Health Insurance in Maryland

Health Insurance in Maryland

Being the earning member of your family, you are obligated to provide a secured future to your loved ones. Healthinsurance is expensive and you need to assess your financial resources and the risks associated with the lack of proper health coverage. More than 47 million Americans are uninsured, majority of whom are working families. The rising healthcare costs force these families, especially children, into a financial rut in the event of physically crippling hazards. However, for those families who are not covered under their employers’ health group plan, there are low-priced state sponsored health insurance programs.

Maryland has witnessed a tremendous improvement since the last four year as it stands at 26th spot in the 2008 Healthiest States List of United Health Foundation. In 2007, the state stood at 28th position and at 32nd position in 2006. The state, having the population of more than five million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Maryland who meet specific eligibility requirements.

The Maryland Insurance Administration protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 13.8% of the residents are uninsured despite the strong public health funding and low percentage of crime rates. Approximately, 38.3% uninsured Maryland citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

Health insurance is one thing that you cannot afford to survive without. When purchasing health coverage, it is prudent to contact a licensed health insurance agent/broker to avail the benefits of health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Maryland. These regulations apply to all insurance companies offering individual or family health insurance in Maryland:

Medical Underwriting
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
84 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women including breast cancer screening, mastectomy stay for more than 48 hours, reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs, OB/GYN as primary care pro
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Maryland. These regulations apply to all insurance companies offering small group health insurance in Maryland:

Small Group Size
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue
Premium Rating Factors
Adjusted Community Rating
Rate Adjustment Factors
Look-Back Period
Pre-existing condition exclusionary period
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Maryland. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
18 months
Maximum Premium Increase
State Legislation Reference
Title 31 of the Maryland Insurance Administration, Chapter 4
Additional Notes
The election period is 45 days.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Maryland to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Maryland is summarized in the chart below:

Plan Name
Maryland Health Insurance Plan (5MHIP)
Phone Number
HIPPA Eligibility Required?
Available Carriers
CareFirst BlueCross BlueShield and CareFirst BlueChoice
Pre-Existing Condition Waiting Period
2 months
Enrollment Periods
Open to new members
Premium Limits
No more than 150% of standard rate
Lifetime Maximum Benefit
$2 million
Special Notes

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Maryland provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Maryland Children’s Health Program (5MCHP)
Phone Number
Apply Online
Age Limits
Under 19
Insurance Carrier
Maryland HealthChoice Program
Length of Coverage
12 months
Residency Requirements
Maryland resident
Other Eligibility Requirements
Household income should be up to 200% FPL
The children must not be eligible for Medicaid
Pregnant women any age with income up to 250% FPL are eligible
Pre-Existing Condition Exclusions
$0 or monthly premium payment depending on family income.

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Maryland:

Governing Agency
Maryland Department of Health and Mental Hygiene
Phone Number
Residency Requirements
Maryland resident and qualified immigrant
Federal Poverty Line Income Limits
Pregnant Women up to 250% FPL;
Infants and children (5ages 0-19): 200% FPL;
Medically Needy Individual: 49% FPL;
Medically Needy Couple: 41% FPL;
Working Parents: 40% FPL;
Non-Working Parents: 33% FPL;
SSI Disabled (5non-elderly) at or below 74% of FPL;
Working Disabled at or below 300% of FPL
Additional Resources

Maryland Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Maryland’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Maryland: At-A-Glance
Provides exclusive health data of the Maryland state., a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.