Find the Best Plan for You
Maryland Health Connection offers private plans called “qualified health plans” from insurance companies you recognize. All plans have been certified by Maryland Health Connection to meet certain standards and offer core health benefits.
All plans offer essential health benefits
All plans through Maryland Health Connection (except Catastrophic plans) must offer core benefits like these and more, cover pre-existing conditions, and offer free preventive services.
- Doctor visits
- Emergency care
- Mental health care
- Maternity and newborn care
- Pediatric care
- Preventive care (wellness visits, shots and screenings)
Understand how plans are different
There are several categories of insurance plans: metal levels called Bronze, Silver, Gold, and Platinum, as well as Catastrophic plans. Plans in these categories differ based on how you and the plan share the costs of your care.
If you qualify for cost-sharing reductions (reduced out-of-pocket costs like deductibles and copays), you can access these savings only by choosing a Silver plan.
|Plan Level||Insurance Company Pays
|60% of health care costs||40% of health care costs|
|70% of health care costs||30% of health care costs|
|80% of health care costs||20% of health care costs|
|90% of health care costs||10% of health care costs|
Some plans allow you to see almost any doctor or use any health care facility; others limit your choices to a network of doctors and facilities, or require you to pay more if you use providers outside the network.
Understand how much your plan will cost
After you enroll in a plan, you’ll receive a monthly bill (the premium) you have to pay every month, on time, to stay covered. There are also costs you may pay when you use medical services:
- Deductible – the amount you owe for covered health care services before your health insurance or plan begins to pay.
- Coinsurance – your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. For example, you may pay a coinsurance of 20% of the cost for a medical test. Your plan pays for the rest.
- Copayment – a fixed amount you pay (for example, $15) for a covered service, such as a doctor visit.
Find a doctor in your plan
You will pay the lowest costs for services when you see a doctor or provider in your plan’s network.
Call your doctor’s office to ask if they accept your insurance, check with your insurance company, or search online.
Frequently Asked Questions
Call HealthChoice at 800-977-7388 for more information and to enroll. You can also use the online provider search to find doctors who accept your MCO.Permalink
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.Permalink
If you qualify for Medicaid, MCHP, or MCHP Premium, you can enroll in those programs at any time.
Open Enrollment to buy a qualified health plan for 2017 is from Nov. 1, 2016 to Jan. 31, 2017.
Outside of the annual Open Enrollment period, you can buy a plan or change plans only if you’ve had special circumstances like having a baby or losing other health coverage. Learn more here about whether you may qualify and how to enroll.
Note, the open enrollment period does not apply to Medicaid, MCHP, or MCHP Premium. If you believe you or your children may be eligible these programs, you can use Maryland Health Connection to sign up at any time throughout the year.Permalink
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.Permalink
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.Permalink