Medicare in Maryland

In this article...
  • Medicare offers health coverage options for retired adults. But there are many options to choose from. Start your research with this guide to Medicare in Maryland.

What Maryland Medicare Plans Are Available?

Medicare is a federal program that provides health insurance to eligible people in the United States. Marylanders aged 65 and over, or those diagnosed with a long-term disability, may be able to access the program. Medicare offers Original Medicare and Medicare Advantage plans, as well as options to help pay for medication and deductibles.

Original Medicare 

Original Medicare is the federal government’s health insurance plan. In 2020, there were 921,366 Marylanders enrolled in the program. Original Medicare is also known as Medicare Part A and Part B because it’s provided in two parts:

  • Part A health insurance covers inpatient care, such as hospital care, hospice services and short-term nursing facility care. It can also cover some home health care. 
  • Part B health insurance provides cover for medical check-ups, preventive services and medically necessary services and devices. It also covers some mental health care and medical transportation. 

Part A and Part B have separate premiums. Part A is based on how much you paid in Medicare taxes while working while Part B premiums are based on your current income. For both programs, you also have to pay deductibles and coinsurance when you use health services. When enrolled in Original Medicare you can see any provider who accepts Medicare payments. 

Medicare Advantage

Medicare Advantage (MA), also known as Medicare Part C, was introduced in 2006 to provide an alternative to the traditional system. If you have a MA plan, you aren’t covered by Original Medicare. Medicare Advantage plans are offered by private health insurance companies, and in 2020, there were 131,973 Marylanders enrolled in one.

By law, these plans must provide the same benefits as Medicare Part A and B. The advantage of these plans is that many provide extra coverage that’s not included in Original Medicare, such as dental care. There are four types of MA plans available to consumers:

  • Health Maintenance Organization (HMO) plans. Beneficiaries of these plans have a primary care physician who directs their care, and they must get treatment from in-network providers to receive the full benefits.
  • Preferred Provider Organizations (PPO) plans. Similar to HMO plans, PPO plans have a network of providers, but the rules are generally more flexible, and it can be easier to get specialist appointments or extra tests.
  • Private Fee-For-Service (PFFS) plans. These plans are designed to be flexible, with beneficiaries free to find their own providers. However, the policy only pays providers who accept the policy rates. 
  • Special Needs Plans (SNP). These plans are tailored to meet the needs of people with particular needs, such as those with diabetes or HIV. SNPs contract with providers who can best help those with the specific condition. 

Medicare Part D Prescription Drug Plan

Medicare Part D is an optional prescription drug coverage plan. It helps seniors pay for medications that have been prescribed by a health care professional, letting them maintain medication schedules. Part D plans are almost always offered by private insurance companies authorized to offer plans to Medicare beneficiaries. Some Medicare Advantage plans include prescription drugs as part of the regular plan, but if it doesn't, you can add a Medicare Part D plan separately. 

Medicare Supplement Insurance

Medicare Supplement Insurance, or Medigap, helps Marylanders on Original Medicare pay for the gaps in Medicare coverage, such as copays and deductibles. Some plans also cover Part B excess charges and part of the cost of emergency care when traveling out of the country. These plans are offered by authorized private insurers. 

Who Is Eligible for Maryland Medicare?

People generally become eligible for Medicare in Maryland when they turn 65. It’s also available for people with certain disabilities and anyone with end-stage renal disease. 

Automatic Enrollment

People who have received retirement benefits from Social Security or the Railroad Retirement Board for at least four months before they turn 65 are automatically enrolled in Original Medicare when they turn 65. This coverage begins the first day of the month you turn 65. You can change to a Medicare Advantage plan during a relevant enrollment period. 

Enrollment Periods

Beneficiaries can take advantage of certain enrollment periods to sign up for or change their Medicare coverage. 

The initial enrollment period lasts for seven months. It begins three months prior to your 65th birthday and includes your birthday month and the three months following your birthday. You may face a lifetime late penalty if you don’t sign up during this period.

The general Medicare enrollment period runs from January 1 to March 31 each year. People who miss their initial enrollment periods can sign up then. This coverage starts on July 1 of that year.

Special enrollment periods let you enroll or make changes to your Medicare when certain events happen. For example, people moving back to the United States after living overseas or those who left a job that provided medical insurance can enroll during special enrollment periods. Rules, such as how long you have to make changes, are different for each circumstance. 

The open enrollment period runs from October 15 to December 7 each year. At this time, you can switch between Medicare Advantage and Original Medicare. If you have a Medicare Advantage plan, you can also change plans to one that better suits your needs. Beneficiaries who haven’t signed up for a Part D Prescription Drug Plan may also enroll for one at this time. 

There is a second Medicare Advantage open enrollment period from January 1 to March 31 each year when people enrolled in Medicare Advantage can switch to a different plan. Alternatively, they can switch to Original Medicare and join a Medicare drug plan.

How Do I Enroll in Medicare in Maryland?

Applications for Medicare go through the Social Security Administration (SSA). Those eligible for automatic enrollment don’t need to do anything. Others can enroll in the program using the SSA’s simple online form. Alternatively, you can visit your local Social Security office or call 1-800-772-1213.

Contact Information for Maryland Medicare, Medicaid and Insurance Help

If you have further questions about Medicare and other health insurance options in Maryland, these agencies can assist:

  • HelpAdvisor provides information about health insurance options for seniors in Maryland, including Medicare, Medicare Advantage and Medicaid.
  • The State Health Insurance Assistance Program (SHIP) has staff and volunteers available throughout Maryland to help seniors navigate their health insurance options. 
  • Maryland’s Seniors Prescription Drug Assistance Program (SPDAP) is a subsidy program that helps eligible seniors pay the premium for their Medicare prescription drug plan. 

The Maryland Insurance Administration has information about insurance available in Maryland and can assist people with complaints about insurance companies.

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