Home / Shop and Compare / Medicaid Basics & Benefits

Medicaid Basics & Benefits

Medicaid Basics & Benefits

You or members of your family may qualify for Medicaid through Maryland Health Connection to receive free or low-cost health care. Enrollment in Medicaid and the Maryland Children’s Health Program (MCHP) is year-round.

Who qualifies for Medicaid or MCHP?

Look up your income and household size below to see if you may qualify. If you’re pregnant or have a family with children, you may earn more and still qualify (PDF).

There is no income limit for individuals enrolled in foster care in Maryland until age 26.

Medicaid Chart

Download Adobe Reader
 

How do I enroll in Medicaid or MCHP?
What does Medicaid cover?
What happens after I enroll?

Frequently Asked Questions

No. Different income standards apply to individuals seeking coverage on the basis of being aged, blind, disabled, living in a nursing home, or medically needy, and those applying for the Qualified Medicare Beneficiary Program (QMB) or the Specified Low-Income Medicare Beneficiary Program (SLMB).

These individuals cannot apply for benefits using MarylandHealthConnection.gov. Please contact your local department of social services for more information or apply online at myDHRbenefits.dhr.state.md.us.

Permalink

Be the first person to like this faq.

If you are pregnant, have just had a baby, or have an infant or child up to age 5, you may be eligible for the Maryland Women's Infant and Children (WIC) Program where you can get nutritious foods and other free health services for you and your young children. Click here for more information.

If you qualify for Medicaid, you also may qualify for cash assistance, food supplement programs (SNAP), energy assistance, or other programs. Please contact your local department of social services for more information or apply online at myDHRbenefits.dhr.state.md.us.

Permalink

Be the first person to like this faq.

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 Department of Health and Mental Hygiene.

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 2016 premium amounts are:

  • Premium for families between 200-250% FPL: $53 per month
  • Premium for families between 250-300% FPL: $66 per month
  • American Indians do not have to pay a monthly premium to enroll in MCHP Premium.
Permalink

7 people found this faq useful.

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’s "My 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).

Permalink

10 people found this faq useful.

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).

Permalink

9 people found this faq useful.

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.

Permalink

3 people found this faq useful.

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 Plan

If you buy a qualified health plan during open enrollment for 2017:

  • If you enroll between Nov. 1 and Dec. 15, 2016, your coverage will begin Jan. 1, 2017.
  • If you enroll between Dec. 16, 2016 and Jan. 15, 2017, your coverage will begin Feb. 1, 2017.
  • If you enroll between Jan. 16 and Jan. 31, 2017, your coverage will begin March 1, 2017.

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.
Permalink

19 people found this faq useful.

You can buy a dental plan through Maryland Health Connection. Open Enrollment is Nov. 1 to Jan. 31, for coverage that starts as soon as Jan. 1, 2016.

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 for 2017.

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 advanced 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.

Permalink

21 people found this faq useful.

Whether you qualify will depend on your income level and family size. In general, single Maryland residents without children with household incomes less than $16,394 are eligible. There are higher income limits (PDF) for pregnant women and children.

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).

Permalink

12 people found this faq useful.