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FAQs

Frequently Asked Questions

Get answers to your health coverage questions.

General

Our Consumer Support Center provides over-the-phone support with enrollment questions and help applying. The call center offers assistance in more than 200 languages, as well as TTY services for the deaf and hard of hearing.

Call toll-free 1-855-642-8572 (TTY: 1-855-642-8573).

Hours are Mondays to Fridays 8 a.m. - 6 p.m.

Our highest call volume is on Monday, so you will wait longer to reach a consumer service representative. If your reason for calling can be addressed by us later in the week, please call back Tuesday through Friday during business hours 8 a.m.-6 p.m. to shorten your wait time.

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Under the Affordable Care Act, the individual shared responsibility provision calls for each individual to have minimum essential health coverage (known as “minimum essential coverage”) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.

To be considered enrolled in “health coverage” under the Affordable Care Act, the individual must be enrolled in minimum essential coverage, which includes Medicaid, Maryland Children’s Health Program (MCHP), MCHP Premium, employer-sponsored coverage, Medicare, a health plan through Maryland Health Connection or a health plan through the individual or small group markets.

Depending on your income, you may qualify for a premium tax credit and cost-sharing reduction to make coverage more affordable. You may also qualify for Medicaid, MCHP, or MCHP Premium.

Learn more about the tax penalty, exemptions and what qualifies as minimum essential coverage.

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Maryland Health Connection is Maryland’s official health insurance marketplace. It offers Marylanders a range of health coverage options from health insurance carriers and public health care programs. You can get the coverage you need online, over the phone or in person.

Maryland Health Connection is also the only place in Maryland where individuals, families, and small businesses can get financial help with their health coverage costs, if they qualify.

Maryland Health Connection was established to meet the requirements of the federal Health Care Reform law (or Affordable Care Act), which gave states the opportunity to either establish their own “health insurance exchange” (or marketplace) or allow the Federal government to operate an exchange on behalf of their residents.

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Maryland Health Connection is open to all legal residents of Maryland. In general, to obtain health coverage through Maryland Health Connection, you must live in Maryland and be a U.S. citizen or be lawfully present. To enroll in a QHP, you cannot currently be incarcerated, except if you are incarcerated pending disposition.

Maryland Health Connection is for you if:

  • You need health coverage
  • You need health coverage and you’re interested in finding out whether you are eligible for help with paying for your coverage through Medicaid, Maryland Children’s Health Program or through a QHP
  • Your employer doesn’t insure you or doesn’t offer affordable coverage. Employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.69% of annual household income.
  • The coverage offered by your employer doesn’t meet some basic standards, known as providing “minimum value.” Employer coverage provides “minimum value” if it covers 60 percent of health care costs on average. Your employer should be able to tell you if your plan meets this standard.
  • You’re self-employed
  • You’ve been denied insurance due to a pre-existing condition
  • You’re insured but looking for cost savings
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A qualified health plan or “Marketplace plan” is a health plan that has been certified by Maryland Health Connection to meet certain standards. All of our qualified health plans qualify as minimum essential coverage. So, if you buy one, you will not have to worry about a penalty for not having insurance when you file your taxes. And, all of our qualified health plans cover essential health benefits and meet our other standards.

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The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act is called “minimum essential coverage.” If you do not and you are not exempt from the requirement to have coverage, you will be expected to pay a penalty when you file your taxes.

The health coverage below is considered “minimum essential coverage.” If you are covered by any of the following throughout the year, you are all set and will not have to pay a tax penalty:

  • Any plan you get through Maryland Health Connection or any individual insurance plan you already have that is not through Maryland Health Connection
  • Any employer plan that qualifies as minimum essential coverage. Nearly all employer plans meet this standard, including COBRA and retiree plans
  • Medicare (Part A)
  • Medicaid
  • MCHP or MCHP Premium
  • TRICARE
  • Most Veterans Affairs Health Programs
  • Peace Corps Volunteer Plans
  • Other plans may also qualify. Call 1-855-642-8572 (TTY 1-855-642-8573) if you’re not sure.
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Medicaid is a joint federal-state program that provides health coverage, long term care, and supplemental assistance with Medicare costs to low-income children, adults, parents, caretaker relatives, adults without dependent children, pregnant women, and the aged, blind, and disabled. In Maryland, Medicaid (also called Medical Assistance or “MA”) is administered by the Maryland Department of Health.

The Maryland Children's Health Program (MCHP) provides access to health insurance coverage for higher income uninsured children up to age 19, under 200% FPL through the Maryland Managed Care Program, HealthChoice. MCHP does not require the payment of a premium.

MCHP Premium is low-cost health insurance coverage for higher-income children up to age 19 between 200% FPL and 300% FPL. MCHP Premium provides access to health insurance coverage for eligible uninsured children through the Maryland Managed Care Program, HealthChoice, for a modest monthly premium.

You may make an MCHP Premium payment online at http://dhmh.maryland.gov/payments.

The premium amount charged for MCHP Premium is assessed per family, not per child. The 2017 premium amounts are:

  • Premium for families between 200-250% FPL: $54 per month
  • Premium for families between 250-300% FPL: $67 per month
  • American Indians do not have to pay a monthly premium to enroll in MCHP Premium.
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The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through Maryland Health Connection. If your income is 400% of the federal poverty level or less, you may qualify for a premium tax credit.

Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premium each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.

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You may qualify for savings on out-of-pocket costs known a “cost-sharing reduction” if your income is 250% of the federal poverty level or less. If you are an American Indian or Alaska Native, you may qualify for a cost-reduction if your income is 300% of the federal poverty or less. Additionally, if you are an American Indian or Alaska Native, regardless of income, you won’t have any out-of-pocket costs for items or services provided by the Indian Health Service, tribal programs, or urban Indian programs (known as I/T/Us), including Contract Health Services.

A cost sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care.

In addition to meeting the household size and income requirements, you must buy a plan in the Silver category in order to receive a cost-sharing reduction.

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The coverage offered through Maryland Health Connection includes qualified health plans from name-brand insurance companies. Individuals eligible for Medicaid, MCHP, or MCHP Premium can select from several managed care organizations (MCOs) that participate in HealthChoice, the State’s Managed Care Program.

Plans offered by insurance companies through Maryland Health Connection have competitive pricing and benefits. Qualified health plans cover at least 60% of your annual medical costs. Some plans will cover 70%, 80% or 90% of your annual medical costs. In addition, all qualified health plans offered through Maryland Health Connection qualify as “minimum essential coverage”, provide a common set of “Essential Health Benefits” as required under the Affordable Care Act, and meet standards for quality and value set by the State.

Medicaid, MCHP, and MCHP Premium provide health coverage at low-or no-cost to eligible individuals.

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The annual open enrollment period for 2018 health plans is November 1 to December 15, 2017. Coverage starts January 1, 2018.

However, you can enroll in health coverage any time of year if you qualify for Medicaid, the Maryland Children's Health Program (MCHP) or MCHP Premium, or if you’ve recently experienced certain qualifying life events, such as having a baby or losing other health coverage.

Learn more here about whether you may qualify and how to enroll.

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The annual open enrollment period is November 1 to December 15, 2017 for 2018 health or dental plans. Coverage starts January 1, 2018.

However, you may enroll in health coverage year-round if you qualify for Medicaid, the Maryland Children's Health Program (MCHP) or MCHP Premium. Look up your income and household size to see if you may qualify.

You also may be able to buy a health plan outside of open enrollment if you’ve recently experienced a major life event or special circumstances like having a baby or losing other health coverage. Learn more here about whether you may qualify to buy a plan and how to enroll.

In most cases you have 60 days from the date of the qualifying event to enroll in a health insurance plan, change your plan (either metal tier, insurance company, or both), or add a newly eligible beneficiary to your current plan. It is important to report the qualifying event early so that you’ll have as much time as possible to enroll.

If you choose to enroll in a new plan through a special enrollment period, please note that you will not be able to carry over any expenses that may have gone toward your deductible or out-of-pocket maximum in your previous plan.

If you think you may qualify for a special enrollment period, you can update your application at MarylandHealthConnection.gov using the "Change My Information" button in your account, or call our Consumer Support Center at 1-855-642-8572 (TTY: 1-855-642-8573). You should try to call us within 30 days of the event. A representative will ask you for information so we can figure out if you qualify for a special enrollment period. If you do, the representative will help you enroll in coverage.

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You can purchase a plan directly from an insurance company, but you will not be eligible for any financial assistance. Financial assistance (including tax credits and cost sharing) is available only through Maryland Health Connection.

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Using Our Online Application

It’s important to know that if you are enrolled in a qualified health plan, the primary applicant when you applied (the plan subscriber) is the contract holder with the insurance company. For this reason, to change the primary applicant you will need to disenroll the entire household from coverage and then re-enroll with a different primary applicant.

You should note when changing policies that insurance companies currently do not transfer accumulators such as deductibles and copays from one policy to the next.

Follow these steps below carefully to avoid a gap in coverage:
Step 1: At least 10 days before the end of the month, disenroll the entire household from coverage (effective the last day of the month) by logging into your account at MarylandHealthConnection.gov and using the "End My Current Coverage" Quick Link. See our quick guide (PDF).

Step 2: Wait 5 days, and then create a new account through MarylandHealthConnection.gov. In this new account, complete an application for coverage with a new primary applicant and any other remaining household members (which may include the previous primary applicant).

Under the Special Enrollment questions, choose loss of coverage. The new plan will be effective the first day of the following month.

Remember, when choosing a new primary applicant, he or she does not need to be applying for coverage, but must be at least 18 years old. If the primary applicant is not seeking coverage, the second person listed in the household on the application will be considered the primary subscriber by the insurance company.

Learn more here about who in the application may be the primary applicant.

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In most cases, when you apply for coverage, the account holder (who defaults to the primary applicant) should be the household member you want as the contract holder with your insurance company.

Once you enroll in a plan, the primary applicant cannot easily be changed.

Some factors to consider when choosing the primary applicant include:

  1. The primary applicant does not need to be applying for coverage, but must be at least 18 years old. If the primary applicant is not seeking coverage, the second person listed in the household on the application will be considered the primary subscriber by the insurance company.
  2. If you expect one member of your household to end their coverage within the year (such as becoming eligible for Medicare, or enrolling through an employer), make another adult the primary applicant.
  3. If your household has mixed immigration status, make the adult who is a U.S. citizen or lawfully present the primary applicant, even if that person is not seeking coverage.
  4. If you are a married couple, both citizens or lawfully present, and seeking coverage for just one of you, make the person seeking coverage the primary applicant.
  5. If you are seeking coverage only for a dependent child under 17, an adult must be listed as primary, even if the adult is not seeking coverage. If you have more than one dependent (for example, you are a single parent seeking coverage for each of your 3 children but not yourself), complete a separate application for each child.

If you need to change the primary applicant, you will need to disenroll the entire household from coverage and then re-enroll with a different primary applicant. Follow these steps carefully to avoid a gap in coverage.

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If you have been denied coverage due to a false incarceration claim, please call our consumer support center at 1-855-642-8572.

You may provide ANY of the following documentation to prove that you are no longer, or have never been incarcerated:

  • Official release papers from institution
  • Document(s) showing active employment or evidence that you live in the community, like a pay stub or utility bill from the last 60 days, or a current lease agreement.
  • A signed affidavit (PDF) saying that you live in the community

You may mail this documentation to the following address:
Maryland Health Connection
P.O. Box 857
Lanham, MD 20703

Or you may bring your documentation to your local Health Department, local Department of Social Services or local Connector Entity. You can find their information here.

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Recommended browsers: MarylandHealthConnection.gov supports a variety of common browsers. We encourage you to complete your application in Chrome or Internet Explorer 9 or 10.

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The online application is available from 7 a.m. to 11 p.m. daily.

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When you create a new application, be sure to complete the “Build Your Household” section. If you have not completed this section, your application will not be saved. As you complete subsequent sections of the application, each section will be saved once you click “Confirm” at the end of the section. Partially completed sections will not be saved.

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If you experience the message “Sorry, we are unable to verify your identity at this time,” it means the federal data services that we use are not available.

You should consider these options:

• Try back at a later time
• Call us at 855-642-8572 (TTY 855-642-8573) and complete your application over the phone
• Apply in person through a local navigator or authorized insurance broker.

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If your account’s “My Inbox” indicates you need to provide verification of your information (such as income, identity or citizenship), you will see a link to submit your document by uploading it to your account.

You can log into your MarylandHealthConnection.gov account from your desktop, or download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device.

The system will only allow you to upload one verification document per additional verification item. Before uploading a verification document, follow these steps:

  • If several sources of verification information are required for one verification item, scan all of them and combine them into a single Word document. For example, if you must submit documentation about your income and you have paystubs from multiple jobs, you should combine all of your income documents into one file and submit them as a single file.
  • Save the document as a .pdf or .bmp
  • Ensure that the document size is 2 MB or less

If you are having issues combining your information into a single verification document, mail the documents to Maryland Health Connection, P.O. Box 857 Lanham, MD 20703.

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No, the system is not designed to work with multiple tabs or windows open at the same time. When you start your browser application, make sure only one window is open at a time. The system also works best when you delete cookies and temporary Internet files when you log out.

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The online application is available in Spanish. However, please note that some questions from our Federal Partners are not translated. Please visit our Find Help page if you need assistance applying in Spanish.

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Please note that details for each plan, the Summary of Benefits of Coverage, are available only in English at this time. If you need help in another language understanding a plan, please visit our Find Help page for assistance by phone or in person.

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When you apply for coverage, you’ll need to provide some information about yourself and each member of your household who is enrolling:

  • Birthdates
  • Social Security Numbers (or document numbers for legal immigrants)
  • Citizenship or immigration status
  • Tax returns for previous years
  • Employer and income info (pay stubs, W-2 forms)
  • Policy numbers for any current health insurance and information about employer-sponsored coverage you or someone in your household is eligible for.
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If you see a message stating we cannot electronically verify your identity, here’s what to do so you can move on with your application:

  1. Write down the reference code on the message.
  2. Call the Experian service using the phone number in the message. You will be asked a series of questions to which only you know the answers. If the agent is able to verify your identity, they will unlock your application and you may proceed with the application.

OR if you do not wish to call the service above, or if the Experian agent cannot verify your identity by phone, our representatives can verify your identity in person. Please note our consumer support center is unable to verify identity by phone.

Bring a government-issued ID such as one of those below to a local health department or connector entity office:

  • Driver's license issued by a State or Territory
  • Clinic, doctor, hospital, or school record
  • Finding of identity from a Federal or State governmental agency
  • Finding of identity from an Express Lane agency
  • Identification card or official document issued by federal, state, or local government
  • Military dependent's identification card
  • Native American tribal documents
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If you encounter an error during the application process, please try logging out of your account and log back in prior to calling the consumer support center.

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Enrollment and Special Circumstances

Our Consumer Support Center provides over-the-phone support with enrollment questions and help applying. The call center offers assistance in more than 200 languages, as well as TTY services for the deaf and hard of hearing.

Call toll-free 1-855-642-8572 (TTY: 1-855-642-8573).

Hours are Mondays to Fridays 8 a.m. - 6 p.m.

Our highest call volume is on Monday, so you will wait longer to reach a consumer service representative. If your reason for calling can be addressed by us later in the week, please call back Tuesday through Friday during business hours 8 a.m.-6 p.m. to shorten your wait time.

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The annual open enrollment period for 2018 health plans is November 1 to December 15, 2017. Coverage starts January 1, 2018.

However, you can enroll in health coverage any time of year if you qualify for Medicaid, the Maryland Children's Health Program (MCHP) or MCHP Premium, or if you’ve recently experienced certain qualifying life events, such as having a baby or losing other health coverage.

Learn more here about whether you may qualify and how to enroll.

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Individuals can apply for Medicaid at any time. Medicaid is not subject to an open enrollment period.

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The annual open enrollment period is November 1 to December 15, 2017 for 2018 health or dental plans. Coverage starts January 1, 2018.

However, you may enroll in health coverage year-round if you qualify for Medicaid, the Maryland Children's Health Program (MCHP) or MCHP Premium. Look up your income and household size to see if you may qualify.

You also may be able to buy a health plan outside of open enrollment if you’ve recently experienced a major life event or special circumstances like having a baby or losing other health coverage. Learn more here about whether you may qualify to buy a plan and how to enroll.

In most cases you have 60 days from the date of the qualifying event to enroll in a health insurance plan, change your plan (either metal tier, insurance company, or both), or add a newly eligible beneficiary to your current plan. It is important to report the qualifying event early so that you’ll have as much time as possible to enroll.

If you choose to enroll in a new plan through a special enrollment period, please note that you will not be able to carry over any expenses that may have gone toward your deductible or out-of-pocket maximum in your previous plan.

If you think you may qualify for a special enrollment period, you can update your application at MarylandHealthConnection.gov using the "Change My Information" button in your account, or call our Consumer Support Center at 1-855-642-8572 (TTY: 1-855-642-8573). You should try to call us within 30 days of the event. A representative will ask you for information so we can figure out if you qualify for a special enrollment period. If you do, the representative will help you enroll in coverage.

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Examples of life events that may allow you to enroll in coverage through Maryland Health Connection outside of the annual open enrollment period include:

  • Getting married or divorced
  • Having a child, adopting a child, or placing a child for adoption or in foster care
  • Certain changes in income
  • Moving to or from Maryland, and moves within the state
  • Having a change in disability status
  • Gaining or losing a dependent
  • Certain losses of other health coverage (such as your employer stopped offering coverage or you lost a job that provided you with health insurance)
  • Becoming ineligible for Medicaid, MCHP, or MCHP Premium
  • Turning 26 years old if you are enrolled in coverage through your family’s plan
  • COBRA coverage period ends
  • Other changes that may affect eligibility include: change in tax filing status; change of citizenship or immigration status; incarceration or release from incarceration; change in status as an American Indian/Alaska Native or tribal status
  • You face exceptional circumstances or you tried to enroll in coverage, but major errors were made to your application. These are reviewed on a case-by-case basis.

It is important to note that generally you cannot qualify for a special enrollment period if you lose your health coverage because you stopped paying your premiums. Also, there is no special enrollment period available to people because they become ill, develop a chronic condition, become pregnant, or have an accident.

Whether you qualify for a special enrollment period depends on the type of event and how it affects your eligibility for coverage.

Medicaid enrollment is year-round; you do not need to qualify for a special enrollment period in order to apply for benefits outside open enrollment.
 

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For those individuals or small households that don’t require assistance, we estimate that it may take about 30–45 minutes to complete the enrollment process. For larger households, or those with complex situations or eligibility issues, it may take longer.

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No. While you can use MarylandHealthConnection.gov to compare plans, get financial help (if you qualify), and enroll in health coverage, you can also:

  • Apply in person through a trained and certified insurance broker or in-person navigator or caseworker at your local Health Department or Department of Social Services.
  • Call us at 855-642-8572 (TTY: 855-642-8573) to talk with a trained specialist who can answer your questions and guide you through the enrollment process – in many different languages.
  • Apply through the mail. If you want to send a paper application, you should call the consumer support center at 855-642-8572. They will mail you a paper application with a barcoded coversheet to fill out and mail back to Maryland Health Connection.
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Maryland Health Connection has lots of different kinds of trained and certified individuals to help you enroll.

Authorized insurance brokers can help you choose an insurance company and health plan that meet the needs of you and your family, and help enrollees with any administrative problems. There is no fee when you use an authorized insurance broker.

They are licensed by the Maryland Insurance Administration and authorized by Maryland Health Connection. Many belong to professional organizations whose members agree to abide by a code of conduct.

Navigators and In-Person Assisters are certified and can give you general guidance about health coverage and help you enroll. Navigators and In-Person Assisters work at Connector Entities. Maryland Health Connection has established six Connector Entities that serve different regions of the state.

Caseworkers work in local Health Departments (PDF), local Departments of Social Services, and other assigned facilities. Caseworkers can give you general guidance about health coverage and help you apply for coverage. Caseworkers work closely with Medicaid, MCHP, and MCHP Premium and can assist you with questions you may have about these programs.

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Please contact our Consumer Support Center at 1-855-642-8572 (TTY: 855-642-8573) for further assistance.

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Medicaid

If you are eligible for Medicaid, MCHP, or MCHP Premium:

  • Your coverage begins on the first day of the month that you applied. For example, if you apply on December 18 and are found eligible, your coverage will be considered effective as of December 1.
  • You may also be able to get help with medical bills that you incurred up to 3 months before you applied. Applicants who are in need of retroactive coverage and did not select this option during online enrollment should contact their local health department (PDF) or department of social services.

Qualified Health Plans

The annual open enrollment period is November 1 to December 15, 2017. Coverage starts January 1, 2018.

Make sure you pay your monthly bill:

  • Your qualified health plan requires a monthly payment, known as a premium. The insurance company you select will send you a monthly bill with payment instructions. View our Payment Guide for information on initial billing and contact information for your insurance company.
  • Your coverage only will be effective as long as you pay your monthly premium on time, and you continue to qualify for enrollment in a qualified health plan. If you haven’t received a bill, call your insurance company.

Special Enrollment Period

If you enroll in a qualified health plan through a special enrollment period:

  • In most cases, if you qualify for a special enrollment period to change plans and report your new plan selection to Maryland Health Connection between the 1st and the 15th of the month, your coverage will begin on the 1st of the following month.
  • If you report your new plan selection between the 16th and the last day of a month, your coverage will begin on the 1st of the next following month. For example, if you select your plan July 16, your coverage will begin Sept. 1.
  • For some life events, your coverage may be available sooner. In the case of a birth, adoption, or placement in foster care or for adoption, the plan will take effect on the date of the event. For example, if you have a baby on May 20, and select a plan through Maryland Health Connection on June 1, coverage for you and the baby will begin May 20.
  • In the case of marriage or loss of certain other health coverage, the plan selected through a special enrollment period will take effect on the 1st of the month following your marriage or loss of coverage. For example, if you lose your employer-sponsored coverage June 10 and select your plan June 20, your coverage will begin July 1.
  • If you report a change to your information, you will receive a new eligibility determination letter from Maryland Health Connection.
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Applying Outside Open Enrollment and Special Enrollment Periods

If you are eligible to buy a plan now (because of a special circumstance), you can enroll online at MarylandHealthConnection.gov, call our Consumer Support Center at 1-855-642-8572 (TTY 1-855-642-8573) or visit a navigator or insurance broker near you.

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If you do not qualify for Medicaid, you may be able to buy a plan now if you have special circumstances like getting married, having a baby or losing other health coverage.

If you think you may qualify to buy coverage now, enroll online at MarylandHealthConnection.gov, call our Consumer Support Center at 1-855-642-8572 (TTY 1-855-642-8573) or visit a navigator or insurance broker near you.
 

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For most life events, if you qualify for a special enrollment period to change plans and report your new plan selection to Maryland Health Connection between the 1st and the 15th of the month, your coverage will begin on the 1st of the following month.

If you report your new plan selection to Maryland Health Connection between the 16th and the last day of a month, your coverage will begin on the 1st of the next following month. For example, if you select your plan July 16, your coverage will begin Sept. 1.

For certain life events that may qualify you for a special enrollment period, the plan will become effective following a different timeline. In the case of a birth, adoption or placement in foster care, the plan selected through a special enrollment period will take effect on the date of the birth, adoption or placement in foster care. For example, if you have a baby May 20 and select a plan through Maryland Health Connection on June 1, coverage for you and the baby will begin May 20.

In the case of marriage or loss of certain other health coverage that is considered minimum essential coverage, the plan selected through a special enrollment period will take effect on the 1st of the following month after your plan selection is reported to Maryland Health Connection. For example, if you lose your employer-sponsored coverage June 10 and select your plan June 20, your coverage will begin July 1.

In order for your coverage to be active, you must pay your monthly premium to the insurance company on time. The insurance company will send you a monthly bill. Call them to pay if you haven't received a bill.

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If you are newly eligible for Medicaid or MCHP, this coverage becomes effective retroactive to the 1st of the month in which you newly qualify for Medicaid or MCHP.

If you are enrolled in a qualified health plan through Maryland Health Connection when you become eligible for Medicaid or MCHP, your qualified health plan coverage will end on the last day of the month during which you newly qualify for Medicaid/MCHP.

You may choose to remain enrolled in your qualified health plan coverage instead of enrolling in Medicaid/MCHP, but you would not be eligible for any tax credits or cost-sharing reductions for that health plan.
 

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If you are currently enrolled in a qualified health plan through Maryland Health Connection and experience a change in income or other life event that changes your tax credit amount but you do not qualify for a special enrollment period, the new amount of tax credit will be sent to your insurance company, and you will receive an updated bill that reflects the new tax credit amount.

As with your original enrollment, if you are eligible for a tax credit, you may elect to: (1) take the full amount you are eligible for each month in advance to apply towards your monthly premium cost; (2) take a smaller amount of tax credit each month than the full amount you are eligible for in advance; or (3) not take any part of the credit in advance monthly and instead receive your full tax credit for 2015 on your 2015 tax filing.
 

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If you have contacted the Call Center and are eligible to select a different plan but do not within 60 days, your current enrollment will not change except for any changes to your tax credit amount, which will be sent to your insurance company.

If factors beyond your control prevent you from reporting or selecting a health plan within the 60-day special enrollment period, you should alert the Call Center as soon as possible.
 

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Outside of the annual Open Enrollment period, you may be able to buy or change a plan if you've had a major life event or special circumstance such as getting married, having a baby or losing health coverage.

If you qualify for Medicaid, you may enroll year-round.

If you think you may qualify to buy coverage or change plans outside of the annual Open Enrollment period, you can apply or update your information at MarylandHealthConnection.gov, call our Consumer Support Center at 1-855-642-8572 (TTY 1-855-642-8573), or visit a navigator or insurance broker near you.

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Enrollment in Medicaid and the Maryland Children’s Health Program (MCHP) is year round. You can enroll in Medicaid/MCHP at any time if you qualify.

You may be eligible for Medicaid now, even if you weren’t in the past. The best way to know if you’re eligible for Medicaid is to apply. Your child or a member of your household may be eligible for Medicaid even if you’re not.

You can apply at any time online at MarylandHealthConnection.gov or by visiting a local connector entity, health department or department of social services. You can also apply by calling our Consumer Support Center at 1-855-642-8572 (TTY 1-855-642-8573).

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A Special Enrollment Period allows you to enroll in a qualified health plan through Maryland Health Connection or change your current plan outside of the annual open enrollment period.

You may newly enroll or change plans only if you have certain life events and are otherwise eligible to enroll in coverage through Maryland Health Connection (including that you are a US citizen, US National or lawfully present in the US; you are not incarcerated; and you live in Maryland).

You have 60 days from the date of the triggering event to report the event to Maryland Health Connection and select your plan, if you are eligible to enroll.

If you believe you have experienced an error with your application and/or enrollment through Maryland Health Connection, please report your issue to the Consumer Support Center.

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There are a variety of life events and circumstances that may allow you to enroll in a qualified health plan through Maryland Health Connection or change your current plan. Whether you qualify for a special enrollment period depends on the type of event and how it affects your eligibility for coverage.

Examples of life events that may allow you to enroll in coverage through Maryland Health Connection outside of the annual open enrollment period include:

  • Getting married or divorced
  • Having a child, adopting a child, or placing a child for adoption or in foster care
  • Certain changes in income
  • Moving to or from Maryland, and certain moves within the state
  • Having a change in disability status
  • Gaining or losing a dependent
  • Certain losses of other health coverage (such as employer ending coverage, or loss of job or employee leaving a job that provides coverage — but not termination for consumer’s failure to pay plan premium)
  • Becoming ineligible for Medicaid or MCHP
  • Turning 26 years old if you are enrolled in coverage through your family’s plan
  • COBRA coverage period ends
  • Other changes that may affect eligibility include: change in tax filing status; change of citizenship or immigration status; incarceration or release from incarceration; change in status as an American Indian/Alaska Native or tribal status
  • Certain errors or exceptional circumstances. These are reviewed on a case-by-case basis.

You also should report other changes that may not affect your eligibility for coverage, such as corrections to name, date of birth, or Social Security number.

As part of the eligibility decision process, you may be asked to provide documentation regarding your income, lawful presence, incarceration status and/or American Indian or Alaska Native affiliation.

It is important to note that generally you cannot qualify for a Special Enrollment Period if you lose your health coverage because you stopped paying your premiums. Also, there is no Special Enrollment Period available to people because they become ill, develop a chronic condition or have an accident.

Becoming pregnant is not considered a life event that triggers a special enrollment period to enroll in a qualified health plan through Maryland Health Connection outside of open enrollment or to change your current health plan. However, giving birth will qualify you for a special enrollment period. If you are pregnant, you should report this information to Maryland Health Connection as soon as possible because you may qualify for Medicaid. You can apply for Medicaid at any point during your pregnancy.

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When one household member experiences a qualifying life event and is eligible for a Special Enrollment Period, all household members may enroll in the newly selected health plan (even if the other household members are not currently enrolled in coverage through Maryland Health Connection).

All household members must still meet the eligibility requirements for enrollment through Maryland Health Connection. The only exception is while American Indians qualify for a Special Enrollment Period each month, their household members are only eligible for a Special Enrollment Period on that basis if they are also American Indians.
 

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Eligibility

In most cases, when you apply for coverage, the account holder (who defaults to the primary applicant) should be the household member you want as the contract holder with your insurance company.

Once you enroll in a plan, the primary applicant cannot easily be changed.

Some factors to consider when choosing the primary applicant include:

  1. The primary applicant does not need to be applying for coverage, but must be at least 18 years old. If the primary applicant is not seeking coverage, the second person listed in the household on the application will be considered the primary subscriber by the insurance company.
  2. If you expect one member of your household to end their coverage within the year (such as becoming eligible for Medicare, or enrolling through an employer), make another adult the primary applicant.
  3. If your household has mixed immigration status, make the adult who is a U.S. citizen or lawfully present the primary applicant, even if that person is not seeking coverage.
  4. If you are a married couple, both citizens or lawfully present, and seeking coverage for just one of you, make the person seeking coverage the primary applicant.
  5. If you are seeking coverage only for a dependent child under 17, an adult must be listed as primary, even if the adult is not seeking coverage. If you have more than one dependent (for example, you are a single parent seeking coverage for each of your 3 children but not yourself), complete a separate application for each child.

If you need to change the primary applicant, you will need to disenroll the entire household from coverage and then re-enroll with a different primary applicant. Follow these steps carefully to avoid a gap in coverage.

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It depends on whether or not you had access to affordable minimum essential coverage before you got hired, such as an employer's plan, COBRA, Medicare or Medicaid.

You may be able to enroll now, while waiting for your employer's coverage to start, if you recently lost other health coverage (for example, leaving your old job that provided coverage) or experienced other special circumstances such as moving to Maryland, having a baby or getting married. Be sure to report these changes to Maryland Health Connection as soon as possible to avoid a gap in coverage when your new position starts.

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Yes. Coverage for those with pre-existing conditions was one of the big changes made possible by the Affordable Care Act. As of 2014, you cannot be denied coverage or charged more for medical coverage just because you have a pre-existing health condition.

In Maryland, the cost of your coverage is based on your age, geographic location (county), and the plan that you select.

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Generally, your household includes the people you put on your tax form: you, your spouse, and any children or relatives you financially support.

When filling out your application, do include:

  • Yourself;
  • Your spouse;
  • Your children who live with you, even if they make enough money to file a tax return themselves;
  • Your unmarried partner who needs health coverage;
  • Anyone you include on your tax return as a dependent, even if they don’t live with you ; and
  • Any relative under 21 who you take care of and lives with you.

When filling out your application, don't include:

  • Your unmarried partner who doesn’t need health coverage and is not your dependent;
  • Your unmarried partner’s children if they are not your dependents;
  • Your parents who live with you, but file their own tax return and are not your dependents;
  • Other relatives who file their own tax return and are not your dependents; or
  • Roommates and other unrelated people who are not your dependents.

To learn about who qualifies as a dependent, refer to IRS Publication 501.

Relationship Include in household? Notes
Dependent children, including adopted and foster children Yes Include any child you’ll claim as a tax dependent, regardless of age.
Children, shared custody Sometimes Include children whose custody you share only during years you claim them as tax dependents.
Non-dependent child under 26 Sometimes Include them only if you want to cover them on your Maryland Health Connection plan.
Unborn children No Don’t include a baby until it’s born. You have up to 60 days after the birth to enroll your baby.
Dependent parents Yes Include parents only if you’ll claim them as tax dependents.
Dependent siblings and other relatives Yes Include them only if you’ll claim them as tax dependents.
Spouse Yes Include your legally married spouse. In most cases, married couples must file taxes jointly to qualify for savings.
Separated spouse Yes Include a separated spouse, even if you don't live together, unless you're legally divorced.
Divorced spouse No Don't include a former spouse, even if you live together.
Spouse, living apart Yes Include your spouse, even if you're separated, unless you’re legally divorced. (See next row for an important exception.)
Spouse, if you’re a victim of domestic abuse, domestic violence, or spousal abandonment Not required In these cases, you don’t have to include your spouse.
Unmarried domestic partner Sometimes Include an unmarried domestic partner only if you have a child together or you’ll claim your partner as a tax dependent.
Roommate No Don’t include people you just live with — unless they’re a spouse, tax dependent, or covered by another exception in this chart.
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Generally, you may enroll in the same qualified health plan as other members of your tax household. This includes your spouse and children up to age 26.  If your household includes a child or other relative, such as an elderly parent, who is over 26 and is disabled, they may also enroll in same the plan as you.

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The Affordable Care Act allows parents to keep their children on their health insurance plan until age 26.

Children can join or remain on a parent's plan even if they are:

  • Married
  • Not living with their parents
  • Attending school
  • Not financially dependent on their parents
  • Eligible to enroll in their employer’s plan
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First, if your employer offers coverage, you may want to sign up for insurance through your job. If you enroll in your employer’s coverage, it does not matter that you live and work in different states.

If you choose not to be covered by your employer’s insurance, or your family members are not offered coverage through your employer and do not have their own employer-sponsored coverage, you may obtain individual or family coverage through Maryland Health Connection if you are a Maryland resident. You need to be a resident of Maryland to sign up for coverage through us, but you do not need to work in the State of Maryland.

As a Maryland resident, you may also be eligible for Medicaid coverage. You can apply for Medicaid coverage using Maryland Health Connection at any time regardless of whether you have coverage through an employer’s health plan.

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Generally, if you have a work or student visa, you can qualify for coverage through Maryland Health Connection.

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Yes. In Maryland, “marriage” is defined as the legal union of two persons. So, same-sex married couples are treated exactly the same way in Maryland as heterosexual married couples when it comes to evaluating whether they qualify for assistance in purchasing health coverage.

Remember that all married couples can qualify for premium tax credits and/or cost-sharing reductions through Maryland Health Connection plans only if they intend to file a joint federal tax return for the year they’re getting coverage (unless they meet certain exceptions).

If you qualify to file taxes as the “Head of Household” or you meet certain special circumstances, including if you are the victim of domestic violence, you may be exempt from the requirement to file taxes jointly. If you believe you may qualify for an exception from the joint filing requirement, you should contact Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573) to proceed with your application.

Married couples are not required to file taxes or file their taxes jointly to be determined eligible for Medicaid.

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Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment period. You will have 60 days starting from the date you lose your employer health coverage to alert the Maryland Health Connection to this change in your circumstances and select a qualified health plan, if eligible to enroll.

You can apply for Maryland Health Connection health plans and may qualify (depending on your income) for premium tax credits and cost-sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to exhaust your COBRA benefits, otherwise qualify for a special enrollment period, or wait until the next open enrollment period (whichever comes first) if you want to switch to a Maryland Health Connection plan.

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During the annual open enrollment period, you can sign up for a Maryland Health Connection plan (if you’re eligible) even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Maryland Health Connection plan coverage begins to avoid a gap in coverage.

After open enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment period, unless you experience another qualifying life event, and you will have to wait until the next open enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment period.

The cost of your COBRA plan is not considered when determining your eligibility to enroll in a health plan through Maryland Health Connection. We only consider whether or not you are currently enrolled in COBRA, as long as you are otherwise eligible to enroll in a QHP because of your residency and citizenship or immigration status.

 

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If you get divorced or experience another qualifying life event that affects your eligibility (including moving to a new state, certain changes in your income, and losing your current coverage), you may be eligible to obtain health coverage through Maryland Health Connection during a special enrollment period outside of the open enrollment period. Talk to a Maryland Health Connection representative if you would like more information about this.

If you have employer-sponsored coverage through your former spouse, you may also be able to purchase federal or state COBRA continuation coverage for a limited time.

If you buy COBRA continuation coverage, you are not eligible for premium tax credits or cost-sharing reduction plans while you are enrolled in COBRA. You may be eligible to enroll in a health plan through Maryland Health Connection instead of COBRA.

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Yes, you can buy individual insurance through Maryland Health Connection. However, if you could be covered by the plan offered by your spouse’s employer – and this plan is considered “affordable” and meets certain other requirements – you are not eligible for premium tax credits or cost-sharing reductions for the qualified health plan you obtain through Maryland Health Connection.

Employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.69% of annual household income. Employer coverage also must meet some basic standards, known as providing “minimum value.” Employer coverage provides “minimum value” if it covers 60 percent of health care costs on average.

Your employer should be able to tell you if your plan meets this standard. Ask your employer to fill out an Employer Coverage Tool (PDF).

 

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Yes, but if you buy an individual plan through Maryland Health Connection, you may not qualify for financial help, such as lower costs on your monthly premiums or lower out-of-pocket costs. Specifically, if your employer’s plan is considered “affordable” and meets certain other requirements, you will not be eligible for premium tax credits or cost-sharing reductions for the coverage you obtain through Maryland Health Connection.

Employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.69% of annual household income. Employer coverage also must meet some basic standards, known as providing “minimum value.” Employer coverage provides “minimum value” if it covers 60 percent of health care costs on average.

Your employer should be able to tell you if your plan meets this standard. Ask your employer to fill out an Employer Coverage Tool (PDF).

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You are always welcome to apply for coverage through Maryland Health Connection, but you and/or your family members won’t be eligible for tax credits to help pay the premium unless your employer-sponsored coverage is unaffordable or doesn’t meet the minimum value requirements.

For 2017, coverage is only considered unaffordable if your cost for coverage for a single person (specifically, the employee) under the employer plan is more than 9.69% of your income. So although you may feel your family coverage is unaffordable in practical terms, it is considered technically affordable under federal law.

For 2017, if the cost of covering your family members is more than 8.16% of your household income, they may be eligible for an exemption from the mandate penalty. This means that you won’t have to pay a penalty when you file your taxes because they don’t have insurance. To see if you qualify for these exemptions, check out the exemption forms and filing process.

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If you are on Medicare, you don’t need to do anything. You are considered covered and have satisfied the requirement to have health insurance. When you file your taxes, you will not owe a penalty for failure to have health coverage. In fact, companies that sell qualified health plans are not even allowed to sell these plans to you if they know you are covered by Medicare.

People who are enrolled in Medicare are not eligible for a premium tax credit, no matter what their income level. Remember, if you choose to later enroll in Medicare, you may face a penalty for late enrollment. Please visit Medicare.gov for more information about Medicare eligibility and enrollment.

Note, Medicare supplement insurance (Medigap) and Part D drug plans cannot be purchased using Maryland Health Connection. If you’d like more information on these programs, you can visit Medicare.gov.

 

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Yes, you almost certainly are eligible for coverage through Maryland Health Connection. We strongly encourage you to apply. Depending on your income, you may qualify for Medicaid or premium tax credits and cost-sharing reductions.

Remember that once you become eligible for Medicare, you should report this change to Maryland Health Connection. You will no longer be eligible for premium tax credits or cost-sharing reductions.

Depending on your income, you may be eligible for assistance with your Medicare premiums, copays, and deductibles by applying for the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) Programs. For an application, call the Medicare Buy-In Program at 1-800-638-3403 or you can visit your local Department of Social Services to complete a QMB/SLMB application once you are enrolled in Medicare.

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In general, catastrophic plans are available only to people who are under 30 or for people 30 and older who cannot afford a qualified health plan. People who are under 30 years old may enroll in a catastrophic plan without taking any special steps.

However, if you are 30 or older, you will need to show that you cannot afford coverage or face a hardship if you want to enroll in a catastrophic insurance plan. In order to enroll in a catastrophic insurance plan, you must first be approved for an individual exemption based on affordability or hardship (including those whose former plans were dropped or cancelled due to the Affordable Care Act). Learn more about these exemptions.

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No, individuals who are eligible for Medicaid are not eligible for a premium tax credit or cost-sharing reduction. However, you may buy yourself a qualified health plan at full cost (either through Maryland Health Connection or from a participating insurance company).

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No, individuals who are in MCHP or MCHP Premium cannot qualify for a premium tax credit or cost-sharing reduction; however, you may buy your children a qualified health plan at full cost (either through Maryland Health Connection or from a participating insurance company).

Electing to decline MCHP or MCHP Premium coverage for your children and to purchase a qualified health plan for the entire family will have a few implications. If you qualify for a premium tax credit, it can only be used toward the cost of your qualified health plan coverage premium. In addition, if you are eligible for a cost-sharing reduction, you will not be able to receive them if you enroll in the same plan as your children who are MCHP-eligible. In that case, your family must enroll in two different qualified health plans in order to keep the cost-sharing reduction. The parents will need to enroll in one plan (with cost-sharing reduction) and the MCHP-eligible children in another (without cost-sharing reduction).

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No, you don’t have to file jointly — and you can still qualify for a premium tax credit and other savings.

If you’re living apart from your spouse and are a victim of domestic abuse, domestic violence, or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner, you can say you’re “unmarried” on your Maryland Health Connection application without fear of penalty for misstating your marital status.

This will let you (and possibly your dependents) qualify for premium tax credits and other savings based on your income.

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Financial Help

At the end of the application for health coverage, you will be asked to confirm whether Maryland Health Connection may use your tax return information to determine whether you qualify for financial help with your coverage in future years.

You can choose to give Maryland Health Connection permission for less than five years, or zero years, and you can change your answer at any time.

Maryland Health Connection uses data from a variety of courses, including your tax return, to determine whether you are eligible for financial help paying for health insurance each year. If you choose not to allow Maryland Health Connection to use this information, your financial help will not be automatically renewed each year, and you will need to reapply every year during the annual Open Enrollment period.

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Depending on your income and household size, you may qualify for different types of financial help.

If your income is below a certain level – for example, less than $16,643 for a single person or less than $33,948 for a family of four – you may qualify for Medicaid.

If you have an income of up to $47,520 a year as a single person, you may qualify for tax credits to help cover your monthly health insurance payments. Families may also be eligible, depending on income and size. For example, a family of four earning up to $97,200 a year might qualify. Tax credits are applied toward your monthly health insurance premiums.

In addition to your income, your age and county of residence also may affect how much financial help you could qualify for.

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Whether you qualify will depend on your income level and family size. In general, single Maryland residents without children with household incomes less than $16,643 are eligible. If you’re pregnant or have a family with children, you may earn more and still qualify.

Maryland residents above these income levels may be eligible for financial help with a qualified health plan purchased through Maryland Health Connection.

When you fill out an application with Maryland Health Connection, you’ll learn if you or your children qualify for free or low-cost coverage through Medicaid, MCHP, or MCHP Premium.

If you require nursing home care, have high or recurring medical bills, or have special health care needs, you may be eligible for Medicaid on a different basis. To apply for Medicaid based on these needs, call 1-800-332-6347 or apply for benefits using myDHRbenefits.dhr.state.md.us (formerly SAIL) or by going to your local Department of Social Services (DSS).

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Yes, if you meet the following criteria:

  1. You are not eligible for qualifying health coverage, such as affordable employer-sponsored coverage, or a government program, such as Medicaid.
  2. You are a Maryland resident and a citizen or lawful resident of the United States, and not incarcerated (other than pending final disposition of charges).
  3. Your household income is between 100% and 400% of the federal poverty level (for an individual, between $12,060 and $47,520; for a family of four, between $24,600 and $97,200, in 2017).
  4. You enroll in coverage through Maryland Health Connection.

You must also file taxes to get the tax credit, even if you would not usually file (for example, if your income is lower than the amount in which people are required to file taxes). You can file taxes this year, even if you didn’t file taxes last year. You can also claim tax dependents on your taxes this year that you may not have previously claimed. Anyone in your household who is not claimed as a tax dependent this year must file taxes to receive a tax credit. If you do not need health coverage but your tax dependents do, you can get a tax credit for them if you file taxes.

If you are married and want to get the tax credit, you must file taxes using the “married filing jointly” tax status for this year, unless you qualify to file taxes as the “Head of Household” or you meet special circumstances, including if you are the victim of domestic violence. If you think you meet special circumstances, you should contact Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573) to proceed with your application.

Additionally, you must not have failed to reconcile tax credits you received from a previous year in your annual tax filing.

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Your tax credits will be paid monthly, directly to the health insurance company that you enrolled with through Maryland Health Connection. You may also choose to receive them at the end of the year through your annual tax filing.

During the year, it’s important to report changes in your income or household size to Maryland Health Connection as soon as possible. You can adjust your tax credit so you don’t wind up owing money or getting a big refund on your next tax return.

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No, the Affordable Care Act prohibits married couples who file their taxes separately, rather than jointly, from receiving premium tax credits. (Married couples are not required to file taxes or file their taxes jointly to be determined eligible for Medicaid.)

  • If you’re married and will file a joint federal tax return for the year you want coverage: You’re eligible for a premium tax credit and other savings if you qualify based on your income and other factors.
  • If you’re married and will file separately for the year you want coverage: You can enroll in a Maryland Health Connection plan together but you’re not eligible for a premium tax credit or other savings, and you may have to complete a separate application.
  • If you’re married and plan to file as head of household for the year you want coverage: You can say you’re "unmarried" on your Maryland Health Connection application. You’re then eligible for a premium tax credit and other savings if you qualify based on your income and other factors. See IRS rules for filing as head of household.
Important:
There’s an exception for people who are victims of domestic abuse. If you’re living apart from your spouse and can’t file a joint return with your spouse as a result of domestic abuse, you’re allowed to state on the application that you’re unmarried. This will allow Maryland Health Connection to determine if you qualify for premium tax credits and cost-sharing reductions. These savings depend on your household income and family size.
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Reporting Your Income

If you are currently self-employed and are unable to provide other verification of your income, due to reasons such as recently becoming self-employed or a major change in your self-employment income, you can use this affidavit to prove your income status.

Once you complete your application through Maryland Health Connection, you will receive a verification notice in the mail requesting verification of income. In response to this request, you may either complete this affidavit and upload it to your online account or send it with the cover letter from the notice to the following address:

Maryland Health Connection
P.O. Box 857
Lanham, MD 20703

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If you do not currently have an income, you can use this affidavit (PDF) as a verification document to prove your income status. Once you complete your application through Maryland Health Connection, you will receive a verification notice in the mail requesting verification of income.

In response to this request, you may either complete this affidavit and upload it to your online account or send it with the cover letter from the notice to the following address:

Maryland Health Connection
P.O. Box 857
Lanham, MD 20703

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When you apply for financial help with health coverage through Maryland Health Connection, you’ll need to estimate your income for the year you want health coverage to see if you qualify for lower costs.

It is important to enter your household income information correctly to make sure you’re receiving the right amount of financial help (such as a tax credit you can receive in advance to lower your monthly premium). If you receive more tax credit than you were eligible to receive, you will owe it back when you file your federal taxes for that year.

Calculate Your Household Income

Start by adding up the following items for:

  • You and your spouse, if you are married and will file a joint tax return
  • Any dependents who make enough money to be required to file a tax return. It’s important to include income information for everyone in your household, even if not all those people are applying for coverage.

Whose income should you include?

Include these sources of income:

  • Wages, salaries, and tips
  • Net income from any self-employment or business (generally the amount of money you take in from your business minus your business expenses)
  • Unemployment compensation
  • Social Security benefits, including Social Security Disability (even if the payments are not taxed by the IRS), Retirement (including Railroad retirement), or Survivor's Benefits each month. These do not include Supplemental Security Income (SSI)
  • Alimony
  • Retirement income
  • Investment income
  • Pension income
  • Rental income
  • Other taxable income such as prizes, awards, and gambling winnings.

Don't include these:

  • Child support
  • Gifts
  • Supplemental Security Income (SSI)
  • Veterans’ disability payments
  • Workers’ compensation
  • Proceeds from loans (like student loans, home equity loans, or bank loans)
  • Scholarship and fellowship payments for tuition and fees and course-related expenses required of all students

Income deductions you may claim:

You also may subtract these deductions from your household income, if they are not already subtracted from the amount you list as income. (There may be limits on the amount you can claim.):

  • Alimony you pay
  • Student loan interest you pay
  • Educator expenses if you’re a teacher and pay for supplies out-of-pocket
  • Contributions to your individual retirement account if you don’t have a retirement account through a job

For more information on reporting your income, see IRS Publication 525.

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If your income changes, it is very important that you alert Maryland Health Connection. The amount of the tax credit you receive to buy a qualified health plan, if you are eligible for one, is based on your modified adjusted gross income (MAGI) income.

If your actual MAGI income at the end of the tax year is lower than you projected on your application for coverage, you may be entitled to additional financial help. If that is the case, the additional amount may be returned to you in the form of a tax refund (or subtracted from your balance due).

On the other hand, if your MAGI income is higher during the tax year than you projected and you are enrolled in a qualified health plan and receiving advance premium tax credits, you may have received more financial help than you should have. In this case, you may need to reimburse the government for some of the tax credit that was paid on your behalf to your insurer (or it may be subtracted from your refund).

During the year, it’s important to report changes in your income or household size to Maryland Health Connection as soon as possible. You can adjust your tax credit so you don’t wind up owing money or getting a big refund on your next tax return.

 

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Yes. Although the tax credit is paid directly to an insurer on a monthly basis, it is in fact a tax credit that must be claimed on your annual income tax return.  Maryland Health Connection will provide you with IRS Form 1095-A by January 31 that you will use to help file your annual income tax return.

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If you can claim your child or another person as a dependent on your tax return, include the person as part of your household in your application. It doesn’t matter whether he or she is a full-time student.

Also include anyone who is under 21 and lives with you, whether or not you claim them on your tax return. If your child files a separate tax return, they may be eligible for financial assistance based on their own income but they are still eligible to enroll in the same qualified health plan as you.

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Your household income is one of several items used to determine your eligibility for premium tax credits. While we cannot provide tax advice, when applying for subsidies through Maryland Health Connection, veterans’ disability benefits should not be included in your household income.

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Yes, all of your Social Security benefits (except Supplemental Security Income (SSI)) will be counted as income in determining your eligibility.  This will not affect your federal income taxes on these Social Security benefits. You will need to file a tax return if you are eligible for and elect to receive premium tax credits, even if you don’t meet the IRS income threshold for filing an annual tax return.

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No, child support payments you receive are not counted.

Income that you pay for child support is not considered a deduction.

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Yes. You deduct alimony that you pay from gross income to determine adjusted gross income. It will be excluded from income in determining your eligibility for premium tax credit and cost-sharing reductions.

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When you apply for financial assistance through Maryland Health Connection, you will be asked to estimate your expected income for the upcoming year. Often a good place to start is to consider what your income is this year, or what income you reported on your tax return last year.

However, if your circumstances have changed since then, for example, if you recently lost your job, you should make your best estimate of what your income will be next year.

Maryland Health Connection will compare your estimated income against records at the Internal Revenue Service, Social Security Administration and other sources. If your estimate and official records don’t match, but you meet all other eligibility requirements, you will be asked to provide documentation to support your income projections.

If you are eligible for Medicaid or eligible for enrollment in a qualified health plan, you may enroll in health coverage through Maryland Health Connection for up to 90 days while you gather and submit your income documentation for verification. You may also receive the premium tax credit and cost-sharing reductions during the 90 day period. It is very important that you provide any documentation requested by Maryland Health Connection in a timely manner; if you don’t your coverage may change or be terminated.

If you experience a change in income during the year, you should report it to Maryland Health Connection. Keep in mind that if you are eligible for premium tax credit and if you estimate your income incorrectly and end up claiming more help than you are eligible for, you may have to pay back some or all of the premium tax credit you received. If you over-estimate your income and end up claiming less help than you are entitled to, the difference will be refunded to you when you file your income taxes the following year.

 

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Scholarship and fellowship payments for tuition and fees and course-related expenses required of all students are not counted as income in determining your eligibility. Payments for room and board are included.

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The answer depends on whether she earns enough income to be required to file a federal income tax return on her own. Generally, child dependents aren’t required to file a return or pay taxes on their income if they earn less than $6,300 in a year. If your daughter earns less than that in a year, you would not count her income as part of your household income, but if she earns more than that amount, you would count it.

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Yes, you must report your spouse’s income. Your eligibility for lower costs on health insurance is based on the income of everyone in your household, whether they need insurance or not.

Important: Remember that if you’re eligible for your spouse’s job-based insurance, you may not be eligible for lower costs on coverage through Maryland Health Connection based on your household income. This is true whether you’re enrolled in your spouse’s insurance plan or not. You’ll be eligible for lower costs only if your spouse’s insurance is considered unaffordable or does not meet the minimum value.

For purposes of premium tax credit eligibility, employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.69% of annual household income.

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Yes, you will be considered as a household of two for both Medicaid and premium tax credits. However, your grandchild will be considered as her own household for Medicaid, MCHP, and MCHP Premium, and your income will not count in determining her eligibility for these programs. Assuming she does not have her own income she will likely be eligible for Medicaid, MCHP, or MCHP Premium and not eligible for premium tax credits for coverage in Maryland Health Connection. You could, of course, purchase coverage for her in Maryland Health Connection but you would not be eligible for a premium tax credit to help pay for her plan.

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It’s common for income to fluctuate, particularly if you are self-employed, perform seasonal work or have multiple jobs. To achieve the best result for financial assistance, you should report income changes to Maryland Health Connection during the year, as they happen.

Reporting income changes as they happen will help ensure that your actual annual income is close to your estimated income. If you claim a premium tax credit during the year and your actual annual income edges over 400% FPL (for an individual, $47,080; for a family of four, $97,000 in 2015), you will need to pay back the full credit amount. To avoid this result, if you estimate your income will be close to 400% FPL, you could also consider waiting until you file your taxes to take all or a portion of the premium tax credit on your tax return instead of receiving advance payments.

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No, your final premium credit amount will be determined based on your income for the year as reported on your tax return. The fact that it ended up being lower than 138% of the poverty line (the Medicaid limit for most individuals, except children and pregnant women) does not mean you have to pay back the premium tax credit you received. In fact, your final credit amount will likely be larger than the amount you received in advance.

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Yes. There is no requirement to have filed a tax return for any prior year in order to qualify for a premium tax credit. However, there is a requirement to file a return in the year in which you receive a premium tax credit (e.g., if a premium credit is received for 2016, the taxpayer must file a 2016 tax return in spring 2017).

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Yes. Although the general rule is that people are not eligible for subsidies through Maryland Health Connection when they are also eligible for affordable job-based health coverage, there is a special rule for young adults under 26.

As long as a young adult under 26 is not claimed as a tax dependent by his or her parents, the availability of dependent coverage under her parents’ health plan does not affect her eligibility for premium tax credits through Maryland Health Connection.

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No. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost-sharing reductions are not reconciled.

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Deduction Type Limit
Alimony paid Amount deducted should not exceed total income
Certain business expenses of reservists, performing artists, and fee-basis government officials Amount deducted should not exceed total income
Deductable part of self-employment tax Amount deducted should not exceed 7.65% of annual income
Domestic Production activities deduction Amount deducted should not exceed 9% of annual income
Student loan interest paid Generally, the amount an applicant may deduct is the lesser of $2,500 or the amount of interest the applicant actually paid.
Health savings account deduction
  • $3,350 if a single-person household
  • $6,650 for family coverage
Moving expenses if the applicant is moving to live much closer to their job Amount deducted should not exceed total income
Penalty on early withdrawal of savings Amount deducted should not exceed total income
Contributions to an individual retirement account if the applicant doesn’t have a retirement account through a job
Self-employed health insurance deduction Amount deducted should not exceed total income
Tuition costs for school if the applicant pays for the costs out-of-pocket and deducts them on their tax return on line 34 Amount deducted should not exceed total income
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Social Security Questions

Maryland Health Connection asks for Social Security numbers for everyone listed on the application; however, providing one is required only for (1) an adult or child who has an SSN and is applying for coverage or (2) a non-applicant who has filed taxes for the household within the last two years and wants help paying for coverage for the applicant(s). (Nonapplicants include people who are only applying on behalf of someone else, but not for themselves, such as a parent applying for a child.)

Providing an SSN for other people who are not applying for coverage is optional; however, doing so will enable Maryland Health Connection to electronically verify household income and other information that is needed to determine eligibility.

If someone has an SSN, but does not provide it or enters it incorrectly, he/she may need to submit documentation to support any important information in the application that Maryland Health Connection was unable to verify.

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Yes. People who do not have an SSN can still apply for health coverage through Maryland Health Connection. They, or the person applying for them, should check the box “Do not have an SSN” and answer the question “Are you applying for an SSN?”

If you do not have an SSN and are not applying for one, you should also select the reason you are not. If you have, an Individual Tax Identification Number (ITIN) instead of an SSN, enter it in the space provided. If you are not applying for coverage for yourself and applying only on behalf of another person, you can leave this information blank for you unless you are the tax filer for the household and want help paying for coverage for the applicant(s).

We ask for this information because Medicaid and MCHP require applicants seeking coverage to have an SSN, apply for one, or have a reason that exempts them from the SSN requirement. Applicants who may be eligible for Medicaid should apply for an SSN, if they can get one. If an SSN is issued, they should update their application with it.

Applicants who are not applying for an SSN for one of the following reasons are exempt from the Medicaid SSN requirement:

  • Not eligible for an SSN
  • An SSN can only be issued for non-work reasons
  • Well established religious objection

Applicants may still enroll in a Qualified Health Plan without applying for an SSN. However, if you don’t have an SSN, you may need to provide additional information because Maryland Health Connection will not be able to electronically verify your SSN or other information such as income.

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People can apply for an SSN or get assistance with applying for one in the following ways:

People who have applied for an SSN and are applying for coverage through Maryland Health Connection should select “Yes” for the question “Are you applying for an SSN.” If an SSN is issued, you should update your application.

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Maryland Health Connection uses your Social Security number to verify household income and other information in your application to determine whether you’re eligible for financial help to lower health coverage costs.

When you apply, Maryland Health Connection is required by federal law to verify your SSN with the Social Security Administration to ensure that it was issued to that individual, and your SSN may be used to verify household size and income with the Internal Revenue Service.

Your SSN also may be verified through secure electronic data matches with the U.S. Department of Homeland Security to confirm the citizenship and/or immigration status of people applying for coverage. SSNs collected through Maryland Health Connection are not used for immigration enforcement purposes.

After you enroll, your SSN may be used to verify continued eligibility and in reports to the IRS about your enrollment and eligibility for premium tax credits and cost-sharing reductions.

To maintain operation of the marketplace, Maryland Health Connection may share your SSN with marketplace contractors, other federal or state agencies responding to concerns about security, and the insurance company that issues your plan.

For more information, see Maryland Health Connection’s Privacy Notice.

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Maryland Health Connection is required by federal law to verify people’s SSNs and other information when determining eligibility for health insurance programs.

If you did not enter your SSN, entered it incorrectly, or do not have one, you may receive a notice in your account inbox or the mail requesting that you provide additional information because Maryland Health Connection was not able to electronically verify an SSN or other information, such as income.

If you have a SSN, a copy of one of the documents below is acceptable:

  • Social Security card
  • Tax form(s)
  • Benefit or income statement from Social Security containing your SSN

If you do not have an SSN or are applying for one, a copy of one of the documents below is acceptable:

  • Pending application for an SSN
  • Letter from Social Security stating that you’re not eligible for an SSN or are only eligible for a non-work SSN
  • Letter stating that you refuse to obtain an SSN for established religious objections
  • Affidavit/Exemption from Obtaining an SSN (for people who are not eligible for an SSN, can only obtain one for non-work purposes, or who have a religious objection.)

Other types of documents may be acceptable. If you do not see a particular type of document listed, contact Maryland Health Connection or, your local health department (PDF) or department of social services.

How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703. Please include the cover page with a barcode that came with your notice.

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Immigration Status, Residency and Citizenship

Yes, people who are living in the United States legally can sign up for coverage through the Maryland Health Connection. The test is whether you are “lawfully present.” You are lawfully present if you fit into one of the following categories:

  1. Lawful Permanent Resident (LPR). You are a lawful permanent resident if you have permission to live and work in the United States. Applicants for LPR status may also qualify.
  2. Refugees and others who can’t return to their home country. This group includes people who were granted asylum, and those whose deportation or removal was temporarily paused.
  3. Humanitarian immigrants, including:
    • Certain Cuban and Haitian nationals.
    • Individuals paroled into the U.S. or granted temporary protected status.
    • Individuals who have applied for special immigrant juvenile status.
  4. Survivors of domestic violence, trafficking, and other serious crimes, including:
    • Abused spouses and children who qualify for protection under the Violence Against Women Act (VAWA), as well as parents and/or children of an abused spouse or child.
    • Immigrant survivors of human trafficking.
    • U-Visa holders.
  5. People with valid non-immigrant status, including:
    • Visa holders such as tourists, students and visitors on business.
    • Citizens of Micronesia, the Marshall Islands or Palau.
  6. Longtime residents, including:
    • Non-citizens who gained legal status under the Immigration Reform and Immigrant Control Act of 1986.
    • Individuals who qualify for Family Unity status, protecting them from deportation or removal.
    • Individuals whose removal would cause extreme hardship to themselves or others.

There are some other situations where lawfully present immigrants may be eligible for health coverage. For more details, please talk to a Maryland Health Connection representative.

If you are an undocumented immigrant, you will not be able to get coverage through the Maryland Health Connection. You may be eligible for coverage of emergency medical services only, including labor and delivery, if you meet all other Medicaid eligibility requirements. For more information about Emergency Medicaid, click here.

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Sorry, you will not be able to obtain health coverage through Maryland Health Connection. Only Maryland residents who are U.S. citizens or are lawful residents can obtain coverage through Maryland Health Connection.

Applicants who do not have proper immigration status may still be eligible for Emergency Medicaid, including labor and delivery, if they meet all other Medicaid eligibility requirements. For more information about Emergency Medicaid, click here.

You may also be eligible to purchase health coverage in the individual market outside of Maryland Health Connection by contacting an authorized insurance broker.

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Individuals who are not legally in the United States and most applicants who have not met the five year bar are not eligible for full Medicaid benefits.  However, these individuals may be eligible for Medicaid coverage of emergency medical services, including labor and delivery services. In order to qualify for emergency medical services, the applicant must meet all other Medicaid eligibility criteria, including income limits. Individuals should contact their local Department of Social Services for additional information on qualifying for emergency medical assistance.

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We know that many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Some families may have members who can’t buy health insurance through the Marketplace, alongside other family members who are eligible to use the Marketplace, like lawfully present immigrants.

Any information collected through the application process for the applicant and non-applicant will not be used for immigration enforcement purposes. We will verify your lawfully present status only to check what health insurance programs you may be eligible for and to process your qualified health plan enrollment. Learn more about how we use your data. These “non-applicants” will be asked to provide a Social Security Number, but it is entirely optional. They do not have to provide one. The only exception is that if someone is filing taxes and has a Social Security Number, he or she is expected to provide that Social Security Number even if he or she only wants coverage for other family members.

We encourage you to apply for health coverage and get coverage for those in your family that are eligible. Personal information in your application won’t affect your immigration status. Enrolling in health coverage — and using the health insurance that this important law extends to eligible individuals — will not prevent your loved ones who are undocumented from getting a green card in the future or who do not yet have a green card at risk.

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It is probably because you have not been lawfully residing in the United States for five years or more. Under federal law, Maryland cannot provide Medicaid to most immigrants until they have been lawfully residing in the U.S. for five years. But, the good news is that you can buy a qualified health plan and may qualify for financial help to lower your insurance costs.

The lawfully present immigrants that we can and do provide Medicaid, MCHP, and MCHP Premium to include: refugees, asylees, and other humanitarian immigrants; veterans and military families; and pregnant women and children.

Some lawfully present immigrants who are authorized to work in the United States cannot enroll in Medicaid, even if they have been in the country for five or more years, such as those here on student visas or temporary work visas due to their residency status

Undocumented immigrants may not enroll in Medicaid, MCHP, or MCHP Premium coverage, but may still be eligible for Emergency Medicaid, including labor and delivery services, if they meet all other eligibility requirements. For more information about emergency medical services through the Medicaid program, click here.

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Yes, lawfully present immigrants are eligible to enroll in a qualified health plan, or “Marketplace plan,” through Maryland Health Connection if they are Maryland residents. In addition, lawfully present immigrants can get tax credits to help pay premiums and cost-sharing reductions for health insurance through Maryland Health Connection. They can get tax credits to help pay premiums if their income is below 400% of the federal poverty level. The amount they pay for using services through their plans in the form of deductibles, copayments or coinsurance will also be lowered thanks to a cost-sharing reduction if they make below 250% of the federal poverty level (or 300% if they are an American Indian or Alaska Native). As with citizens, to get this help, they cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Remember that lawfully present immigrants who make less than 100% of the federal poverty level also can get help paying premiums and cost-sharing if they cannot enroll in Medicaid. Many lawfully present immigrants cannot enroll in Medicaid until they have been in the United States for five or more years, but may still be eligible for emergency medical services through the Medicaid program, including labor and delivery services, if they meet all other eligibility requirements. For more information about Emergency Medicaid, click here.

Undocumented immigrants cannot receive help paying for premiums or cost–sharing reductions for Maryland Health Connection coverage and may not buy health insurance through Maryland Health Connection even at full cost.

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Adults Age 65+ and Medicare Eligibility

If you are on Medicare, you don’t need to do anything. You are considered covered and have satisfied the requirement to have health insurance. When you file your taxes, you will not owe a penalty for failure to have health coverage. In fact, companies that sell qualified health plans are not even allowed to sell these plans to you if they know you are covered by Medicare.

People who are enrolled in Medicare are not eligible for a premium tax credit, no matter what their income level. Remember, if you choose to later enroll in Medicare, you may face a penalty for late enrollment. Please visit Medicare.gov for more information about Medicare eligibility and enrollment.

Note, Medicare supplement insurance (Medigap) and Part D drug plans cannot be purchased using Maryland Health Connection. If you’d like more information on these programs, you can visit Medicare.gov.

 

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Yes, you almost certainly are eligible for coverage through Maryland Health Connection. We strongly encourage you to apply. Depending on your income, you may qualify for Medicaid or premium tax credits and cost-sharing reductions.

Remember that once you become eligible for Medicare, you should report this change to Maryland Health Connection. You will no longer be eligible for premium tax credits or cost-sharing reductions.

Depending on your income, you may be eligible for assistance with your Medicare premiums, copays, and deductibles by applying for the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) Programs. For an application, call the Medicare Buy-In Program at 1-800-638-3403 or you can visit your local Department of Social Services to complete a QMB/SLMB application once you are enrolled in Medicare.

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The vast majority of people 65 or older who are eligible for Medicare or are enrolled in Medicare are not eligible to enroll in health coverage through Maryland Health Connection.

In general, most people get Medicare Part A (Hospital Insurance) for free, but some have to pay a premium for this coverage.

Individuals are eligible for Medicare Part A starting at age 65 with no cost if:

  • They're a citizen or lawful permanent resident and the individual or their spouse has earned 40 credits (about 10 years of work); or
  • The individual or their spouse is a government employee or retiree who hasn't paid into Social Security but has paid Medicare payroll taxes while working.

NOTE: An individual can qualify for Medicare based on a spouse's work record if the spouse is at least 62 and the individual is at least 65. An individual may also qualify based on the work record of a divorced or deceased spouse.

In addition, an individual under 65 may qualify for Medicare at no cost if:

  • The individual has been entitled to Social Security Disability Insurance benefits for at least 24 months; or
  • The individual receives a disability pension from the Railroad Retirement Benefits and meets certain conditions; or
  • The individual has Lou Gehrig's disease (amyotrophic lateral sclerosis); or
  • The individual has permanent kidney failure requiring regular dialysis or a kidney transplant — and the individual or their spouse has paid Social Security taxes for a certain length of time, depending on their age.

In general, someone may purchase Medicare coverage if they’re not eligible for Medicare Part A at no cost:

  • if they're a citizen or legal resident for at least 5 years;
  • age 65 or older; and
  • pay premiums for Part A (hospital insurance). There are staggered premium rates depending on work credits (less than 30, 30-39, and then once a consumer reaches 40 credit they don't have to pay premiums).

Low-income individuals who buy-in to Medicare may be eligible for the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) programs. These programs help offset the cost of purchasing Medicare coverage. Marylanders can apply for QMB and SLMB at their local department of social services office.

A consumer can enroll in Part B without buying Part A. But if the consumer buys Part A, they must enroll in Part B. The consumer can enroll in Part D without enrolling in Part A or B. The consumer will pay the same premiums as other enrollees for Part B and D.

There are exceptions that allow certain individuals who are enrolled in Medicare or eligible for Medicare to apply for coverage through Maryland Health Connection, including:

  • Active Medicare enrollees who qualify as a parent/Caretaker Relative (CTR) (regardless of their age) may also qualify for Medicaid benefits
  • Active recipients of Social Security Disability Insurance (SSDI) benefits who qualify for Medicare but are in the 24-month waiting period
    • Everyone eligible for SSDI benefits is also eligible for Medicare after a 24-month qualifying period. Individuals in this waiting period may use Maryland Health Connection to apply for Qualified Health Plan and Medicaid coverage

Note: An individual eligible for Supplemental Security Income is automatically eligible for Medicaid.

For more information about Medicare eligibility and benefits, please visit: https://www.medicare.gov/eligibilitypremiumcalc/.

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Yes; if you are 65 or older and receiving Medicare, and you meet certain income and asset limits, you may apply for a Medicaid program to help low-income Medicare recipients. You can apply for these programs (Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary) at a local Department of Social Services office.

Visit mydhrbenefits.dhr.state.md.us to find an office near you.

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Yes; however, an individual is not eligible for a financial assistance program through Maryland Health Connection if they are eligible to enroll in Medicare Part A at no cost because they are considered to have “minimum essential coverage.” These individuals may only enroll in a Qualified Health Plan without financial assistance. Medicare is likely the best coverage option for individuals in this situation.

When an individual becomes eligible for premium-free Medicare or enrolled in Medicare either at no cost or with a cost, they lose their eligibility for Marketplace subsidies after a brief transition period.

There are exceptions that allow certain individuals who are eligible for Medicare at no cost to apply for coverage through Maryland Health Connection, including:

  • Active Medicare enrollees who qualify as a parent/Caretaker Relative (CTR) (regardless of their age) may also qualify for Medicaid benefits
  • Active recipients of Social Security Disability Insurance (SSDI) benefits who qualify for Medicare but are in the 24-month waiting period
    • Everyone eligible for SSDI benefits is also eligible for Medicare after a 24-month qualifying period. Individuals in this waiting period may use Maryland Health Connection to apply for Qualified Health Plan and Medicaid coverage

Note: An individual eligible for Supplemental Security Income is automatically eligible for Medicaid.

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No. Maryland Health Connection cannot sell individuals who are already enrolled in Medicare Part A and/or Part B (regardless of whether Medicare is at no cost or has a premium) any Qualified Health Plan coverage because it would duplicate their Medicare benefits.

These individuals also are not eligible for advance premium tax credits (APTC) or cost-sharing reductions (CSR).

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U.S. citizens and lawful permanent residents at least age 65 between 100% and 400% FPL ($12,060 to $48,240 for an individual in 2017), who have been in the U.S. for five years, may buy-in to Medicare if they don’t have the work history to qualify for premium-free Medicare, or they can purchase Qualified Health Plan coverage through Maryland Health Connection.

Low-income individuals who buy-in to Medicare may be eligible for Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) programs. Marylanders can apply for QMB and SLMB at their local department of social services office.

Individuals who choose to purchase QHP coverage may be eligible for advanced premium tax credits (APTC) or cost-sharing reductions (CSR) if

  1. Their income is between 100% and 400% FPL ($12,060 to $48,240 for an individual in 2017); and
  2. They do not have access to other minimum essential coverage, such as an employer-sponsored health plan.

Premium tax credits are available to lawfully residing immigrants with incomes below 100 percent of the poverty line who are not eligible for Medicaid because of their immigration status. U.S. citizens and lawful permanent residents at least age 65 whose income is below 100% FPL (less than $12,060 for an individual in 2017) are not eligible for APTC or CSR, even if they elect not to buy-in to Medicare Part A. Depending on their financial circumstances, they may qualify for QMB/SLMB if they choose to enroll in Medicare coverage. You can apply for these programs at your local department of social services office.

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Even though they are older than 65, recent lawfully present immigrants are eligible to buy Qualified Health Plan coverage through Maryland Health Connection.

Just like other applicants who cannot qualify for Medicaid because they do not meet the five-year bar, they may qualify for advance premium tax credits (APTC) and cost-sharing reductions (CSR) to help with the cost of purchasing a QHP if:

  • They are lawfully present; and
  • Their income is less than 400% FPL ($48,240 for an individual in 2017)
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If you are already enrolled in a qualified health plan, you may not be disenrolled when you turn 65 and are eligible for Medicare. You may remain enrolled in your qualified health plan coverage as long as you pay your premium, but once eligible for Medicare, you will no longer be eligible for financial assistance.

Whether you are eligible for Medicare or not, you can still enroll in a dental plan through Maryland Health Connection. Starting in 2016, standalone dental plans are available through Maryland Health Connection even if you do not purchase a QHP.

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People with questions about Medicare can call 1-800-MEDICARE or visit http://www.medicare.gov/ for plan information.

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Veterans Health Administration (VA) Coverage and Eligibility

Yes. If you are enrolled in any of VA’s programs below, you have coverage under the standards of the Affordable Care Act (health care law):

  • Veteran’s health care program
  • Civilian Health and Medical program (CHAMPVA)
  • Spina bifida health care program
  • Children of Women Vietnam Veterans program

Learn more about other types of health insurance that meet the Affordable Care Act requirement.

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You may apply by visiting www.va.gov/healthbenefits/enroll, calling 1-877-222-VETS (8387), or going in-person to your local VA health care facility.

There are three VA Medical Centers that serve the state of Maryland:

  1. VA Maryland Health Care System (Anne Arundel, Baltimore city, Baltimore County, Howard, Carroll, Cecil and Harford counties, and the Eastern Shore): http://www.maryland.va.gov/patients/eligibility.asp
  2. Washington DC VA (Montgomery, Prince George’s, Charles, Calvert and Saint Mary's counties): http://www.washingtondc.va.gov/patients/eligibility.asp
  3. Martinsburg VA (Frederick, Washington, Allegany and Garrett counties) http://www.martinsburg.va.gov/patients/eligibility.asp
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Yes. You can continue to use VA health care coverage for all your health care needs, or complement your VA care with a private health plan through Maryland Health Connection, a private health plan you buy on your own from an insurance company, or coverage from other federal health care programs if you qualify, including Medicare, Medicaid and TRICARE.

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Because VA care meets the standard for health care coverage, you wouldn’t be eligible for financial assistance through Maryland Health Connection.

However, you may still purchase private health insurance at full cost through Maryland Health Connection or off-exchange through a health insurance company to complement your VA health care coverage.

If you are eligible for VA health care but are not enrolled in a VA health care program, you may still receive financial assistance for a plan through Maryland Health Connection if you are otherwise eligible.

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VA can’t make this determination. If you apply through Maryland Health Connection, you will find out if you can get lower costs on your monthly premiums for private health insurance plans.

Remember, if you are enrolled in a VA health care program, you don’t need to take additional steps to meet the health coverage requirements under the health care law.

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Your family members who are not enrolled in a VA health care program can apply through Maryland Health Connection to get coverage.

They may get lower costs on monthly premiums or out-of-pocket costs. They also may be eligible for free or low-cost coverage through Medicaid or the Maryland Children’s Health Program (MCHP).

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For information on VA health care and the Affordable Care Act, visit VA’s website at www.va.gov/aca, or call 1-877-222-VETS (8387), Mondays through Fridays 8 a.m. to 8 p.m.

For information on Maryland Health Connection, call our consumer support center at 1-855-642-8572 (1-855-642-8573), or find free, in-person help.

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After Applying: Verifying Your Information

If you have outstanding verifications (for example, we need to confirm citizenship or income), in most cases, your enrollment in Medicaid, MCHP or MCHP Premium is pending. You cannot obtain services until you submit your outstanding verifications and they have been approved.

Click here to see the types of documents accepted (PDF) to verify income, citizenship, identity or immigration status.

You may submit these documents online through MarylandHealthConnection.gov in your account inbox. If you are unable to submit these documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.

If you have questions about acceptable documentation, please call 1-855-642-8572 (TTY: 1-855-642-8573).

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If you submitted a paper application, you may receive a letter from Maryland Health Connection that asks you to sign your application and/or provide additional information to complete your application. To ensure that we can process your application, you must provide us with the information requested. If you do not provide us with the information in 45 days, your application will be closed. You must submit a new application if you are still interested in applying for coverage through Maryland Health Connection.

If you have any questions about your application, please contact Maryland Health Connection at 1-855-642-8572 for further assistance.

 

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If you have outstanding verifications (for example, we need to confirm information about your citizenship or income based on what you provided in your application), you will receive a notice requesting certain information. If you have outstanding verifications, you are eligible to enroll in health plan during this period. You have up to 95 days to provide the documents requested. If you do not provide the requested information within 95 days, your eligibility may change or your coverage may end.

Click here to see the types of documents accepted (PDF) to verify income, citizenship, identity or immigration status.

You may submit these documents online through Maryland Health Connection at www.marylandhealthconnection.gov. If you are unable to submit these documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.

If you have questions about acceptable documentation, please call 1-855-642-8572 (TTY: 1-855-642-8573).

Once we receive the requested information, your household’s eligibility for enrollment in a health plan may change. In order to remain enrolled in a QHP, we must be able to confirm that you are a U.S. citizen, U.S. national or lawfully residing in the U.S.

In addition, your eligibility for financial assistance, such as advance premium tax credits (APTC) and cost-sharing reduction benefits, could change. If we determine that your income is less than what you reported on your application, you could receive a tax credit and assistance with out-of-pocket costs, or the amount of the tax credit and out-of-pocket cost assistance that you were found eligible for may increase. If we determine that your income is more than what you reported on your application, you may get less financial help and have to pay back some or all of the tax credit that you received during the year when you file your federal tax return for that year.

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If you do not currently have an income, you can use this affidavit (PDF) as a verification document to prove your income status. Once you complete your application through Maryland Health Connection, you will receive a verification notice in the mail requesting verification of income.

In response to this request, you may either complete this affidavit and upload it to your online account or send it with the cover letter from the notice to the following address:

Maryland Health Connection
P.O. Box 857
Lanham, MD 20703

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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

The following types of documents are accepted for verification of income. Other verification documents may be accepted if you do not have the specific type listed here:

  • Most recent pay stubs (two weekly; two biweekly; or one monthly)
  • Tax records or returns
  • Unemployment Award Notice
  • Business records
  • Statement of Projected Earnings
  • Department of Labor statement
  • Employer letter
  • Income Source Statement
  • Social Security Administration benefits information (e.g. Benefit Verification Letter, also called a Budget Letter; Benefits Letter or Income Letter; Payment History; Earning Record)
  • Signed Affidavit of Current Income

Self-Employment

  • 1040 SE with Schedule C, F, or SE (for self-employment income)
  • 1065 Schedule K1 with Schedule E
  • Tax return
  • Bookkeeping records Receipts for ALL allowable expenses
  • Bank Statements (personal & business) and cancelled checks
  • Signed time sheets and receipt of payroll, if you have employees
  • Most recent quarterly or year-to-date profit and loss statement

Unearned Income

  • Annuity statement
  • Statement of pension distribution from any government or private source
  • Worker’s compensation letter
  • Prizes, settlements, and awards, including court-ordered awards letter
  • Proof of gifts and contributions
  • Proof of inheritances in cash or property
  • Proof of strike pay and other benefits from unions
  • Sales receipts or other proof of money received from the sale, exchange or replacement of things you own
  • Interests and dividends income statement
  • Loan statement showing loan proceeds
  • Royalty income statement or 1099-MISC
  • Proof of bonus/incentive payments (like a letter of bank statement showing deposit)
  • Proof of severance pay
  • Pay stub indicating sick pay
  • Letter, deposit, or other proof of deferred compensation payments
  • Pay stub indicating substitute/assistant pay
  • Pay stub indicating vacation pay
  • Proof of residuals
  • Letter, deposit, or other proof of travel/business reimbursement pay
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

The following types of documents are accepted for verification of citizenship. Other verification documents may be accepted if you do not have the specific type listed here:

  • U.S. Passport
  • Certificate of U.S. Citizenship
  • Certificate of Naturalization
  • Native American tribal documents (e.g. Tribal Enrollment Card, Certificate of Degree of Indian Blood, Tribal Census document, or documents on tribal letterhead signed by the tribal official)

OR one of the documents below, which must also be accompanied by proof of identity:

  • U.S. Public Birth Certificate
  • Certification of Report of Birth
  • Consular Report of Birth Abroad of a U.S. Citizen
  • Certification of Birth
  • U.S. Citizen ID Card
  • Northern Marianas ID Card
  • Adoption Papers showing the person’s name and U.S. place of birth
  • Evidence of U.S. Civil Service employment before June 1, 1976
  • U.S. Military Record showing U.S. place of birth
  • U.S. Medical Record showing U.S. place of birth
  • U.S. life, health or other insurance record showing U.S. place of birth
  • Religious record showing U.S. place of birth recorded in the U.S.
  • School record showing the child’s name and U.S. place of birth
  • Federal or State census record showing U.S. citizenship or U.S. place of birth
  • Documentation that a child meets the requirements of Section 101 of the Child Citizenship Act of 2000 (8 U.S.C. 1431)
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

The following types of documents are accepted for verification of identity. Other verification documents may be accepted if you do not have the specific type listed here:

  • Driver’s license issued by a State or Territory with a photo or other identifying info
  • Identification card or official document issued by federal, state or local government with a photo or other identifying info
  • Military Dependent’s Identification Card
  • School Identification Card with a photo
  • U.S. Military Card or Draft Record
  • U.S. Coast Guard Merchant Mariner Card
  • Clinic, doctor, hospital or school record for children under age 19
  • Finding of identity from a Federal or State governmental agency
  • Finding of identity from an Express Lane agency
  • Two documents containing consistent information that corroborates an applicant’s identity (e.g. employer identification cards, high school and college diplomas [including high school equivalency diplomas], marriage certificates, divorce decrees, and property deeds or titles)
  • Native American tribal document
  • Foreign passport, or identification card issued by a foreign embassy or consulate that contains a photograph
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

The following types of documents are accepted for verification of immigration status. Other verification documents may be accepted if you do not have the specific type listed here:

  • Permanent Resident Card (“Green Card”, I-551)
  • Temporary I-551 Stamp (on passport or I-94, I-94A)
  • Machine Readable Immigrant Visa (with temporary I-551 language)
  • Employment Authorization Card (EAD, I-766)
  • Arrival/Departure Record (I-94, I-94A)
  • Arrival/Departure Record in foreign passport (I-94)
  • Foreign Passport
  • Reentry Permit (I-327)
  • Refugee Travel Document (I-571)
  • Certificate of Eligibility for Nonimmigrant (F-1) Student Status (I-20)
  • Certificate of Eligibility for Exchange Visitor (J-1) Status (DS-2019)
  • Notice of Action (I-797)
  • Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
  • Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
  • Evidence of eligibility as a Cuban/Haitian Entrant
  • Document indicating withholding of removal (or withholding of deportation)
  • Document indicating resident of American Samoa
  • Administrative Order staying removal issued by the Department of Homeland Security
  • Document indicating a member of a federally recognized Indian tribe or American Indian born in Canada
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

Other verification documents may be accepted if you do not have the specific type listed here:

  • I-872 American Indian Card (Texas and Oklahoma Kickapoo American and Mexican members).
  • U.S. American Indian/Alaska Native tribal enrollment or shareholder documentation (tribal enrollment/membership card)
  • Enrollment or membership document from a federally-recognized tribe or the Bureau of Indian Affairs (BIA). It must be on tribal letterhead or an enrollment/membership card that contains the tribal seal and/or an official signature.
  • Document issued by an Alaska Native village/tribe, or an Alaska Native Corporation Settlement Act (ANCSA) regional or village corporation acknowledging shareholder status.
  • Letter from the Marketplace granting a tribal exemption based on tribal membership or Alaska Native shareholder status.
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

Other verification documents may be accepted if you do not have the specific type listed here:

  • Official release papers from the institution or Department of Corrections
  • Parole papers
  • Unexpired state ID, driver’s license, work ID, or passport
  • Paystubs
  • Federal, state, or local benefit letter
  • Clinic, doctor, or hospital records for services provided
  • Medical claim explanation of benefits provided
  • School record/schedule showing enrollment (i.e. for college students)
  • Bank or credit card statement showing transaction history (showing only the name of the individual in question; no joint accounts)
  • Military records
  • Cell phone bill (showing only the name of the individual in question)
  • Lease (must be an active lease where the individual is currently residing)
  • Signed notarized statement from the individual with alleged false incarceration inconsistency indicating they’re living in the community and includes their name, date of birth, and address
  • Written statement from someone within the community which states the name, date of birth, address, phone number, their relationship with the individual with alleged false incarceration inconsistency, and that the individual is present and participating within the community
  • Rent receipts (showing only the name of the individual with the false incarceration inconsistency)
  • A written explanation of circumstances as to why the applicant doesn’t have documentation
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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Maryland Health Connection is required by federal law to verify people’s SSNs and other information when determining eligibility for health insurance programs.

If you did not enter your SSN, entered it incorrectly, or do not have one, you may receive a notice in your account inbox or the mail requesting that you provide additional information because Maryland Health Connection was not able to electronically verify an SSN or other information, such as income.

If you have a SSN, a copy of one of the documents below is acceptable:

  • Social Security card
  • Tax form(s)
  • Benefit or income statement from Social Security containing your SSN

If you do not have an SSN or are applying for one, a copy of one of the documents below is acceptable:

  • Pending application for an SSN
  • Letter from Social Security stating that you’re not eligible for an SSN or are only eligible for a non-work SSN
  • Letter stating that you refuse to obtain an SSN for established religious objections
  • Affidavit/Exemption from Obtaining an SSN (for people who are not eligible for an SSN, can only obtain one for non-work purposes, or who have a religious objection.)

Other types of documents may be acceptable. If you do not see a particular type of document listed, contact Maryland Health Connection or, your local health department (PDF) or department of social services.

How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703. Please include the cover page with a barcode that came with your notice.

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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

Other verification documents may be accepted if you do not have the specific type listed here:

  • Driver’s license
  • State ID
  • Mortgage payment receipt
  • Mortgage deed showing primary residency
  • Lease agreement
  • School enrollment documentation
  • Utility bill
  • Government mail (SSA statement, DMV notice, etc.)
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

Other verification documents may be accepted if you do not have the specific type listed here:

  • Completed Employer Coverage Tool (PDF) and a cover letter signed by the employer
  • Letter or other documentation from an employer or other documentation with this information:
    • Statement that the employer doesn’t currently offer coverage to the employee (or the employee’s family member)
    • Statement that the employer doesn’t provide coverage that meets the minimum value standard
    • Statement showing the cost of the employee's share of the premium for the lowest-cost self-only plan that meets the minimum value standard (factoring in wellness incentives), if offered
  • Health insurance letter that contains confirmation of health coverage and expiration dates for coverage received outside of the Marketplace
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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When you apply through Maryland Health Connection, you may be requested to provide documentation to verify information you provided in your application.

Other verification documents may be accepted if you do not have the specific type listed here:

  • Letter from health insurer including coverage termination date
  • Statement of health benefits that provides confirmation of health coverage and expiration dates
  • Letter from Veterans Administration that provides confirmation of health coverage and expiration dates
  • Letter from Peace Corps that provides confirmation of health coverage and expiration dates
  • Letter or statement of Medicare or Medicaid benefits that proves confirmation of health coverage and expiration dates
  • Letter or statement of Medicaid or Maryland Children’s Health Program (MCHP) benefits that proves confirmation of health coverage and expiration dates
  • Letter from the Social Security Administration that provides confirmation of health coverage and expiration dates
How do I provide my documents?
  1. Log into your online account at MarylandHealthConnection.gov and upload documents using the link in “My Inbox.” Get uploading tips here.
  2. Download our free mobile app (Enroll MHC) to submit documents using the camera of your mobile device (iOS or Android)
  3. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703.
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After Enrollment

Once you are eligible for Medicaid, you’ll choose a managed care organization to oversee your care. Compare MCOs here (PDF). If you do not pick an MCO within 28 days, you will be automatically assigned to one.

The MCOs that you can choose are:

  • Aetna Better Health of Maryland
  • AMERIGROUP Community Care
  • Jai Medical Systems
  • Kaiser Permanente
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare
  • University of Maryland Health Partners

You can enroll in an MCO any of these ways:

  • Visit MarylandHealthConnection.gov and log into your account.
  • Download our free mobile app, Enroll MHC.
  • Call us at 1-855-642-8572 (TTY: 1-855-642-8573).
  • Request an enrollment kit be mailed to you. You can do so in your online account or by calling us. Complete the MCO enrollment form and mail it back in the envelope provided (no stamp needed).

Ask your doctors which MCOs they accept, or use the MCO provider search tool to find doctors by name, specialty, location or MCO.

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It’s important to know that if you are enrolled in a qualified health plan, the primary applicant when you applied (the plan subscriber) is the contract holder with the insurance company. For this reason, to change the primary applicant you will need to disenroll the entire household from coverage and then re-enroll with a different primary applicant.

You should note when changing policies that insurance companies currently do not transfer accumulators such as deductibles and copays from one policy to the next.

Follow these steps below carefully to avoid a gap in coverage:
Step 1: At least 10 days before the end of the month, disenroll the entire household from coverage (effective the last day of the month) by logging into your account at MarylandHealthConnection.gov and using the "End My Current Coverage" Quick Link. See our quick guide (PDF).

Step 2: Wait 5 days, and then create a new account through MarylandHealthConnection.gov. In this new account, complete an application for coverage with a new primary applicant and any other remaining household members (which may include the previous primary applicant).

Under the Special Enrollment questions, choose loss of coverage. The new plan will be effective the first day of the following month.

Remember, when choosing a new primary applicant, he or she does not need to be applying for coverage, but must be at least 18 years old. If the primary applicant is not seeking coverage, the second person listed in the household on the application will be considered the primary subscriber by the insurance company.

Learn more here about who in the application may be the primary applicant.

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Becoming pregnant is not considered a life event that triggers a special enrollment period to enroll in a qualified health plan through Maryland Health Connection outside of Open Enrollment or to change your current health plan. Giving birth will qualify you for a special enrollment period.

However, if you become pregnant, you should update your information with Maryland Health Connection as soon as possible because this change may make you eligible for Medicaid (PDF). You can apply for Medicaid at any point during your pregnancy.

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To end your household's qualified health plan or Medicaid coverage, you may log into your account at MarylandHealthConnection.gov and use the "End My Current Coverage" Quick Link. See our quick guide (PDF) .

Request cancellation by the last day of the month you want your coverage to end.

You also may end coverage by calling our consumer support center at 1-855-642-8572 (TTY: 1-855-642-8573), or getting free, in-person help.

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Individuals with questions about payments for coverage through MCHP Premium should contact the MCHP Premium Case Management Unit at 410-767-6883 (toll-free: 1-866-269-5576).

You may make an MCHP Premium payment online at http://dhmh.maryland.gov/payments.

The premium amount charged for MCHP Premium is assessed per family, not per child. The 2017 premium amounts are:

  • Premium for families between 200-250% FPL: $54 per month
  • Premium for families between 250-300% FPL: $67 per month
  • American Indians do not have to pay a monthly premium to enroll in MCHP Premium.
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Your managed care organization (MCO) through Medicaid covers doctor visits, pregnancy care, prescription drugs, hospital and emergency services, and more, at no cost.

Your MCO covers these services and more:

  • Visits to the doctor, including regular checkups and specialists
  • Pregnancy care
  • Family planning and birth control
  • Prescription medicines
  • Hospital and emergency services
  • Primary mental health services through your doctor

Compare MCOs (PDF)
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MCHP gives full health benefits for children up to age 19, including these and more:

  • Doctor visits (wellness and sick care)
  • Lab work and tests
  • Vision care
  • Immunizations (shots)
  • Prescription medicines
  • Hospital and emergency services
  • Primary mental health services
  • Dental care through the Maryland Healthy Smiles Dental Program
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The MCOs that you can choose are:

  • Aetna Better Health of Maryland
  • AMERIGROUP Community Care
  • Kaiser Permanente
  • Jai Medical Systems
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare
  • University of Maryland Health Partners

Compare MCOs (PDF)
Download Adobe Reader

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When your Medicaid application is complete and verified, you will choose a managed care organization (MCO) to provide your care.

There are several ways to choose your MCO and primary care doctor:

  • Visit MarylandHealthConnection.gov and log into your account.
  • Download our free mobile app, Enroll MHC.
  • Call us at 1-855-642-8572 (TTY: 1-855-642-8573).
  • Request an enrollment kit be mailed to you. You can do so in your online account or by calling us. Complete the MCO enrollment form and mail it back in the envelope provided (no stamp needed).

The MCOs that you can choose are:

  • Aetna Better Health of Maryland
  • AMERIGROUP Community Care
  • Jai Medical Systems
  • Kaiser Permanente
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare
  • University of Maryland Health Partners

Compare MCOs
MCO Report Card

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When you make a doctor’s appointment, let them know you are enrolled in Medicaid or MCHP and give them the name of your MCO.

After you find a doctor and schedule your first appointment, bring the following:

  • Your red and white Medical Assistance card, and your MCO card
  • A list of any medications you are currently taking
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Now that you’ve enrolled, you’ll be receiving some additional materials from Maryland Health Connection and your new insurance company. Please note that these materials may vary depending on the plan you chose.

Information From Your Insurance Company
Your health insurance company will send you information by mail or email about your insurance plan and how to pay your monthly bill (premium). Payments should be made directly to the insurance company.

First Bill
You will receive a bill and payment instructions from your insurance company. See our payment guide with instructions from your insurance company. Pay your bill by the first of the month if you can. It is important to pay your first bill immediately.

Member ID Card
Your insurance company will mail you a member ID card after you pay your bill. You can use health services once the bill is paid, even if you haven’t received a card.

Find a Doctor in Your Plan
You will pay the lowest costs for services when you see an “in-network” doctor. To find a doctor who accepts your plan:

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If you have questions about your bill or coverage, contact your insurance company directly:

Payment Guide

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Your insurance company will mail you a member ID card after you pay your bill. You can use health services once the bill is paid, even if you haven’t received a card.

Your insurance company may allow you to print a temporary ID card if you need care prior to receiving your member ID card.

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1. You’ll be mailed a red and white medical assistance card. Do not throw away this card.

2. You’ll choose a managed care organization (MCO) to provide your care, once your application is complete and verifiedLearn more about choosing an MCO.

3. You will renew your Medicaid or MCHP coverage once a year, or it may be automatically renewed. You’ll be contacted when it is time to renew.

If your child is enrolled in MCHP Premium and you have questions about submitting the monthly payment, please contact the MCHP Premium Case Management Unit at 410-767-6883 (toll-free: 1-866-269-5576).

You may make an MCHP Premium payment online at http://dhmh.maryland.gov/payments.

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In addition to your monthly bill, or premium, there are costs you may pay out-of-pocket when you use medical services:

  • Deductible: The amount you owe for health care services before your health insurance begins to pay.
  • Coinsurance: Your share of the costs of a covered health care service. This is calculated as a percent (for example, 20%) of the allowed amount for the service.
  • Network: The list of the doctors, health care providers, and hospitals that a health plan has contracted with to provide medical care to its members.
  • Copayment (copay): A set amount you pay for a covered health care service. For example, your copayment to see your primary care provider may be $15.

Glossary.

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Medicaid enrollment is year-round. Medicaid recipients have an annual right to change MCOs if they so choose.

You may change MCOs for any reason within the first 90 days of initial enrollment.

You also may change MCOs in select circumstances, such as combining all household members or children into the same MCO, or if you moved and your current MCO does not provide service in the county where you now live.

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After you enroll, it’s important to tell Maryland Health Connection right away if you’ve had changes in your household or income to be sure you are receiving the right coverage and financial help.

You can update your information by revisiting your application online and changing what’s necessary. Or you can call us at 1-855-642-8572 (TTY: 1-855-642-8573), or find free-in-person help at MarylandHealthConnection.gov/help.

Changes you should report include:

  • Getting married or divorced
  • Having a child, adopting a child, or placing a child for adoption or in foster care
  • Changes in income
  • Moving to Maryland, and moves within the state
  • Having a change in disability status
  • Gaining or losing a dependent
  • Certain losses of other health coverage (such as employer ending coverage, loss of job, or leaving a job that provides coverage)
  • Turning 26 years old and coming off of your parent’s health plan

You also should report other changes that may not affect your eligibility, such as changes to your address and corrections to your name, date of birth, or Social Security Number.

Learn more at MarylandHealthConnection.gov/lifechanges.

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If the recipient was in an MCO within the last 120 days, then they will go back into the previous MCO if there are slots available; if not, they will be randomly assigned. If the recipient is new to Medicaid or it has been more than 120 days since they were enrolled in an MCO, the recipient will be randomly assigned to an MCO. If the recipient is a newborn, the child will be assigned to their mother’s MCO.

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Coverage, Benefits and Plans

Once you are eligible for Medicaid, you’ll choose a managed care organization to oversee your care. Compare MCOs here (PDF). If you do not pick an MCO within 28 days, you will be automatically assigned to one.

The MCOs that you can choose are:

  • Aetna Better Health of Maryland
  • AMERIGROUP Community Care
  • Jai Medical Systems
  • Kaiser Permanente
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare
  • University of Maryland Health Partners

You can enroll in an MCO any of these ways:

  • Visit MarylandHealthConnection.gov and log into your account.
  • Download our free mobile app, Enroll MHC.
  • Call us at 1-855-642-8572 (TTY: 1-855-642-8573).
  • Request an enrollment kit be mailed to you. You can do so in your online account or by calling us. Complete the MCO enrollment form and mail it back in the envelope provided (no stamp needed).

Ask your doctors which MCOs they accept, or use the MCO provider search tool to find doctors by name, specialty, location or MCO.

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When you shop for a plan through MarylandHealthConnection.gov, you can review exactly what is covered, and the costs for specific medical services.

You can also visit your insurance company’s website or review any information mailed to you for what your plan covers. Call your insurer directly if you have questions.

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To end your household's qualified health plan or Medicaid coverage, you may log into your account at MarylandHealthConnection.gov and use the "End My Current Coverage" Quick Link. See our quick guide (PDF) .

Request cancellation by the last day of the month you want your coverage to end.

You also may end coverage by calling our consumer support center at 1-855-642-8572 (TTY: 1-855-642-8573), or getting free, in-person help.

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If you need coverage before Maryland Health Connection qualified health plans become effective on January 1, you may have some options:

If you are eligible for Medicaid, MCHP, or MCHP Premium, you can sign up at any time during the year. Look up your income and household size (PDF) to see if you may qualify.

You can apply for Medicaid, MCHP, or MCHP Premium at any time:

You may be able to buy a qualified health plan directly from a participating insurance company.

Finally, if you have recently experienced a major life event or special circumstance, you may be eligible to enroll in a qualified health plan through Maryland Health Connection outside of the annual Open Enrollment period. Learn more here about whether you may qualify to buy a plan and how to enroll.

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Medicaid

If you are eligible for Medicaid, MCHP, or MCHP Premium:

  • Your coverage begins on the first day of the month that you applied. For example, if you apply on December 18 and are found eligible, your coverage will be considered effective as of December 1.
  • You may also be able to get help with medical bills that you incurred up to 3 months before you applied. Applicants who are in need of retroactive coverage and did not select this option during online enrollment should contact their local health department (PDF) or department of social services.

Qualified Health Plans

The annual open enrollment period is November 1 to December 15, 2017. Coverage starts January 1, 2018.

Make sure you pay your monthly bill:

  • Your qualified health plan requires a monthly payment, known as a premium. The insurance company you select will send you a monthly bill with payment instructions. View our Payment Guide for information on initial billing and contact information for your insurance company.
  • Your coverage only will be effective as long as you pay your monthly premium on time, and you continue to qualify for enrollment in a qualified health plan. If you haven’t received a bill, call your insurance company.

Special Enrollment Period

If you enroll in a qualified health plan through a special enrollment period:

  • In most cases, if you qualify for a special enrollment period to change plans and report your new plan selection to Maryland Health Connection between the 1st and the 15th of the month, your coverage will begin on the 1st of the following month.
  • If you report your new plan selection between the 16th and the last day of a month, your coverage will begin on the 1st of the next following month. For example, if you select your plan July 16, your coverage will begin Sept. 1.
  • For some life events, your coverage may be available sooner. In the case of a birth, adoption, or placement in foster care or for adoption, the plan will take effect on the date of the event. For example, if you have a baby on May 20, and select a plan through Maryland Health Connection on June 1, coverage for you and the baby will begin May 20.
  • In the case of marriage or loss of certain other health coverage, the plan selected through a special enrollment period will take effect on the 1st of the month following your marriage or loss of coverage. For example, if you lose your employer-sponsored coverage June 10 and select your plan June 20, your coverage will begin July 1.
  • If you report a change to your information, you will receive a new eligibility determination letter from Maryland Health Connection.
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Medical insurance companies:

  • CareFirst
  • Kaiser Permanente
  • Cigna

Dental insurance companies:

  • Alpha Dental
  • Dominion Dental
  • Delta Dental
  • CareFirst
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These are all types of qualified health plans offered through Maryland Health Connection. The Platinum, Gold, Silver, and Bronze plan categories cover different percentages of your medical expenses. These major types of coverage are designed to make it easier for you to compare plans. Health insurance plans that cover more of your expenses when you receive health care services – for example, when you visit the doctor or go to the hospital – will typically have a higher monthly premium.

MHC Metal Level Chart

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All qualified health plans offered through Maryland Health Connection provide the same set of “essential health benefits,” which include:

  • Doctor visits and other ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
  • Prescription drugs
  • Emergency services
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Essential health benefits represent the minimum services that all plans must cover. In fact, all individual and small group plans sold in Maryland now must cover essential health benefits. It does not matter if they are sold by us or if they are sold outside of the Maryland Health Connection. Some of the Maryland Health Connection plans may offer additional benefits or even more reduced cost-sharing for some services.

When you sign up, the Evidence of Coverage (EOC) on the plan information page will show you each plan’s coverage so you can compare the benefits side-by-side. In addition, once you choose a plan, the insurance company will send you a Summary of Plan Benefits that should be used as a reference. You may contact the insurance company for clarification of the coverage provided by your plan if you need further assurances or guidance.

For information on Medicaid benefits, click here. You can also click here (PDF) to compare services covered by MCOs in Maryland.

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Yes. People under age 30, or those who are older than 30 and have been certified by the federal Department of Health and Human Services to qualify for a hardship or affordability exemption, may purchase a “catastrophic” health plan through Maryland Health Connection. Click here for more information on exemptions.

“Catastrophic” health plans protect you from very high medical costs caused by an unanticipated condition or event. You are generally required to pay all of your medical costs up to a certain amount. Costs for essential health benefits over that amount are generally paid by the insurance company. You will also get three primary care visits per year and key preventive benefits at no cost.

Premiums tend to be lower with a catastrophic plan as compared to a traditional health insurance plan. However, if you qualify for and buy a catastrophic plan, you won’t be eligible for tax credits that may lower your premium costs or for other subsidies.

When you fill out an application for coverage, you’ll see catastrophic plans listed as an option if you qualify for them. If you don’t qualify, you won’t see them as an option to select.

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Maryland Health Connection offers several health plans that are compatible with HSAs.

Maryland Health Connection does not sell HSAs, but HSAs might be offered by an insurance company or other outside vendor.

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Yes: Open enrollment for 2018 dental plans was November 1 to December 15, 2017. Coverage started January 1, 2018.

You can choose either from a dental-only plan or a dental plan in addition to your health plan. Maryland Health Connection offers child-only and family dental plans.

All of our qualified health plans cover dental services for children. In fact, preventive dental services for children – such as checkups – are free of all cost-sharing. In addition, we currently offer stand-alone dental plans for children who are not enrolled in a health plan through Maryland Health Connection.

If you’re enrolling in Medicaid, your MCO may offer limited adult dental services (PDF). For pregnant adults and children younger than 21, dental care, including exams, cleanings, fillings, and braces if medically necessary are covered through the Healthy Smiles Dental Program (1-855-934-9812).

Please note that dental benefits are not protected by the out-of-pocket maximum established by the Affordable Care Act. Also, any advance premium tax credits that a person receives through Maryland Health Connection cannot be used to help pay for the costs of standalone dental plans.

Note that the Affordable Care Act treats dental coverage differently for children versus adults. For children, dental coverage is an “essential health benefit,” which means it must be made available to you and is included in Maryland as part of a medical plan. Insurers do not have to offer adult dental coverage.

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No, in general, once you sign up for a plan, you cannot change plans until the next Open Enrollment period. A change in your health situation — such as a new illness or an accident — does not make you eligible for a special enrollment opportunity. But, if you experience certain other qualifying life events — such as moving or the birth of a child — you may be able to switch plans midyear through a special enrollment period.

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It will depend on which doctors are part of the “network” put together by your plan. You may be able to keep all of your current physicians, but keep in mind that some doctors may be out-of-network, including doctors who practice in other states. While you can see out-of-network providers, your insurance company may not cover as much (or any) of the cost of a non-emergency visit. It is important that you contact the insurance company to ask them about their network outside of Maryland and make sure that you know if your specific doctor is in-network or not.

You can also use our provider search at marylandhealthconnection.gov/find-a-doctor to find doctors by plan, location, name and more.

You may also want to explore multi-state plans offered through Maryland Health Connection.

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College students have several choices for health coverage. But there’s no special student exemption from the penalty that people without coverage must pay.

  • If you’re covered by your school’s student health plan, in most cases you’re considered covered under the health care law. So, you won’t have to pay the mandate penalty when you file taxes. You should double check with your student health plan to see if it qualifies as minimum essential coverage under the health law.
  • Even if you have access to a student health plan, you can choose to buy a health plan through Maryland Health Connection instead. You may qualify for lower costs based on your income.
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To find a doctor who participates in your health plan or MCO, visit marylandhealthconnection.gov/find-a-doctor.

You can also ask your current doctors which health plans they accept, or call the insurance company or check their website for a health provider directory.

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All plans through Maryland Health Connection and Medicaid plans cover pregnancy and childbirth (which include services provided before and after your child is born). This is true even if your pregnancy begins before your coverage takes effect.

Medicaid and Pregnancy/Childbirth

You can sign up for Medicaid at any time if you meet income and other eligibility criteria (PDF). You can apply for Medicaid at any point during your pregnancy; it does not matter if it is outside the open enrollment period. If you think you may qualify for Medicaid, it is best to apply as soon as possible.

Qualified Health Plans and Pregnancy/Childbirth

Health plans must provide a Summary of Benefits and Coverage document, which describes how the plan covers the costs of having a baby. You’ll see a link to a summary when you compare plan details or when you preview plans and prices before you apply through Maryland Health Connection.

If you did not enroll in a qualified health plan during open enrollment, becoming pregnant is not considered a life event that triggers a special enrollment period.

However, giving birth will qualify you for a special enrollment period. When you enroll in the new plan, your coverage can be effective from the day the baby was born. If you already had a qualified health plan through Maryland Health Connection, you can do one of two things when your baby is born: (1) Keep your current plan and add your child to your coverage; or (2) change to a different plan through Maryland Health Connection.

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Plans through Maryland Health Connection must cover the following preventive services for adults without charging a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

These services are free only when delivered by a doctor or other provider in your plan’s network.

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults over 50
  7. Depression screening for adults
  8. Diabetes (Type 2) screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
  12. Obesity screening and counseling for all adults
  13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  14. Syphilis screening for all adults at higher risk
  15. Tobacco Use screening for all adults and cessation interventions for tobacco users
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A copayment is a fixed fee (for example, $15) that you pay for a covered health care service, usually at the time you receive the service. The amount can vary by the type of covered health care service.

Coinsurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any annual deductibles you owe in the plan year. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance plan pays the rest of the allowed amount.

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Most health plans must cover a set of preventive health services for children at no cost. This includes qualified health plans through Maryland Health Connection, as well as coverage through Medicaid or the Maryland Children’s Health Program (MCHP).

Plans through Maryland Health Connection must cover the following preventive services for children without charging a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

These services are free only when delivered by a doctor or other provider in your plan’s network.

  1. Alcohol and drug use assessments for adolescents
  2. Autism screening for children at 18 and 24 months
  3. Behavioral assessments for children ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years
  4. Blood pressure screening for children ages: 0 to 11 months1 to 4 years , 5 to 10 years11 to 14 years15 to 17 years
  5. Cervical dysplasia screening for sexually active females
  6. Depression screening for adolescents
  7. Developmental screening for children under age 3
  8. Dyslipidemia screening for children at higher risk of lipid disorders ages: 1 to 4 years5 to 10 years,11 to 14 years15 to 17 years
  9. Fluoride chemoprevention supplements for children without fluoride in their water source
  10. Gonorrhea preventive medication for the eyes of all newborns
  11. Hearing screening for all newborns
  12. Height, weight and body mass index (BMI) measurements for children ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years
  13. Hematocrit or hemoglobin screening for all children
  14. Hemoglobinopathies or sickle cell screening for newborns
  15. Hepatitis B screening for adolescents at high risk, including adolescents from countries with 2% or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence: 11 – 17 years.
  16. HIV screening for adolescents at higher risk
  17. Hypothyroidism screening for newborns
  18. Immunization vaccines for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
  19. Iron supplementsfor children ages 6 to 12 months at risk for anemia
  20. Lead screening for children at risk of exposure
  21. Medical history for all children throughout development ages: 0 to 11 months1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years
  22. Obesity screening and counseling
  23. Oral health risk assessment for young children ages: 0 to 11 months1 to 4 years5 to 10 years
  24. Phenylketonuria (PKU) screening for newborns
  25. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  26. Tuberculin testing for children at higher risk of tuberculosis ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years
  27. Vision screening for all children
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Plans through Maryland Health Connection must cover the following preventive services for adults without charging a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

These services are free only when delivered by a doctor or other provider in your plan’s network.

Services for pregnant women or women who may become pregnant

  1. Anemia screening on a routine basis
  2. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  3. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.” Learn more about contraceptive coverage.
  4. Folic acid supplements for women who may become pregnant
  5. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  6. Gonorrhea screening for all women at higher risk
  7. Hepatitis B screening for pregnant women at their first prenatal visit
  8. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  9. Syphilis screening
  10. Expanded tobacco intervention and counseling for pregnant tobacco users
  11. Urinary tract or other infection screening

Get more information about services for pregnant women from HealthFinder.gov

Other covered preventive services for women

  1. Breast cancer genetic test counseling (BRCA) for women at higher risk
  2. Breast cancer mammography screenings every 1 to 2 years for women over 40
  3. Breast cancer chemoprevention counseling for women at higher risk
  4. Cervical cancer screening for women age 21 and older
  5. Chlamydia infection screening for younger women and other women at higher risk
  6. Domestic and interpersonal violence screening and counseling for all women
  7. Gonorrhea screening for all women at higher risk
  8. HIV screening and counseling for sexually active women
  9. Human Papillomavirus (HPV) DNA test every 3 years for women with normal cytology results who are 30 or older
  10. Osteoporosis screening for women over age 60 depending on risk factors
  11. Rh incompatibility screening follow-up testing for women at higher risk
  12. Sexually transmitted infections counseling for sexually active women
  13. Syphilis screening for women at increased risk
  14. Tobacco use screening and interventions
  15. Well-woman visits to get recommended services for women under 65
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Dental Plans

No. Under the health care law, most people must have health coverage or pay a fee. Dental coverage is optional, so you don't need it to avoid the penalty.

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Browse dental plans and prices, and enroll online for coverage at MarylandHealthConnection.gov. Open enrollment for 2018 is November 1 to December 15, 2017.

When you apply through Maryland Health Connection, you will be able to buy a dental-only plan, or enroll in dental at the same time you buy a health plan.

For 2017, Maryland Health Connection offers 18 dental plans from six participating dental insurance companies. These plans are for the entire calendar year and are certified by Maryland Health Connection for quality.

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No; Advance Premium Tax Credits may only be applied to qualified health plans sold through Maryland Health Connection.

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Open Enrollment for dental plans through Maryland Health Connection is Nov. 1 to Dec. 15.

Your dental plan will continue each year as long as you pay your monthly premium on time. Your premium may increase or decrease each year depending on household changes.

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Stand-Alone Dental Plans through Maryland Health Connection have a pediatric Out-of-Pocket Maximum of $350 for one child and $700 for two or more children.

For adult family members (older than 19), a Stand-Alone Dental Plan is not required to have a set Out-of-Pocket Maximum. Instead, most SADPs have an Annual Maximum for adult members, meaning the plan will pay out benefits only up to a certain amount. After an adult member reaches the Annual Maximum, the SADP will stop paying for dental services and procedures.

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A plan can only put a lifetime maximum benefit on services that are not considered essential health benefits.

A lifetime maximum benefit is the maximum amount a plan will pay out for specific services. For example, pediatric dental services are considered an essential health benefit, so there is no cap to how much a dental plan will pay for pediatric dental care. Adult dental services are not considered essential health benefits, so dental plans may put a cap on how much they will pay out for adult dental services.

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Yes, all dental plans sold through Maryland Health Connection offer statewide coverage.

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Visit Maryland Health Connection’s provider search at marylandhealthconnection.gov/find-a-doctor to search by carrier, plan name or provider.

You can also call the insurance company or check their website for a health provider directory. Be sure to call your doctor's office to confirm they accept your plan.

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Yes, there typically will be separate bills.

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Maryland Health Connection offers child-only and family dental plans for 2016.

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Yes; you can purchase a dental-only plan, or buy a dental plan at the same time you enroll in a health plan.

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You can get help understanding dental plans and benefits from the National Association of Dental Plans. For more information, visit www.nadp.org.

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Yes: Open enrollment for 2018 dental plans was November 1 to December 15, 2017. Coverage started January 1, 2018.

You can choose either from a dental-only plan or a dental plan in addition to your health plan. Maryland Health Connection offers child-only and family dental plans.

All of our qualified health plans cover dental services for children. In fact, preventive dental services for children – such as checkups – are free of all cost-sharing. In addition, we currently offer stand-alone dental plans for children who are not enrolled in a health plan through Maryland Health Connection.

If you’re enrolling in Medicaid, your MCO may offer limited adult dental services (PDF). For pregnant adults and children younger than 21, dental care, including exams, cleanings, fillings, and braces if medically necessary are covered through the Healthy Smiles Dental Program (1-855-934-9812).

Please note that dental benefits are not protected by the out-of-pocket maximum established by the Affordable Care Act. Also, any advance premium tax credits that a person receives through Maryland Health Connection cannot be used to help pay for the costs of standalone dental plans.

Note that the Affordable Care Act treats dental coverage differently for children versus adults. For children, dental coverage is an “essential health benefit,” which means it must be made available to you and is included in Maryland as part of a medical plan. Insurers do not have to offer adult dental coverage.

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Exemptions and the Tax Penalty

As of January 1, 2014, most U.S. residents are required to have health coverage.  You (and each person in your tax household who doesn’t have coverage) may be assessed a tax penalty unless you apply for and qualify for an exemption. Learn more here about the penalty, exemptions, and download forms to apply for an exemption.

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To ensure that you have coverage for the entire year, you should enroll in a qualified health plan by December 15 for coverage that will begin on January 1.

Under federal law, you will not face a penalty if you are uninsured for less than three months. But, since it can be hard to predict when you might face such gaps in coverage, you may want to ensure that you have coverage as early in the calendar year as possible.

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For each month that you did not have coverage, you will be assessed a penalty equivalent to 1/12 of the yearly penalty.

The federal government has set the following yearly tax penalties for individuals who do not have coverage:

  • For 2014, 1% of your gross household income over the federal income tax filing threshold, or $95 per individual – whichever is greater.
  • For 2015, 2% of your gross household income over the federal income tax filing threshold, or $325 per individual – whichever is greater.
  • For 2016, 2.5% of your gross household income over the federal income tax filing threshold, or $695 per individual – whichever is greater.
  • For 2017, 2.5% of your gross household income over the federal income tax filing threshold, or $695 per individual and $347.50 per child under 18 – whichever is greater.

Tax penalties also cannot exceed the national average cost of buying a Bronze plan.

The law provides exemptions for certain individuals, including those below a certain income and those who are without coverage for fewer than three months.

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U.S citizens who live abroad for at least 330 days within a 12-month period are not required to pay a penalty if they do not have health insurance. Instead, they are treated as having minimum essential coverage for the whole year even if they are actually not enrolled in coverage outside of the U.S.

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If you are a business owner with fewer than 50 full time or full-time-equivalent (FTE) employees, you are not required to offer health insurance to your employees. And, you will not have to pay a penalty if you do not provide insurance to your employees. Your employees can get health coverage through Maryland Health Connection’s individual marketplace.

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If you are covered by any of the following throughout the year (considered “minimum essential coverage”), you will not have to pay a tax penalty:

  • Any plan you get through Maryland Health Connection or any individual insurance plan you already have
  • Any employer plan that qualifies as minimum essential coverage, including COBRA or retiree plans
  • Medicare (Part A)
  • Medicaid
  • MCHP or MCHP Premium
  • TRICARE
  • Most Veterans Affairs Health Programs
  • Peace Corps Volunteer Plans
  • Other plans may also qualify. Ask a Maryland Health Connection representative if you’re not sure.
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College students have several choices for health coverage. But there’s no special student exemption from the mandate penalty for failure to have insurance.

If you’re covered by your school’s student health plan, in most cases you’re considered covered under the health care law. You won’t have to pay the penalty that people without coverage must generally pay. Check with your student health plan to see if it qualifies as minimum essential coverage under the health law.

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Some people are exempt from the requirement to have health coverage and do not have to pay a fee (sometimes called "the penalty") even if they remain uninsured.

Depending on the reason for requesting an exemption, you will need to apply for an exemption when you file your federal taxes or by submitting an application to the federal Department of Health and Human Services (HHS). The federal government will decide who is exempt from the coverage requirement.

Currently, there are a number of situations where someone may be exempt from the tax penalty, including:

  1. Religious objections (that is, you are a member of a recognized religious sect with religious objections to insurance or elements of minimum essential coverage)
  2. Member of a recognized health care sharing ministry
  3. Incarcerated individuals
  4. Member of a federally recognized American Indian tribe (a non-member spouse can be exempt if they apply for a hardship exemption)
  5. You have faced certain hardships such as homelessness or foreclosure
  6. Income too low for you to be required to file a tax return
  7. Inability to afford health coverage (the cheapest Bronze plan option would cost more than eight percent of your household MAGI income)
  8. Short coverage gaps (fewer than 3 consecutive months), although if you do not become covered before the end of the 3-month period, you cannot take advantage of this exemption.
  9. Persons not lawfully present in the United States

Learn more about exemptions from the requirement to have health coverage and how to apply.

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Small Business

Benefits for your growing business:

  • Tax credits to help pay your share of employee premium costs (if you qualify)
  • Flexibility in contributing to your employee’s premiums
  • Simplicity in paying for your employee’s premiums
  • More coverage options for you and your employees
  • Excellent customer service if you have questions about your coverage
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There are two enrollment options available to small business owners in the SHOP Marketplace: Employer Choice and Employee Choice.

In the Employer Choice option, the employer selects a single insurance company, and employees may choose any plan that the insurance company offers.

In the Employee Choice option, the employer selects a metal level, and the employees may choose any plan offered by any insurance company within that metal level.

SHOP Employer Choice Chart

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To learn about the carriers participating on the SHOP this year and see SHOP-certified plans, visit MarylandHealthConnection.gov/small-business/.

Aetna

aetna logo

Phone: 1-855-885-3289
Email: mdsmnewbusin@aetna.com

CareFirst

CareFirst logo

Phone: 1-888-567-9155

Kaiser Permanente

Kaiser Permanente logo

Phone: 1-855-258-9161

UnitedHealthcare

United Health Care logo

Member Services: 1-877-856-2430
Employers/Brokers: 1-888-842-4571

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For information on the SHOP, visit MarylandHealthConnection.gov/SHOP/

  • Select and use a SHOP-authorized broker.
    To see a list of authorized producers, click here (PDF).
  • Contact Maryland Health Connection's SHOP Administrator:
    Phone: (410) 547-8153
    Email: MHBE.SHOP@maryland.gov
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To be eligible to participate in the SHOP Marketplace, you must:

The SHOP will review the employer's application to confirm that the employer meets each of these SHOP eligiblity requirements. Maryland Health Connection will provide the employer with a notice of the employer's eligibility determination.

Eligibility for the Small Business Health Care Tax Credit is determined by the IRS. Please use this tax credit estimator to see if you're eligible HealthCare.gov/shop-calculators-taxcredit/
 

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Your group's effective date will depend on how quickly you move through the process of selecting the plans that you make available to employees, how long the employees have to select their coverage, and how quickly you make your first payment to your selected insurance company.

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The IRS will determine how much your small business may receive. To find out more, visit the IRS website.

The credit is available only if you obtain coverage for your employees through the SHOP Marketplace. You may qualify for employer health care tax credit if you have fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less. To qualify for the Small Business Health Care Tax Credit, you must also pay at least 50% of your full-time employees' premium costs. You don't need to offer coverage to your part-time employees or to dependents.

The tax credit is worth up to 50% of your contribution toward employees' premium costs (up to 35% for tax-exempt employers). The amount of premium assistance you would receive from the Small Business Health Care Tax Credit depends on the amount you contribute to your employee's premiums and how high their annual wages are.

You may apply for the Small Business Health Care Tax Credit only after being deemed eligible to purchase a plan through Maryland Health Connection's SHOP Marketplace. At the end of the year, when you file your business' taxes, you will fill out Form 8941 to claim the tax credit. The IRS will have final say on how much your small business may receive.

For more information on how to claim the tax credit, visit the IRS website.

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Yes, currently you must select a SHOP-authorized broker if you want to apply for coverage. To see a list of authorized producers, click here.

All Maryland Health Connection authorized brokers have undergone a training and credentialing process. They are knowledgeable of the enrollment process and they are trained not to ask for compensation from your small business for their assistance.

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If the employee elects to keep individual coverage through Maryland Health Connection, he may do so. However, if their employer's plan is considered "affordable" (I.e. their employee contribution toward the employer-sponsored health plan for single coverage is less than 9.69% of income) and the employer offers a plan that meets the minimum value standard, the employee would not be eligible for any tax credits or cost-sharing reductions for any months that they continue to be enrolled in an individual qualified health plan. However, if the employee contribution toward the employer-sponsored health plan is considered "unaffordable" or does not meet the minimum value standard, the employee may be eligible for tax credits and cost-sharing reductions (depending on their household income) for any months they continue to be enrolled in the individual marketplace. They will be required to reconcile their advance premium tax credits on their plan year tax filing.

The employee may also terminate their individual coverage and join their employer-sponsored plan through the SHOP. The employee should alert Maryland Health Connection that they would like to terminate their individual coverage. The individual is not responsible for paying back any subsidies received while employer-sponsored coverage was not available to the employee and their dependents.

An employee who is eligible for employer-sponsored coverage through their spouse and/or parent's plan, as applicable, or through a public plan, including Medicare, Medicaid and Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), may elect to keep that coverage and not enroll in their newly offered employer sponsored plan.

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If you are a business owner with fewer than 50 full time or full-time-equivalent (FTE) employees, you are not required to offer health insurance to your employees. And, you will not have to pay a penalty if you do not provide insurance to your employees. Your employees can get health coverage through Maryland Health Connection’s individual marketplace.

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The Small Business Health Options Program (SHOP) helps small business owners to enroll for group health insurance for their employees. The SHOP allows business owners access to group rates and the small business health care tax credit through Maryland Health Connection, Maryland’s health insurance marketplace.

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Appeals

If your health care provider tells you that a certain health care service is needed, but your health insurer or HMO disagrees, you have the right to appeal that decision and have it reviewed by an independent medical expert. A health care provider includes your doctor, a hospital or a person that is licensed to provide health care services, such as a psychologist, chiropractor, or physical therapist.

You may skip to Step 4 below and file a complaint directly with the Maryland Insurance Administration before receiving the health insurer or HMO’s decision if the health insurer or HMO waives its requirement that you first appeal to it, if the health insurer or HMO does not follow any part of its internal appeal process, or if you show a compelling reason, such as showing that a delay could result in your death, serious impairment to a bodily function, serious dysfunction of a bodily organ, or could cause you to be a threat to yourself or others.

Here’s how the process works:

  • Step 1: You will receive a letter from your health insurer or HMO notifying you of its decision.
  • Step 2: Follow the instructions in the first denial letter you receive from your health insurer or HMO to ask your health insurer or HMO to reconsider its decision. If you would like some help, contact the Health Education and Advocacy Unit in the Attorney General’s Office at 877-261-8807 for assistance. Your health care provider, or someone else you authorize to help you, can also do this for you.
  • Step 3: If your health insurer or HMO upholds its original decision to deny payment for the health care service, you may have your case reviewed by an independent medical expert, who will decide if the health care service your health care provider recommended is medically necessary. The Health Education and Advocacy Unit can help you with this too.
  • Step 4: If your policy allows you to file a complaint with the Maryland Insurance Administration (MIA), the MIA will send your case to an independent medical expert. The MIA will send you a copy of the opinion of the independent medical expert. If your policy does not allow you to file a complaint with the MIA, your health insurer or HMO will send your case to an independent medical expert. Your letter from your health insurer or HMO will tell you if you can file a complaint with the Maryland Insurance Administration. There are time limits for filing a complaint, so please carefully read your letter.
  • Step 5: If the independent medical expert finds the health care service recommended by your health care provider is medically necessary, the Insurance Commissioner, after considering all the facts of your case, may order your health insurer or HMO to pay for the health care service in accordance with your policy.

You have the right to appeal other coverage decisions made by your health insurer or HMO but those appeals may not necessarily be reviewed by an independent medical expert.


How to File a Complaint with the Maryland Insurance Administration:
Complaints must be received in writing and include a signed consent form.


Contact the MIA to learn how to submit a complaint:

Maryland Insurance Administration
Attn: Consumer Complaint Investigation Life and Health/Appeals and Grievance
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
Telephone: 410-468-2000 or 800-492-6116
TTY: 1-800-735-2258
Fax: 410-468-2270 or 410-468-2260 (Life and Health/Appeals and Grievance)
Online at www.insurance.maryland.gov.


How to Contact the Health Education and Advocacy Unit:

Office of the Attorney General Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202
Telephone: 410-528-1840 or 877-261-8807
Fax: 410-576-6571
Online at www.oag.state.md.us/consumer/heau.htm

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You can appeal any decision you receive from the Maryland Health Connection. You or your authorized representative have 90 days from the date of the notice containing the decision to ask for a hearing. An authorized representative is someone who you choose to act on your behalf with Maryland Health Connection, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.

If you appeal our decision, you will have a hearing. A hearing is a meeting between you, someone from the State, and a hearing officer. You can talk to them about why you think we made a mistake.

If you disagree with our decision and want to speak to someone about it, or if you need help asking for a hearing, call (855) 642-8572 (TTY: (855) 642-8573).

Learn more here about appealing a decision, including what decisions you can challenge and how to file an appeal.

For assistance with preparing an appeal of your denial of enrollment in a qualified health plan or eligibility for an advance premium tax credit, you can contact the Office of the Attorney General’s Health Education and Advocacy Unit (HEAU) online at www.MarylandCares.org or at (410) 528-1840 or toll free at (877) 261-8807. The HEAU can assist you but cannot represent you at the hearing.

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