Maryland Health Connection

Written by Erica Manfred and Kristeen Cherney | Published on August 24, 2015
Medically Reviewed by George Krucik, MD, MBA on August 24, 2015

What Is Maryland’s Health Insurance Exchange?

When the Affordable Care Act (ACA) was passed in 2010, states built health insurance marketplaces called exchanges. Maryland Health Connection is Maryland’s exchange. It opened in October 2013.

Learn more about Maryland Health Connection and how you can sign up for the right coverage you need.

Participating Companies

Maryland Health Connection offers more than 80 plans from the following carriers:

  • CareFirst
  • Delta Dental
  • DentaQuest
  • Dominion Dental
  • Evergreen
  • Kaiser Permanente
  • United Concordia (dental care)
  • United Healthcare

What’s Covered?

All plans must offer the following essential services:

  • doctor visits
  • emergency care
  • hospitalization
  • preventive care
  • chronic disease management
  • maternity care
  • newborn care
  • pediatric services
  • mental healthcare
  • rehabilitative care (includes speech, occupational, or physical therapy)
  • lab services, such as blood tests
  • prescriptions
  • substance abuse rehab services

Plans

There are four basic plans available through the exchange. These have varying coverage levels:

  • bronze (60 percent of expenses paid out)
  • silver (70 percent)
  • gold (80 percent)
  • platinum (90 percent)

Lower percentage plans will have lower premiums. The downside is higher out-of-pocket costs. A catastrophic plan, with a high deductible, is available for those under the age of 30.

Costs

Many people will want to know how much of a subsidy they qualify for, but the real question is, how much will you pay? Your ultimate decision should be based on your income versus how often you might need to use the coverage.

For a 50-year-old non-smoker, the cost of a silver plan 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.

The challenge is to compare the costs of each plan and decide which offers the best value. The Kaiser Family Foundation provides estimates of the rates in Maryland and information on tax credits.

Credits and Subsidies

Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:

  • Medicaid coverage
  • tax credits
  • subsidies

Adults living at or below 133 percent of the federal poverty level (FPL) may qualify for Medicaid in Maryland. Pregnant women living at or below 259 percent of the FPL may also qualify. The FPL for 2015, according to the Health Insurance Marketplace, is:

  • $11,770 in individual annual wages
  • $15,930 for those in families of two
  • $24,250 for a family of four
  • $40,890 for a family of eight

As of 2015, the maximum annual out-of-pocket cost is $6,350 for individuals and $12,700 for families. This can help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.

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 the FPL), the most you’ll have to pay for health insurance is 9 percent of your wages, which amounts to $2,926 a year, or $244 a month.

Tax credits are based on the silver plan. This helps you determine any extra out-of-pocket costs if you elect a higher or lower plan. The ACA was designed so that the silver plan is more affordable for individuals buying their own insurance. This is regardless of how expensive the healthcare rates are where you live.

Signing Up

To learn more about the Maryland Health Connection, please visit www.marylandhealthconnection.gov. You can also call 1-855-642-8572.

Open enrollment starts November 1, 2015, and ends January 31, 2016. Enrollment assistance is available through:

  • local health departments
  • departments of social services                 
  • the call center
  • local consumer assistance groups (“connector entities”)

Start researching plans before the open enrollment period to ensure you get the best healthcare for you and your family.

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