In Maryland and throughout the United States private insurance is available to Medicare beneficiaries through Medicare Advantage (Medicare Part C). Medicare Advantage is an alternative way to receive your Medicare Part A and Part B benefits. Private insurance companies contracted with Medicare offer Medicare Advantage plans to beneficiaries within specific geographic areas, referred to as service areas, within the state of Maryland and across the United States. Use your zip code to choose a Medicare Advantage plan available where you live in Maryland.
How Medicare Advantage works in Maryland
The U.S. government requires Medicare Advantage plans in Maryland, as in every state, to offer at least the same coverage as Original Medicare, Part A (hospital insurance) and Part B (medical insurance), with the exception of hospice care which remains covered under Part A benefits. In addition, many Medicare Advantage plans have more extensive coverage, offering extra benefits like routine vision services. Many plans also offer prescription drug coverage.
To sign up for a Medicare Advantage plan, you must first be enrolled in Original Medicare, Part A and Part B, and you have to live within the Medicare Advantage plan’s service area.
You can get a Medicare Advantage plan during your Initial Coverage Election Period (ICEP). The Initial Coverage Election Period is usually the same as your Initial Enrollment Period under Original Medicare, which begins three months before you turn 65, includes your birthday month, and ends three months after that month.
If you didn’t enroll in a Medicare Advantage plan when you were first eligible, or if you want to switch Medicare Advantage plans or make certain other coverage changes, you can take advantage of the Fall Open Enrollment Period, which runs from October 15 to December 7 each year. Your new coverage goes into effect on January 1 of the following year.
In certain situations, you may be allowed to switch Medicare Advantage plans in Maryland (as in other states) during a Special Election Period. Those situations include, but are not limited to: moving to a new address where your existing plan isn’t available; losing your current coverage, or experiencing changes in your current plan that affect your health benefits. Special Election Periods vary depending on personal circumstances that might affect your ability to receive Medicare benefits to which you are entitled if you were not permitted to make a change to your Medicare Advantage plan when the circumstance arose.
If you’re enrolled in a Medicare Advantage plan in Maryland and want to switch back to Original Medicare, Part A and Part B, you may do so during the Medicare Advantage Open Enrollment Period, which runs annually from January 1 to March 31. If you drop your Medicare Advantage plan during this period, you can also add a stand-alone Medicare Part D Prescription Drug Plan to go alongside Original Medicare. You also can switch from one Medicare Advantage plan to another.
If you decide to enroll in a Medicare Advantage plan in Maryland, you have to keep Medicare Part A and Part B, and you have to continue paying your Medicare Part B premium.
Types of Medicare Advantage plans in Maryland
You will probably want to familiarize yourself with the various types of Medicare Advantage plans available in Maryland so that you can make an informed decision about this alternative way to receive your Medicare benefits. The main types of Medicare Advantage plans are described below.
- A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that generally requires you to visit doctors, health-care providers, and hospitals included in your plan’s network to receive benefits from the plan except in the instances of emergency care or medically necessary care that is authorized by the plan and not available within the plan’s network. Note that you may have to get a referral from your primary doctor or health provider to receive coverage for certain health services.
- An HMO Point-of-Service plan is more flexible than a standard HMO plan, allowing you to sometimes go out of network for a number of covered health services, but generally at a higher out-of-pocket cost.
- A Preferred Provider Organization (PPO)* plan offers even greater flexibility, allowing you to select doctors, health care providers, and hospitals outside of your plan’s network, but again at a higher out-of-pocket cost.
- A Private Fee-for-Service (PFFS) plan may offer a partial or full network of providers, and sometimes does not involve any networks at all. It is important to check with the provider to see if they accept the plan because not all providers accept it.
- A Medical Savings Account (MSA) plan combines a high deductible with a savings account that you can use to pay for your health-care expenses.
- A Medicare Special Needs Plan (SNP) is for people with particular health needs, offering coverage tailored to suit their specific situations. There are Medicare SNPs for people with chronic conditions, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
- A Medicare Advantage Prescription Drug (MAPD) plan combines health and prescription drug coverage into a single insurance plan.
Comparing Medicare Advantage plans available in Maryland
As a Medicare beneficiary in Maryland, you may find it useful to compare all Medicare Advantage plans available in your area.
The availability and costs of Medicare Advantage plans generally vary depending on where in Maryland you live, the insurance company offering the plan, and specific plan details. You may find that some Medicare Advantage plans in Maryland offer premiums as low as $0. Be sure you consider other costs as well, such as copayments and deductibles, and that you continue paying your Medicare Part B premium no matter which Medicare Advantage plan you choose.
The Medicare Advantage plans available where you live in Maryland may include networks of participating providers. If so, your use of the doctors, hospitals and other health-care providers who participate in the plan’s network has a significant impact on your ability to receive the full benefits of the Medicare Advantage plan. If you currently have doctors and other health-care providers you want to retain, check to see if they participate in the Medicare Advantage plan before you make a final decision to enroll in it.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B. Consider whether a Medicare Advantage Prescription Drug plan would be a good choice to meet your medical and prescription drug coverage needs. If a Medicare Advantage plan offers other extra benefits, such as preventive vision or dental care, consider whether these are important to your coverage needs. With all these options available in Maryland, you can see why it’s a good idea to compare plans.
For more information about Medicare in Maryland, see the following articles:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.