Maryland was a supporter of health care reform throughout its implementation, and organized a state-based health insurance exchange in order to integrate the law. Several parts of the law affected the individual health insurance market in Maryland from the beginning of health reform in 2010, including the removal of lifetime maximums and rescissions. The Affordable Care Act has also given young adults the ability to stay on their parents’ plan as a dependent until age 26. Many more laws, including those with perhaps the broadest impact, became effective in 2014 and later, with the individual and employer mandates as well as guaranteed issue health insurance and subsidized coverage. Since the ACA’s inception, there have been many changes made to Maryland health insurance and health care regulations. The ACA has made more preventive services mandatory and available for free through any health plan.
Health Reform in Maryland
Transitional Period: 2010-2013
These provisions took place from the time the ACA was signed into law until all insurance companies were required to guarantee issue of coverage. Insurance and health care providers must abide by these laws, and Maryland residents can benefit from what the law provides. Firstly, the ACA is responsible for eliminating the lifetime maximum, which means insurers cannot place a dollar limit on the amount of covered care you can receive in your lifetime. Insurance companies are also no longer permitted to rescind (or cancel) a policy without good reason, such as a policyholder lying on their application about not having a certain condition or committing insurance fraud. Before this law was in place, people’s benefits were often terminated due to becoming ill with cancer, which is now illegal.
Preventive care is a large component of the ACA. Maryland residents on any health insurance plan, whether individual or group, now have access to preventive services for no additional cost. More preventive care services were added to the Preventive Services Task Force’s list, including services for all age groups and at-risk populations, like children. Services include annual wellness exams, immunizations, mammograms, and cancer screenings based on age and gender-appropriate risk factors. Women also gained many preventive services for free as insured Maryland residents such as annual exams, birth control, breastfeeding support and supplies.
Children with pre-existing conditions also benefit greatly from the ACA, as no insurer could turn away individuals under age 19 beginning in 2010. This also includes young adults, as the law includes individuals up to age 19 with any pre-existing condition, whether diabetes or acne. Adults with pre-existing conditions could participate in the Pre-Existing Condition Insurance Plan if they were rejected for coverage before the laws changed in 2014. The PCIP was an innovation of the health care law providing coverage to sick individuals without insurance. Maryland also has a high-risk pool, the Maryland Health Insurance Plan, already established for such individuals to receive health insurance.
Full Implementation of Health Reform: 2014 and Later
The bulk of the ACA kicked in on January 1, 2014, including the individual mandate, which requires all Maryland residents to enroll in a health plan or pay a penalty on your annual income taxes. This does not mean everyone has to purchase individual health insurance, as Medicaid, Medicare, military plans, group coverage, and health insurance exchanges are also considered viable forms to avoid the penalty. The state offers subsidized coverage through Maryland Health Connection, which sells comprehensive plans including Essential Health Benefits (EHBs) to those who do not have access to any other coverage. The government provides tax credits or subsidies to assist with monthly premium costs if you earn between 133 and 400% of the poverty line.
Beginning in 2014, Maryland adults with pre-existing conditions can apply for coverage with any health insurer and not be turned away. Additionally, such individuals can only be rated up if they are a smoker or an older applicant. The community rating laws enable anyone to purchase coverage regardless of gender, health status, occupation or medical history, and only see a premium increase based on your area of residence, age group and tobacco use. Services cannot be intentionally omitted for certain health needs, and no more exclusion periods can be issued to hold back certain benefits. Also, there are no annual benefit maximums, as no insurer is able to place a dollar limit on the care received within a coverage year.
More medical services are also covered by certain health plans, as qualified health plans on and off the exchange cover ten categories of EHBs such as maternity and newborn care, prevention and wellness services, and prescription drugs. Mental health and substance abuse services, as well as pediatric care, hospitalization, emergency room visits, ambulatory services, and rehabilitative and habilitative services and supplies are also mandatory. Insurance companies selling plans off the exchange still sell a variety of products in addition to the benefit-rich Obamacare-compliant policies.
Maryland Medical Assistance, the Medicaid program, also expanded under health reform to insure a larger number of individuals and families. The income guideline has been raised to 133 percent of federal poverty level, therefore allowing adults with and without children to join the program. Prior to the health care law, low-income childless adults were unable to receive Medical Assistance in Maryland. If you earn just over 133 percent of poverty, you qualify for the largest subsidy amount on the state’s exchange, and should apply for individual coverage there.
Group coverage has also changed, as the employer mandate requires all large employers with 50 or more full-time workers to offer insurance. Effective in 2015, this provision of the ACA taxes employers who do not cover their full-time workers based on the number of employees they have and how much they earn. However, employers have a few options to remedy this situation. They can purchase a plan with a bare minimum of coverage, as the only requirement is preventive care; or they can provide a voucher for a plan on the exchange in the equivalent amount of what their highest cost group plan would be.
1. Maryland Health Care Reform. “Individuals and Families”. http://www.healthreform.maryland.gov/category/audiences/individuals-families/.