Medicare in Maryland

Medicare is the federal health insurance program that provides retirees with coverage for medical costs. This program is open to those aged 65 and over, as well as those with qualifying disabilities. In Maryland alone, there are over a million people enrolled in Medicare, which accounts for more than 17% of the population of 6.2 million people. Of those enrolled in Medicare, over 15% were enrolled in Medicare Advantage plans in 2021. Annually, Maryland spends approximately $11,377 per Medicare beneficiary, which is several hundred dollars over the U.S. average. 

There are two parts to Original Medicare. Part A includes coverage for services seniors receive while in the hospital, in skilled nursing facilities or in nursing homes. It also covers skilled home health care services and hospice. Part B covers outpatient medical services, including preventative care, emergency medical transportation, durable medical equipment and certain outpatient prescription medications. 

Part C, or Medicare Advantage, is a private health insurance option that provides the same coverage as Medicare, except hospice care which Medicare Part A covers. The Advantage Plans often have added benefits like prescription drugs, dental or vision care.

Part D offers prescription drug coverage that enrollees can add to Original Medicare. Medicare Advantage plans include prescription drug coverage.

This guide provides more in-depth information on what Medicare covers and how seniors can customize their coverage to meet their needs. It also highlights resources that help prospective and current Medicare beneficiaries navigate their benefits, dispute denied claims and find in-network health care providers. 

Options for Medicare Coverage in Maryland

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 (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage (MA), or Part C, is an Original Medicare alternative. Medicare-compliant private health insurance companies service MA plans. Those who have this coverage get most of their Part A and Part B coverage through their plan, and they may have access to coverage for prescription drugs, vision and dental services and fitness programs. There are four main plan types, including HMOs, PPOs, PFFs and SNPs, each with its own rules regarding enrollment, out-of-pocket payment obligations, referrals to see specialists and in-network versus out-of-network providers. 

Seniors can enroll in Medicare Advantage during their Initial Enrollment Period or the annual Open Enrollment Period. There’s also a Medicare Advantage Open Enrollment Period where seniors can switch to a different MA plan or back to Original Medicare. 

Who Should Consider Medicare Advantage 

Seniors who may consider enrolling in Medicare Advantage are those who: 

• Want an all-inclusive plan with added coverage for vision, dental and prescription drugs 
• Want more control over health spending 
• Have chronic health conditions and access to appropriate SNPs 

• Are generally healthy, so may benefit from lower premiums

The Top 10 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 April 2022 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 Prescription Drug Coverage (Part D)

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:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

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 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Maryland

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.