Maryland Medicare Advantage Plans | Your Must-Read Guide

What Are Medicare Advantage Plans in Maryland? 

Medicare Advantage (MA) plans in Maryland are bundled, all-in-one alternatives to Original Medicare that are offered by Medicare-approved private companies. These plans include Medicare Part A and B benefits, and most provide Part D (prescription drug) benefits as well. Many MA plans also offer other benefits such as hearing, vision and dental care.¹ 

What You Need to Know 

The average Medicare Advantage plan premium in Maryland is $48.14 per month, which is more than double the national average in 2021.

You can only enroll in MA plans during certain periods each year.

Most MA plans include Medicare Part D, which is Medicare drug coverage. 

What Types of Medicare Advantage Plans Are Available?

You can choose among several types of MA plans in Maryland, including:

• Health maintenance organizations (HMOs): These plans require you to receive healthcare from providers who belong to a network. A network is a group of doctors and other healthcare providers and facilities that have contracted with a health insurance company to provide services. If you go to providers outside the network, your care might not be covered. You may also be required to get a referral from your primary care doctor to see a specialist. 
• Preferred provider organizations (PPOs): With these plans, you pay less if you see an in-network provider, but you can also be treated by out-of-network providers. You typically don’t need a referral to see a specialist. 
• Special needs plans (SNPs): These plans are designed for people with Medicare who have specific healthcare needs. There are three types of SNPs:
  • Chronic condition special needs plans (C-SNPs): These plans help meet the needs of people with ongoing health conditions, including:
    • Diabetes
    • Cancer
    • End-stage renal disease
    • Autoimmune disorders
    • Chronic, disabling mental health conditions
  • Dual eligible special needs plans (D-SNPs): These plans are for people who have both Medicare and Medicaid. 
  • Institutional special needs plans (I-SNPs): These plans are for people living in nursing homes or who need nursing care at home. 
• Private fee-for-service plans (PFFSs): With this type of plan, you can see any provider who accepts your plan. Some PFFS plans have a network, and you pay less if you see an in-network provider. 
• Medical savings accounts (MSAs): This type of plan combines a medical savings account with a high-deductible Medicare Advantage plan. Your deductible is the amount you pay toward covered healthcare costs before your plan starts to pay those costs. The plan contributes funds to your medical savings account, which you can use to pay for out-of-pocket medical costs. If you run out of money in your MSA before you meet your deductible, you are responsible for the costs until your deductible is reached. Once you meet your deductible, the plan starts paying for Medicare-covered services.²

What Are Prescription Drug Options with Medicare Advantage?

Most MA plans include Medicare Part D, which is Medicare drug coverage. MSAs and some PFFS plans don’t provide Medicare Part D, but in that case you can buy a separate, standalone Part D prescription drug plan. If you buy an HMO or PPO without Part D coverage, you can’t enroll in a separate Part D plan. 

Be forewarned: If you don’t buy a Part D plan when you’re first eligible, you may pay an ongoing late enrollment penalty if you enroll later.^{3 4}

How Do You Choose Medicare Advantage Plans?

Choosing a Maryland MA plan is an important decision. Here are factors to consider:

• Monthly premiums: This is the amount you pay each month for your plan. Some plans have a $0 monthly premium, while others have a cost. Nationally, the average monthly premium for an MA plan is $21.⁵
• Other out-of-pocket costs: MA plans also have other costs. Many have a deductible, and they also have coinsurance and copayments. Coinsurance is a percentage you pay for a given service. You might pay 20% of the cost of a brand-name prescription drug, for example. Copays are a set dollar amount you pay for a service. You might pay $10, for instance, for a visit to your primary care doctor. Plans also have a yearly limit on the amount you pay out of pocket.⁶
• Other plan benefits: MA plans vary when it comes to the additional benefits they offer. Many include vision, dental and hearing care. Almost all plans are offering telehealth, and many offer fitness benefits like a health club membership.⁷ Consider which benefits are important to you when choosing a plan. 

When and How Do You Enroll in Medicare Advantage?

You can only enroll in MA plans during certain periods each year. To enroll, contact insurance companies directly or use the Medicare plan finder to choose a plan and enroll. Enrollment periods include:

• Initial enrollment: This period starts three months before the month you turn 65 and ends three months after the month of your 65th birthday. You can enroll in an MA plan any time during initial enrollment. 
• Open enrollment: Also known as the annual election period, this enrollment period is from October 15 – December 7 each year. During this period, you can join, drop or switch MA plans. 
• Medicare Advantage open enrollment: This period lasts from January 1 – March 31. During this period, you can switch from one MA plan to another MA plan. You also may be able to drop your MA plan and return to Original Medicare. 
• General enrollment: This period is also from January 1 – March 31. If you start Medicare Part B for the first time during this period, you can enroll in an MA plan. Your MA plan coverage would then start July 1.⁸ 
• Special enrollment: You’re also entitled to enroll, change or drop your plan in certain circumstances, including: 
  • Moving out of your plan’s service area.
  • Losing other healthcare coverage, such as Medicaid.
  • Gaining other healthcare coverage, such as through an employer.
  • Your plan becomes unavailable because Medicare has ended your plan’s contract. 
  • Another special situation, such as being diagnosed with a chronic condition that would be best served with a C-SNP.⁹

Who Has Signed up For Medicare Advantage in Maryland?

Just over one out of ten (12%) Maryland residents eligible for Medicare enrolled in Medicare Advantage. That number, known as the penetration rate, reflects a steady increase in enrollment. The number of beneficiaries who chose Medicare Advantage has tripled since 2008 (just over 51,000 in 2008 to roughly 136,000 in 2020).

How Much Do Medicare Advantage Plans Cost in Maryland?

The average MA plan premium in Maryland is $48.14 in 2021. This is significantly higher than the national average of $21.¹⁰ 

In Baltimore, for example, residents have access to 13 MA plans from five different insurance companies. Three plans have a $0 premium, five plans have premiums ranging from $10 to $35, and the rest range from $59 to $142 per month. 

Annapolis residents also have access to 13 MA plans from five insurance companies. Three plans have a $0 monthly premium. Five plans have premiums ranging from $10 to $40, and the rest range from $59 to $142 per month.¹¹

What If You Want to Change Your Medicare Advantage Plan?

You have two opportunities to change your MA plan annually. One is during open enrollment, which lasts from October 15 – December 7 each year. The other opportunity is during the Medicare Advantage open enrollment period from January 1 – March 31 each year.¹²

What Are Medicare Resources in Maryland?

Maryland residents who need help with navigating Medicare and MA plans, finding financial assistance and more can contact the State Health Insurance Assistance Program (SHIP). Assistance is free, and you can find the number for your local office here. 

If you have a complaint about an MA plan, contact the Maryland Insurance Administration. If you need financial assistance, you can apply for Medicaid by calling 1-855-642-8572, visiting your local health department or department of social services, or visiting the Maryland Health Connection website.¹³  

State Medicare Advantage Data in Maryland

Next Steps

To find the MA plan that’s right for you, visit the Medicare Plan Finder. You can shop for plans in your area and enter your prescription information to ensure the drugs you take are covered under the plan you choose. Look at the premium, deductibles and other costs, as well as the out-of-pocket maximums, and choose a plan that offers the coverage you need at a price you can afford.