Medicare in Maryland

Nationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in Maryland, just 11% of Medicare beneficiaries selected Medicare Advantage plans. Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.

By late 2022, about 19% of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 81% were enrolled in Original Medicare. At that point, total private plan enrollment among Medicare beneficiaries nationwide had grown to about 46%, but Medicare Advantage enrollment continues to be less popular in Maryland.

The availability of Medicare Advantage plans in Maryland varies from one county to another. In Allegany County and St. Mary’s County, there are only eight Medicare Advantage plans available in 2023. But there are 39 plans available in Baltimore County.

Medicare beneficiaries can switch back and forth from Medicare Advantage to Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7). There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can change to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

Medigap plans are standardized under federal rules, with ten different plan options available. In Maryland in 2023, there are 43 insurers providing Medigap plans, although some only offer a few of the ten plan designs.

Under federal rules, Medicare beneficiaries have a six-month window, when they are at least 65 and first enrolled in Medicare Part B, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees under the age of 65. In Maryland, Medigap insurers are required to offer Plan A to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees; insurers that offer Medigap Plan C must also offer it to disabled Medigap enrollees who were already eligible for Medicare prior to 2020; under federal rules, Medigap plans C and F cannot be sold to anyone who is newly eligible for Medicare in 2020 or later). The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.

The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then change to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D. And Maryland does limit the pricing on Medigap Plan A for disabled enrollees: It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.

For 2023 coverage, insurers are offering 22 stand-alone Part D plans available in Maryland, with premiums ranging from $8 to $112 per month.

526,104 Maryland Medicare beneficiaries were enrolled in stand-alone Part D prescription drug plans (PDPs) in Maryland as of late 2022. Despite the fact that overall Medicare enrollment has grown, that was a little lower than the state’s PDP enrollment had been a year earlier, due to the growth in Medicare Advantage enrollment.

Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are almost always used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D enrollment in Maryland is also higher than average (about 48% of the state’s Medicare beneficiaries have PDPs, versus 36% nationwide). In addition to the people with stand-alone Part D coverage, 188,786 Medicare beneficiaries in Maryland have Part D benefits as part of their Medicare Advantage coverage.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Maryland includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

If you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, try one of these resources for assistance.

• Maryland Senior Health Insurance Program: Visit the website or call your county office.
• The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.
• The Maryland Health Care Commission’s Consumer Guide to Long Term Care also provides helpful information on preparing for the cost of long-term care.
• Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.