Medicare Advantage Plans in Maryland

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Medicare Part A (hospital) and Part B (medical) benefits, and most also include Part D (prescription drug coverage). Many plans offer additional benefits such as routine dental, vision, hearing, fitness programs, and telehealth.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare Parts A and B. Most people qualify for Medicare enrollment at age 65, though some qualify earlier due to disability, ALS, or ESRD. Be mindful of enrollment periods—Initial, General, and Special Enrollment—as well as penalties for late enrollment or failure to qualify for premium-free Part A.

What Types of Medicare Advantage Plans Are Available in Maryland?

Maryland offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require use of in-network providers and referrals for specialist care.
• Preferred Provider Organizations (PPOs): Provide access to out-of-network care at higher cost, with no referral requirements for specialists.
• Private Fee-for-Service (PFFS) Plans: Allow visits to any provider who accepts the plan’s terms; some plans also include a network for discounted care.
• Special Needs Plans (SNPs): Tailored for beneficiaries with specific conditions or circumstances:
  • C-SNPs: For chronic conditions like diabetes, cancer, mental illness, ESRD, or autoimmune disorders.
  • I-SNPs: For people in nursing facilities or needing in-home nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For individuals with both Medicare and Medicaid. These plans may offer enhanced drug coverage, dental care, and coordination of care—often at little to no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible MA plan with a savings account funded by the insurer to cover medical expenses. You’re responsible for expenses until the deductible is met.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, MSAs and some PFFS plans don’t.

If your plan doesn’t include drug coverage, you may:

• Enroll in a standalone Part D plan (only for specific plan types).
• Face a late enrollment penalty if you delay obtaining coverage without creditable insurance.

How Do You Choose a Medicare Advantage Plan?

Understand Medicare Advantage costs before selecting a plan:

• Premiums: Some plans have $0 monthly premiums, while others charge varying amounts.
• Deductibles, Coinsurance & Copays: Know what you’ll owe for doctor visits, prescriptions, and procedures.
• Out-of-Pocket Maximums: Annual spending caps protect against excessive costs.
• Extra Benefits: Consider if you need dental, vision, hearing, telehealth, OTC allowances, or gym memberships.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, drop, or switch plans.
• General Enrollment (Jan 1–Mar 31): Enroll in an MA plan if you recently enrolled in Part B.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or revert to Original Medicare.
• Special Enrollment Periods: Triggered by:
  • Moving out of your plan’s service area
  • Losing employer or Medicaid coverage
  • Plan termination by Medicare
  • Qualifying conditions like those suited to C-SNPs

What If You Want to Change Your Medicare Advantage Plan?

You can change plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

What Are Medicare Resources in Maryland?

Maryland offers several support programs:

• Maryland SHIP Program: Offers free Medicare counseling to residents.
• Maryland SMP Program: Educates beneficiaries on avoiding healthcare fraud.
• Maryland Insurance Administration: Handles insurance complaints.
• Maryland Medicaid (Maryland Health Connection): Assists low-income residents. Visit marylandhealthconnection.gov or call 1-855-642-8572. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover costs like deductibles, copays, and coinsurance not paid by Original Medicare.

To enroll in Medigap, you must have Medicare Parts A and B. The best time to buy a policy is during your six-month Medigap Open Enrollment Period starting with your Part B enrollment. After this window, you may face medical underwriting.

Medigap doesn’t include prescription drug coverage—consider a separate Part D plan if needed.

There are 10 standardized plans. Medicare Supplement Plan G is the most popular in Maryland. Plans G and N are also among the fastest-growing. Plan F is no longer available to new beneficiaries as of 2020.

Medigap offers predictable costs, broad provider access, and no referrals.

Learn more about Medicare Supplement plans in Maryland.

Next Steps

If you think a Medicare Advantage plan in Maryland is right for you, compare your options using the Medicare Plan Finder tool. Review plan costs, coverage benefits, drug formularies, and provider networks. When you’re ready, enroll during an eligible period to maximize your benefits.