Medicare Advantage in Maryland

Seniors in Maryland looking for alternative options to federally funded Medicare might find what they need with a Medicare Advantage Plan. Traditional Medicare is usually a combination of Plan A hospital coverage and Plan B medical coverage, with an option to add Plan D to help with the cost of prescriptions. The addition of Plan D includes an extra premium that must be paid each month. Medicare Advantage is offered through private insurance companies and combines Part A and B under one plan and often includes prescription coverage without adding to the premium, potentially saving seniors some money on their monthly expenses. Some plans may even include extras, such as vision, dental, hearing, fitness and medical transportation coverage.

Private insurers are required to offer equivalent coverage to Plan A and B for their plans to qualify as Medicare Advantage, but they often limit coverage to their chosen network of care facilities and providers. This network is usually limited within state lines, so seniors who travel frequently may find difficulty obtaining covered medical care when they are outside their home state. Enrollees can still see doctors outside the established network, but they will have to pay significantly more for the care they receive. Conversely, original Medicare is accepted at any facility or provider in the country that has opted in to work with Medicare patients. Medicare Advantage also includes an annual out-of-pocket limit.

Of the 1,113,913 eligible residents in Maryland, just 22% have enrolled in Medicare Advantage as of July 2023. While this sounds low, at less than half the national average of 48%, it is a 17.01% increase from the number of enrollees recorded in 2022.

For interested seniors, this guide provides an overview of how Medicare Advantage works and what it takes to be eligible. It also offers information to assist with choosing a Medicare Advantage Plan that best covers their needs.

The Top 10 Medicare Advantage Plans in Maryland

Medicare Advantage Plans are offered by multiple providers in Maryland, each with a variety of plan options to choose from. This allows seniors to shop around for a plan that fits well with their care needs and their budget. The table below provides information on the 9 most popular providers in the state and includes a cost range that covers the lowest to the highest priced plan for that provider. As of July 2023, the given information is correct. For additional information on specific plans available, seniors can visit Medicare.gov.

How Medicare Advantage Plans Work in Maryland

Understanding how Medicare Advantage plans work in Maryland can help seniors make the best decision for their individual health care needs. Each insurer offers a variety of plans, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). These have different requirements regarding referrals, using in-network and out-of-network providers and the need for a primary care provider. Descriptions of the most common types of plans can be found below.

What Medicare Advantage Plans Cover in Maryland

Medicare Advantage plans must provide all the same benefits of Original Medicare, also known as Part A and Part B, except for hospice care. This includes inpatient hospital care, mental health services, preventive screenings and lab tests. Many Medicare Advantage plans offer extra benefits that aren’t included in Original Medicare, such as dental care, hearing and vision services. Most also include prescription drug coverage.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Maryland

To join a Medicare Advantage plan, an applicant must have Medicare Part A and Part B, be a U.S. citizen or be lawfully present in the country and live in the service area of the plan they want to join. Medicare is available to people aged 65 and over, younger people with disabilities and those with end-stage renal disease. As with other types of health insurance, Medicare has specific enrollment periods. It’s important for seniors to know when they can enroll or change Medicare plans to ensure their health needs are covered. The list below has more information about the timing of Medicare enrollment.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Maryland

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources