What's Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Maryland, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital
- Emergency services
- Hospital stays, including weight loss surgery
- Pregnancy and baby care, including infertility treatments such as in-vitro fertilization
- Mental health and substance abuse services, including behavioral health treatment. This includes inpatient substance abuse services for most people.
- Prescription drugs, including generic and brand-name drugs
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions. This includes acupuncture and nutrition counseling for chronic illness.
- Services for children, including dental and eye care. Treatment for childhood obesity is also covered.
Some services not included: Marriage counseling, long-term care, and weight loss programs.
Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.
Financial Aid and Medicaid
You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:
Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.
You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.
Medicaid Expansion: Some states, including Maryland, expanded Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,500 for a family of four.
Maryland Children’s Health Program (MCHP): Low-income children and pregnant women may qualify for the Maryland Children’s Health Program.
Check with Maryland Health Connection to see if you are eligible for these programs.
Trained navigators and assisters can teach you about the Marketplace and guide you through enrollment. They are supposed to be fair and impartial and cannot take money from insurance companies. Trained insurance agents also can help you with your choices. Here are several ways you can get help with your insurance decisions:
- Call Center: Call 855-642-8572 from 8 a.m. to 8 p.m. Monday to Friday, from 8 a.m. to 6 p.m. Saturday, and from 8 a.m. to 2 p.m. Sunday for information about your insurance options.
Web Site: Find information about Maryland's Marketplace at Maryland Health Connection. You can create an account, find information about different plans, and buy insurance.
Other Resources: Go to the Consumer Assistance site to find the navigators or assisters in your area. The 6 community organizations selected as Connector organizations are:
- Capital Region: Montgomery County Department of Health and Human Services
- Central Region: Health Care Access Maryland
- Lower Eastern Shore Region: Worchester County Health Department
- Southern Region: Calvert Health Care Solutions
- Upper Eastern Shore Region: Seedco Inc.
- Western Region: Healthy Howard Inc.