Medicare is the federal health insurance program that provides health care benefits to those aged 65 and over, along with younger people who have qualifying disabilities or medical conditions. The Original Medicare program features two parts, including Part A, which pays for hospital expenses, and Part B, which covers medical care, such as doctor’s office visits and diagnostic services. These parts don’t include prescription drug benefits, but beneficiaries may add this to their plan by enrolling in Part D coverage.
As an alternative to Original Medicare, beneficiaries can enroll in Medicare Part C, also called Medicare Advantage. This coverage is available through private health insurance companies and provides the same basic services as Original Medicare. In some cases, beneficiaries receive additional benefits not in Parts A and B, such as prescription drug, vision and dental coverage.
As of July 2023, approximately 1.11 million Marylanders are eligible for Medicare, which accounts for roughly 18% of the state’s population of nearly 6.2 million people. This is about 2.74% more than the number of people eligible for coverage in 2022. Nationally, the number of people eligible for Medicare coverage increased by 2.66% between 2022 and 2023.
Of those in Maryland who are eligible for Medicare, about 22%, or 242,870 people, are enrolled in a Medicare Advantage Plan. This is an increase of 20.22% over the number of people enrolled in Medicare Advantage in 2022, when 202,024 people were eligible for this coverage. Altogether, Medicare Advantage Plans saw a 17.01% growth in new subscribers in Maryland. In the United States as a whole, the Medicare Advantage Plans had a 9.75% increase in enrollees, and the percentage of Medicare beneficiaries who opted for Medicare Advantage went up by 6.90%.
Original Medicare provides coverage for many health services, but it’s not the only health insurance option seniors have available to them. Along with the federal program, there are private coverage options to accommodate specific conditions and preferences and pay for services not included in Original Medicare.
Original Medicare, which is administered by the Centers for Medicare & Medicaid Services, provides health insurance for those aged 65 and over, as well as younger individuals who have certain disabilities or end-stage renal disease. This coverage features two parts. Part A, or hospital coverage, pays for inpatient hospital services, nursing home care, hospice and home health care. Part B includes medical services. In most cases, beneficiaries don’t pay a premium for Part A coverage. The premium for Part B coverage starts at $164.90. Additionally, beneficiaries must pay an annual deductible of $1,600 for Part A and $226 for Part B.
Who Should Consider Original Medicare
Original Medicare may be a good option for those who:
Medicare Advantage gives beneficiaries an alternative way to get their Medicare benefits. MA plans are available through private health insurance companies that agree to Medicare’s rules related to coverage. These plans provide Part A and Part B services, and many include prescription drug, vision and dental coverage. There are four basic plan types, including HMOs, PPOs, PFFs and SNPs. Each of these plan types has its own rules regarding cost-sharing obligations, getting referrals to see specialists and plan networks. In Maryland, beneficiaries have nine plans to choose from, although availability may vary depending on the individual’s zip code.
Who Should Consider Medicare Advantage
Seniors who may consider enrolling in Medicare Advantage are those who:
The Top Medicare Advantage Plans in Maryland
There are numerous Medicare Advantage plans available to Maryland residents, and it can be challenging to compare coverage options and out-of-pocket expenses. The following table highlights some of the top Medicare Advantage plans available within the state as of August 2023 and provides an overview of key information such as plan satisfaction ratings, monthly premiums and plan types. For more information on Medicare Advantage, seniors can refer to the Medicare Advantage Plans in Maryland page.
|Medicare Star Rating
|Monthly Cost Range
|$0 – $141
|$0 – $26
|$0 – $69
|$28 – $58
|$0 – $301
|Johns Hopkins Advantage MD
|$0 – $30
|Anthem Blue Cross and Blue Shield
|$0 – $125
|Blue Cross Blue Shield of Michigan
|$0 – $197
|HMSA Akamai Advantage
Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.
Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.
Who Should Consider Medicare Prescription Drug Coverage
Seniors who may benefit from prescription drug coverage include those who:
While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.
For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
For seniors enrolling in Medicare for the first time, wanting to switch to a different plan or needing help with understanding their benefits, several programs can provide one-on-one assistance. Through the following statewide resources, seniors can talk to trained advisors who help them sign up for a plan and find Medicare-certified health care providers in their areas. These resources can also help seniors dispute denied claims and canceled policies and learn how to protect themselves from health insurance fraud, scams and wasteful spending.
Maryland’s State Health Insurance Assistance Program (SHIP) has trained staff and volunteers who provide free Medicare counseling for all seniors in the state. Seniors can call this program to speak with advisors who can answer their questions about what the parts of Medicare cover, initial and open enrollment periods and how to enroll in Medicare Advantage or Medigap plans. SHIP counselors can also help seniors determine whether they qualify for Medicare Savings Programs and navigate the appeals process if they receive a denied medical claim.
Maryland has 24 Area Agencies on Aging, including one for each county and one for Baltimore City. These agencies have benefits counselors who help older adults enroll in Medicare and determine the right Medicare prescription drug coverage for their needs. Counselors can also help older adults understand the enrollment periods, compare Medigap and Medicare Advantage plans in their regions and find health care providers that accept their plan’s coverage. They can also help seniors protect themselves from Medicare fraud and common scams.
The Maryland Insurance Administration oversees all insurance policies sold within the state. Through its website, seniors can get an overview of monthly premiums for all Medigap plans and find answers to frequently asked questions regarding navigating the Health Insurance Marketplace. The website also has an up-to-date list of all carriers that offer Medigap policies in the state and has tips for seniors enrolling in new Medicare plans during the Medicare Open Enrollment Period.
The Maryland Attorney General runs the Health Education and Advocacy Unit, which serves as a third-party advocate for seniors experiencing issues with their Medicare policies. It provides free mediation services to help resolve billing disputes with health care providers, obtain copies of medical records and appeal denied coverage for some or all of a necessary medical service filed with a Medicare Advantage plan. The unit also provides recourse for seniors issued bills for services that are significantly higher than the estimated quote for treatment.
Maryland Senior Medicare Patrol (SMP) is a free nonprofit program that provides valuable information on how seniors can protect themselves from Medicare fraud, scams and waste. It has trained volunteers who help older adults review their medical bills and identify billing for services and goods they didn’t receive. SMP counselors can also help with Medicare Advantage policies canceled without reasonable cause. Services are available in person and over the phone, and in some cases, home counseling visits are available to seniors unable to visit SMP sites.
Through the Social Security Administration, seniors can get an overview of the federal Medicare program and what it covers. It provides information on the parts of Original Medicare and highlights the circumstances and events that initiate Special Enrollment Periods, and it details the mail seniors receive after first enrolling in the program. It also issues Medicare cards for older adults, which contain their Medicare numbers and may be used to prove eligibility for certain programs and services in the community.