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Maryland Health Insurance

Maryland Medical Insurance Overview

The state of the health of Maryland’s residents is generally good, but it does have its strong points and weaknesses, like any other state.  The state is ranked higher than a lot of other states with regard to health factors, along with the population of uninsured people being on the low side.  With the healthcare legislation in place under the Affordable Care Act, it is hoped that Maryland’s residents will see a great improvement in its overall health and healthcare.

With the full realization of the benefits under the ACA, states all across the country will see the landscape of health and healthcare make a change for the better.  By 2020, it is believed that 30 million more people in the country will be able to get health benefits and enjoy greater access to necessary medical services that are associated with having great health insurance coverage.

Maryland’s Health Care Issues

Maryland is in 18th place when its overall health is compared to the health of the citizens of the United States as a whole.  The United Health Foundation offers a variety of data on each state, with Maryland seeing an increase in its rank since 2011.  Below is some of the information provided by the website with reference to the state’s strengths and weaknesses:

Among the weaknesses in the state of Maryland are its high levels of violent crime and high levels of air pollution.  Its strengths include its low percentage of smokers living in the state, its low percentage of children who live in poverty and its high availability of primary care physicians.

Understanding Maryland’s Uninsured Population

Even though many residents in Maryland enjoy health benefits, there is still a great deal of people living in the state without health benefits.  A report on the matter revealed in 2012 that people were unable to obtain insurance coverage because of the rising costs of purchasing a policy.  Insurance rate increases prevented employers and employees from enjoying health benefits.  Many companies in Maryland could not afford to offer health insurance coverage and employees were not able to pay the costs of premiums without help.

In 2014, 6% of residents in Maryland were uninsured, according to the Henry J. Kaiser Family Foundation.  This percentage has dropped from 11% in 2008, but it still leaves a lot of residents who are uninsured.

Below is some information regarding uninsured people living in Maryland:

  • Despite being hit hard by economic problems, many companies operating in Maryland offer benefits to employees.  60% of employers offer health benefits to their workers.
  • Poor adults in Maryland make up 38% of the uninsured population of the state.
  • 23% of poor children and 19% of low income children do not have health insurance in the state of Maryland.

Group Health Plans

If you work in the state of Maryland, there is a good chance that you have health insurance through your employer.  Sixty percent of companies in the state offer some kind of health benefits package to its workers.  If you are looking to get benefits in Maryland, you should first start with your job and ask if they offer benefits.  Talk with someone in Human Resources for information on the available plans and what each one entails.  Getting insurance coverage is a big decision, so you should put a lot of thought into it before you sign any paperwork.  Ninety-seven percent of larger companies operating in Maryland offer insurance benefits, so you are almost guaranteed insurance coverage if you are employed with one of those corporations.

Private health insurance companies are under the regulations of the Maryland Insurance Administration.  For those seeking insurance in this state, it will prove beneficial if you become familiar with what mandates have been set forth by the MIA.  In addition, you can also use the website to obtain information and file a complaint against an insurance company.

Signing Up

Signing up for health benefits through your employer usually calls for you to wait until a designated enrollment period, but this is sometimes waived for newly hired employees.  Joining your employer’s group plan consists of a financial commitment to pay the monthly premiums, so this is a choice that should not be taken lightly.  Monthly premiums are usually removed from your paychecks every time you get paid, so the insurance company gets paid before you do.  There are typically a few options available to employees under a group plan, each with their own levels of coverage, deductibles and premium costs.  Before you make the decision to join, do the appropriate amount of research and consider the following factors:
Do you have dependents or a spouse to cover under your insurance plan?  You should talk about this early on in the enrollment process so you can get them covered, if needed.
Do you have pre-existing medical conditions?  Be sure that the plan you choose offers enough coverage to take care of any medical issues you have.
Does the policy offer enough coverage for you and/or your family members?  You should consider all of the options provided so that you can find the best fitting plan for your situation.

Pre-Existing Condition Exclusion Periods

A pre-existing condition is a medical problem that you have had prior to enrolling in your health insurance plan.  Under HIPAA, you cannot be excluded from coverage, but you can be subject to waiting an exclusionary period of time before your benefits become active.

Keep the following points in mind if you are suffering from a pre-existing condition:

  • The exclusion period is 12 months
  • The maximum amount of time for the look back period is 6 months
  • Dependents aged 19 and younger cannot be required to wait an exclusion period
  • Exclusion periods and affiliation periods happen at the same time
  • A genetic predisposition to illness cannot be treated as a pre-existing condition without a diagnosis.

Affiliation or Waiting Periods

Affiliation periods are something that every enrollee has to wait through for insurance benefits to become available.  This period of time is two months long, but can be extended to three months in the event that you enroll late for coverage

Individual Health Plans

If you don’t have a job, are self-employed or work for a place that doesn’t offer health benefits, you may have to resort to obtaining an individual insurance plan.  Individual policies in the state of Maryland offer coverage to 6 percent of the population of residents.  Eligibility is subject to medical underwriting on this particular plan type and can limit your coverage based on any number of factors.  Costs associated with individual policies vary, but depend on facts like health status, location, age and gender.  The Foundation for Health Coverage Education claims that a healthy young person living in Maryland can get coverage for as low as $82 per month, but the deductible could be quite high.

Continuation Coverage

In the event that you have lost your employment status or have gotten divorced and lost your insurance benefits, you may be able to obtain continuation coverage under COBRA.  The Consolidated Omnibus Budget Reconciliation Act provides coverage for up to 18 months following your loss of insurance benefits, but only in the case of the original company who offered the policy having over 20 workers.  Under HIPAA, you can also obtain continuation coverage if you have exhausted your benefits under COBRA.  Conversion plans are also available if you want to continue the same benefits package under the same insurance provider, but want to convert your plan from group insurance to an individual policy.

Maryland Health Benefit Exchange

After passing Senate Bill 182/House Bill 166, Maryland established its own health benefits marketplace.  Using the Maryland Health Connection website, residents of the state can learn about what options are available, compare them all and obtain insurance coverage.

Under the Patient Protection and Affordable Care Act, each state had to have an active benefits exchange up and running by 2014.

Maryland State Insurance Programs

For low income earners and others who qualify based on health status, age or gender, there are a variety of programs that are state-funded for residents to use.

Medicaid

Medicaid is available on a guaranteed basis to residents who earn an income of 185% or under the Federal Poverty Level.  There are different regulations for those who are blind, disabled or elderly.  Participants in the Medicaid program may be able to receive retroactive coverage for medical services rendered in the three months prior to the enrollment process.

Medical Assistance for Families

Free prescription drugs, emergency room visits and doctor’s visits are available to low income families under this program.  Income requirements under this program allow for the participants to earn 116% of the Federal Poverty Level or under.

Maryland Children’s Health Program (MCHP) and MCHP Premium

These programs cover children and pregnant women who earn income levels between 200 and 300% of the Federal Poverty Level.  Premiums are said to be modest and services offered include dental, shots, vision and medications.  In order to qualify, you must be a Maryland resident who has no insurance coverage.

Women, Infants, and Children (WIC)

WIC is a program that works to improve the health of low-income women, their infants and children five and under.  Nutritional assistance is provided through WIC and there are immunization benefits provided under this program.

Breast & Cervical Cancer Screening Program

Women who need monetary help to obtain screening services for cancer can use this program to obtain breast and cervical cancer screenings.  Women must be between 40 and 64 years of age and earn at or below 250% of the Federal Poverty Level.

Breast & Cervical Cancer Diagnosis & Treatment Program

Services provided under this program include mammograms, breast ultrasounds, colonoscopies and biopsies.  Women can qualify if they earn an income of 250% or below the Federal Poverty Level.

Medicare and the Medicare Prescription Drug Program

Medicare is a program dedicated to covering seniors, disabled persons and those suffering from renal disease.  Seniors must be 65 or older to qualify and need to have worked in a Medicare-covered job for at least ten years.

VA Medical Benefits Package

The VA Medical Benefits Package is strictly for veterans who have served 24 consecutive months in the military and have received an honorable discharge.

Partnership for Prescription Assistance

The Partnership for Prescription Assistance has connections with up to 475 programs that provide assistance to financially strapped people in need of help paying for their prescription drugs.

Vaccines for Children

The Vaccines for Children program is an immunization program covering children whose families are unable to pay for their shots.   Eligible children receive vaccines as recommended by the Advisory Committee on Immunization Practices.

AIDS Insurance Assistance Program

For people who are HIV positive, coverage is available through the AIDS Insurance Assistance Program.  Individuals with HIV can obtain benefits through this program without regard for whether or not they already have insurance coverage.

Primary Adult Care Program (PAC)

This program is available to people 19 years of age and older who qualify based on income and don’t receive coverage through Medicare.  Services offered include free outpatient visits, cheap or free prescriptions and coverage for emergency situations.

National Association of Mental Illness (NAMI) Helpline

The NAMI Helpline is a nationwide organization that offers a multitude of resources and treatment options to those suffering from mental illness.  The helpline is staffed by volunteers who provide information and guidance to sufferers.

The Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act was enacted in 1996 to govern how medical professionals treated your private medical records.  Now, HIPAA also regulates private insurance companies.  They provide limitations on the denial of medical benefits under a group plan to those suffering from pre-existing conditions, regulate the amounts of time that are designated as exclusion and affiliation periods and how much consumers pay for premiums.

Despite all of the work HIPAA has done to protect consumers, it still has not made it mandatory for companies to offer health benefits to their employees.

Along with restrictions on insurance companies, HIPAA also allows for people to obtain COBRA coverage after they’ve lost insurance coverage. Following that, consumers can use HIPAA to obtain continuation coverage.

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