Maryland Health Insurance - Health Plan One

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Health Insurance for the Well Informed

Individual Health Insurance

In 2004, 4% of Maryland residents had individual health insurance (www.statehealthfacts.org). Between the years 2000 and 2004, the percent point change of individual health insurance among the non-elderly population was 0.7%.

Maryland offers many different options when it comes to individual health insurance. In Maryland, medical underwriting is allowed without restriction. Medical underwriting is the process that allows insurance carriers the right to review the medical history of a prospective member. There is a 4 month look back and a 24 month exclusionary period limit for preexisting conditions for those without prior health coverage or those in HMO plans.

There is a high risk pool in Maryland called the Maryland Health Insurance Plan. You may be eligible due to your HIPAA group to individual rights; or if you are a resident of Maryland and you are not eligible for group coverage, COBRA, or Medicaid; you have been accepted for health coverage but with limitations and exclusions; you have a specified medical condition; or you are receiving a Federal Trade Readjustment Allowance.

Coverage under the Maryland Health Insurance Plan includes the following: doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, and preventive care.

Uninsured Marylanders

More than one in four Marylanders under the age of 65 were not insured between 2002 and 2003. In 2004, 13% of Marylanders lacked health insurance according to www.statehealthfacts.org.

In 2005 98% of large employers and 48% of small group employers offered health insurance coverage to their employees. Maryland ranked 13^th in the percent of employees offered health insurance coverage. The average monthly premium in 2006 for a single in a small group was $330 while for a family in a small group it was $864 (www.ahip.org). Between 2000 and 2004, the percent point change of employer-sponsored health insurance was -8.3%. As a result, the uninsured rate and the rate of Maryland residents with individual health insurance rose.

In Maryland, medical underwriting is allowed using community ratings of plus or minus 40% based on age and geography. There are no preexisting condition look backs or exclusions allowed.

Maryland offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. To qualify for COBRA continuation coverage, you must meet three criteria:

1) You must work for an employer with 20 or more employees.

2) You must be covered under the employer’s group health plan as an employee or as a spouse or dependent child of an employee.

3) You must have a qualifying event that would cause you to lose your group health coverage.

Medicaid is a joint state and federal program that furnishes medical assistance to eligible low income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. These individuals must meet certain income and other requirements listed below:

Income requirements

Ages 1-5: 200% of the Federal Poverty Level

Ages 6-19: 200% of the Federal Poverty Level

Pregnant Women and Infants

Pregnant Women: 250% of the Federal Poverty Level

Infants - Ages 0-1: 200% of the Federal Poverty Level

Non-Working: 33% of the Federal Poverty Level
Working: 40% of the Federal Poverty Level

Other populations

Medically Needy Individual- 49% of the Federal Poverty Level

Medically Needy Couple- 41% of the Federal Poverty Level

Covered Services
Ambulance services, ambulatory surgical center, clinic services, dental services, diabetes care, early periodic screening diagnosis and treatment, eyeglasses, family planning, hearing aids, home health services, hospice, hospital inpatient and outpatient services, kidney dialysis, laboratory and x-ray, medical equipment, mental health services, nurse midwife, nursing homes, pharmacy services, physical therapy, physician services, podiatry, school based health related services, substance abuse treatment, transportation, and vision care.

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about Maryland Medicaid at: http://www.dhmh.state.md.us/mma/mmahome.html.

Maryland offers MCHIP (Maryland’s Children Health Insurance Plan) for children under the age of 19 whose family income is up to 200% of the Federal Poverty Level and who are not eligible for Medicaid, and pregnant women whose income is up to 250% of the Federal Poverty Level. Please visit the MCHIP website for more detailed information at: http://www.marylandhealthinsuranceplan.state.md.us/.

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All about Maryland Health Insurance

Maryland Group & Small Business (1-50 employees) Health Insurance

Maryland COBRA Health Coverage

Medicaid in Maryland

Other Maryland Health Insurance Programs

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