With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Maryland, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Maryland
Maryland ranked 24th in United Health Foundation’s 2013 America’s Health Rankings.1 The state’s strengths include a low prevalence of smoking, a low percentage of children in poverty, and ready availability of primary care physicians and dentists. Maryland’s challenges include a high violent crime rate, a high prevalence of low birthweight and high infant mortality rate, and high levels of air pollution.
Maryland individual and family health insurance
On Oct. 1, 2013, the first Obamacare open-enrollment period began and Maryland launched its state-based health insurance exchange, Maryland Health Connection. Those who buy health insurance through Maryland’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Maryland’s individuals and families may also find qualified health plans in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit the Maryland Health Connection exchange to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 67,757 individuals in Maryland selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Maryland enrolled in a marketplace plan increased to 120,145 during the open enrollment period.3
|Maryland’s health insurance exchange:||marylandhealthconnection.gov|
|Maryland department of insurance:||mdinsurance.state.md.us|
Maryland small group health insurance plans
In Maryland, small businesses with 50 or fewer employees may purchase small group health insurance plans through the Maryland Health Connection exchange and in the private marketplace through websites such as such as HealthCare.com. Small businesses that use Maryland Health Connection and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
Maryland state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Maryland’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All sizes; law applies to employer group contracts, regardless of employer|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||102 percent|
|State legislation reference||Maryland Continuation of Coverage|
|More information||800-492-6116 – Maryland Insurance Administration|
|Additional notes||How long the employee and his or her spouse and dependent children must be covered before the qualifying event varies by qualifying event and insured party.|
Maryland high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Maryland expanded its Medicaid program in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Maryland’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Maryland Department of Health and Mental Hygiene|
|How to apply||marylandhealthconnection.gov|
|Open-enrollment period||Year-round in all states|
|Eligibility||Resident of Maryland, U.S. citizen, qualified non-citizens|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Maryland Children’s Health Program, the state’s health insurance program for low-income children:
|How to apply||marylandhealthconnection.gov/ mmcp.dhmh.maryland.gov/chp|
|Phone number||800-456-8900 / TTD for the Disabled 800-735-2258|
|Eligibility8||Children under age 19 who are not eligible for Medicaid, whose modified adjusted gross income is at or below 300 percent of the federal poverty level, and who are uninsured|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
5 U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. “Profile of Affordable Care Act Coverage Expansion Enrollment for Medicaid/CHIP and the Health Insurance Marketplace 10-1-2013 to 3-31-2014. Maryland.” April 2014. Retrieved from http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/pdf/MD.pdf.
4 State of Maryland. “Continuation of Benefits: Comparison of Maryland Continuation of Coverage and Federal COBRA Provisions.” N.D. Retrieved from https://www.mdinsurance.state.md.us/sa/docs/documents/insurer/bulletins/bulletinlh08-13continuationcoveragechart-attachment.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Maryland.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/maryland.html.
8 Maryland Department of Health and Mental Hygiene. “Maryland Children’s Health Prorgam.” N.D. Retrieved from https://mmcp.dhmh.maryland.gov/chp/SitePages/Home.aspx.