinsurance and deductible level. Regardless of the plan you are in, MHIP will cover not only services related to your medical condition, but pharmacy benefits, behavioral health, preventive care, inpatient and outpatient hospital services, and even wellness resources.
Below are the various plan types and their benefit summaries.
MHIP premiums depend on the oldest applicant’s age, their benefit option, and the coverage level. Those who qualify for coverage yet do not have proof of creditable insurance before enrolling in MHIP will be able to receive coverage instantly by participating in the Buy Down program. If they do not, there will be a six month waiting period for benefits to begin. Applicants who are pregnant of have proof of their recent health insurance are not subject to the waiting period.
MHIP Federal Premiums
MHIP Federal rates vary based on age and the plan in which you are enrolled. For members with a higher income, there is a high-deductible plan with a $1500 deductible. Rates cannot be higher than 100 percent of the commercial health insurance market for these plans. If you have a lower income and are eligible to choose one of the MHIP Federal+ options, you will pay a lesser premium than regular MHIP Federal members.
MHIP Federal Premiums
Qualifying Incomes for MHIP Federal+
MHIP Federal+ Premiums
Applying for MHIP
You may apply for MHIP by printing and filling out an Enrollment Form, after having reviewed the guide to understand the program. Once complete, send your application with copies of your residency and eligibility documentation for your eligibility category to:
Maryland Health Insurance Plan
Enrollment and Billing
10455 Mill Run Circle, RR-380
Owings Mills, MD 21117-9685
Application Information: 888-444-9016 or 443-438-0667
1. Maryland Health Insurance Plan. “Enrollment Guide” http://www.marylandhealthinsuranceplan.state.md.us/