Private Health Insurance & the Marketplace
Open Enrollment Period
Maryland’s marketplace is state-run and residents should use Maryland Health Connection to enroll in marketplace plans. Open enrollment runs from November 1, 2020 to December 15, 2020.
Special Enrollment Periods
Under federal law, individuals may enroll in the Marketplace outside of the open enrollment period if they experience certain qualifying events, such as the loss of employer-based insurance, marriage, or having a baby (see a more complete list, here).
Additionally, Maryland offers the following special enrollment periods (SEPs):
- Due to the COVID-19 pandemic, an emergency special enrollment period is open for uninsured Marylanders to enroll in a private health plan through March 15, 2021
- Losing a dependent
- Becoming pregnant
- Residents filing a tax return can check a box indicating that a household member is uninsured and would like to receive information about how to enroll in low- or no-cost insurance. If the uninsured person is eligible for a marketplace plan, the marketplace will send a notice and initiate a SEP for coverage
Restrictions may apply, including those outlined in this FAQ. Some special enrollment opportunities may only be available to individuals who have current marketplace coverage, and some SEPs may only be accessible through the marketplace call center. This is not an exhaustive list of special enrollment opportunities. If you recently experienced a change in circumstances that you think may qualify you for a special enrollment period, check with Maryland Health Connection to determine your enrollment options.
- Under federal law, short-term plans do not cover services for pre-existing conditions and typically provide far fewer benefits and cost-sharing protections compared to health plans available through the marketplace. Federal rules allow these plans to last up to 12 months and be marketed as a substitute for Affordable Care Act coverage. However, states may modify these federal standards to make them more strict and also require short-term plans to follow additional consumer protections.
- Maryland allows short-term plans that last up to 3 months. These products can be sold during the open enrollment period.
Maryland does not require individuals to pay a penalty if they fail to maintain minimum essential coverage.
State-funded Financial Assistance
Under the Affordable Care Act, individuals may qualify for premium tax credits and plans with reduced cost-sharing based on their income and other factors. Maryland does not provide state funds to supplement those federal premium tax credits or cost-sharing reductions.
Coverage for Young Adults
Under the Affordable Care Act, group health plans that offer dependent benefits must allow parents to keep their children up to age 26 on their plan. Maryland law is consistent with this requirement.
The Affordable Care Act gives states the option to expand Medicaid to adults with household incomes at or below 138 percent of the federal poverty level. Maryland has taken advantage of this option so that adults with household incomes at or below 138 percent of the federal poverty level ($17,609 for an individual, $36,156 for a family of 4 annually) are eligible for Medicaid.
Other Medicaid Eligibility Categories
- In Maryland, children under age 19 are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) with household incomes at or below 322 percent of the federal poverty level ($84,364 for a family of 4 annually).
- Pregnant women are eligible for Medicaid with household incomes at or below 264 percent of the federal poverty level ($69,168 for a family of 4 annually).
- Consumers can learn about what coverage options they are eligible for, including Medicaid, through Maryland's state-based marketplace Maryland Health Connection.
CHIP Waiting Period
In Maryland, there is no waiting period for children to enroll in CHIP benefits (waiting periods do not apply to Medicaid).
- Generally, lawfully-residing immigrants are eligible for Medicaid after a 5-year waiting period with some exceptions.
- In Maryland, lawfully-residing children and pregnant women are exempt from the 5-year waiting period.