Medicare Advantage Plans in Maryland

Medicare’s alphabet soup can be daunting. If you live in Maryland and are dipping a toe into Medicare’s waters for the first time, you may be wondering what type of plan is right for you.

Read on to learn all about Medicare Advantage in Maryland, a popular option many people in your state have opted to join.

Maryland is a small but mighty state, with over a million residents currently enrolled in Medicare Advantage plans.

Suppose you live in Maryland and are eligible for Original Medicare (Parts A and B). In that case, you also are eligible to enroll in Medicare Advantage (Part C) after you have Part A and Part B.

Medicare Advantage is a type of Medicare plan you buy from private companies. These companies are approved by Medicare and required to follow specific rules and guidelines.

By law, Part C plans must cover at least as much as Original Medicare. This ensures you have coverage for inpatient services in facilities such as hospitals. It also assures that you have coverage for outpatient services such as doctor’s visits, preventive care, and durable medical equipment.

The difference? Medicare Advantage plans often offer extra coverage that Original Medicare doesn’t. For example, many Part C plans include prescription drug coverage. When purchased separately, this is known as Medicare Part D. If your Medicare Advantage plan covers prescription drugs, you do not need to buy additional coverage for medications.

Other Part C extras may include:

• Vision care
• Dental care
• Hearing aids
• Health and wellness programs
• Transportation
• Over-the-counter drugs

No one owns a fortune-telling crystal ball, but try to gauge your future (and current) healthcare needs when you shop for a Part C plan. Of course, this can be challenging. It may be reassuring to know you can make changes or switch plans in the future if your current plan no longer works for you.

There are a significant number of Part C plans with $0 monthly premiums to choose from in Maryland. As is true throughout the country, not every plan is available everywhere. Your county and zip code will determine which plans you can choose.

According to the Centers for Medicare & Medicaid Services (CMS), there are also several Medicare Advantage plans with premiums to choose from. In 2023, the average Part C premium in Maryland is $34.86. This doesn’t include the monthly Part B premium, which you will typically have to pay in addition to your Part C premium.

For most people in 2023, the monthly Part B premium is $164.90. Based on the income you reported on your taxes two years ago, you may, in some instances, pay a higher monthly premium amount.

If you’re eligible for Original Medicare, you’re eligible for Medicare Advantage in Maryland.

To qualify for Medicare, you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five years or longer. If you meet this requirement, you may be eligible for Medicare if:

• You are 65 or older
• You have a disability
• You have end-stage renal disease

Most Medicare beneficiaries become eligible when they turn 65. In addition to age, you must meet one of these requirements:

• You’re already receiving, or are eligible to receive, retirement benefits from either Social Security or the Railroad Retirement Board
• You or your spouse had Medicare-covered government employment

If you have a disability, you may become eligible for Medicare at any age. You must also meet one of these requirements:

• You receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months. An exception is typically made for people living with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).
• You have ALS. If so, you are entitled to Medicare the first month you receive disability benefits from either SS or RRB.
• You are currently on dialysis or are a kidney transplant patient.

In Maryland, you can sign up for Medicare Advantage plans at multiple times. These include:

Initial Enrollment Period (IEP): If your eligibility is age-based, you can sign up for Medicare during the seven-month period that starts three months before you turn 65 and ends three months afterward.

For people with disabilities other than ALS, this period starts after 24 months of being eligible for, or having received, disability benefits from either Social Security or the Railroad Retirement Board.

Medicare Open Enrollment Period: You can join, switch, or drop a plan during Open Enrollment, which runs from October 15 to December 7 annually.

Medicare Advantage Open Enrollment Period: If you’re already enrolled in a Medicare Advantage plan, you can switch to a different Part C plan once during Medicare Advantage Open Enrollment.

You can also choose to switch from Part C to Original Medicare and add a Medicare Part D plan once during this timeframe. However, this doesn’t work in reverse. If you have Original Medicare, you can’t switch to a Part C plan during this time.

Medicare Advantage Open Enrollment runs from January 1 to March 31 each year.

There are several Medicare Advantage plans throughout the state that include prescription drug coverage.

Some of the plans available have a $0 monthly premium for both health and prescription drug coverage.

Some plans also have a $0 annual drug deductible. Other plans may charge a yearly drug deductible of $400 or more.

Make sure you read through what each plan offers to accurately gauge what you can expect to pay for prescription drugs throughout the year. A GoHealth licensed insurance agent will be happy to help you wade through each plan’s fine print so you get the right one for you.