Overview of Maryland’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. Maryland Health Connection is Maryland’s exchange, open since October 2013. This marketplace offers the ability to look at your different options and learn whether you’re eligible for Medicaid or other financial assistance to reduce the cost of your insurance. Assistance is available through local health departments, departments of social services, a call center, and local consumer assistance groups called “connector entities.”
The Maryland Health Connection offer more than 80 plans from the following carriers: CareFirst, Evergreen, Kaiser Permanente, and UnitedHealthcare (All Savers) for medical care; and CareFirst, Delta Dental, DentaQuest, Dominion Dental, and United Concordia for dental care.
After October 1, 2013, you can compare plans and select the best fit by calling the Consumer Support Center at 1-855-642-8572, by visiting MarylandHealthConnection.gov, or by contacting a navigator, assister, or insurance producer (agent/broker). Comparison tools are also be available on the website.
Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
Per the Affordable Care Act, all plans have to offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There are four basic plans available, all with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Adults living at or below 133 percent of the federal poverty level (also known as FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 259 perfect of the FPL, can qualify for Medicaid in Maryland, based on eligibility requirements that take effect January 1, 2014.
Additional federal financial protection provisions will start in 2015. Those protections include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to the Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
For a 50-year-old non-smoker, the cost of a Silver Plan in Maryland ranges from $275 to $470 monthly. For a 25-year-old non-smoker, the cost of a Bronze Plan ranges from $114 to $247 monthly
See page 14 of this PDF document from the Kaiser Family Foundation for an estimate of the Silver and Bronze rates in Maryland, as well as the expected tax credits, for a single 25-year-old making $25,000, a family of four making $60,000, and a couple aged 60 making $30,000.
Individuals and families with incomes between 133 percent and 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of poverty level), the most you’ll have to pay for health insurance is nine percent of your wages, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the cost of Bronze, Silver, Gold, and Platinum and decide which plan offers the best value for you. Here is a calculator offered by the Kaiser Family Foundation that provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Information on Subsidies
Income eligibility information for Medicaid and reduced premiums is currently available here.
To learn more about the Maryland Health Connection, please visit http://www.marylandhealthconnection.gov/ or call 1-855-642-8572.