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Medicare in Maryland

Need info on Medicare in Maryland? Get cracking with costs, plan options, and more

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Maryland is health insurance available to all legal U.S. residents aged 65 and older. The federal government partially funds it through taxes.

  • Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). helps cover hospital and medical costs. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Maryland combines Parts A and B and often bundles Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other services.

  • The price of Medicare in Maryland starts with standard costs but is adjusted based on details like your work history and income.

Of all the state nicknames, Maryland’s “America in Miniature” may be among the most fitting; whether you prefer urban life, shorelines or quiet country living, you can find it within state lines. Much like our great country, Maryland has something for everyone.

Thanks to Medicare in Maryland, there are ways to maintain your health to keep enjoying everything the state has to offer. If you’re approaching 65 or already there, it’s essential to make sure you understand your Medicare options and how to find a plan that works for you. At GoHealth, we can help you answer some critical questions like the different kinds of Medicare plans in Maryland? What do they cost? Can I get Medicare Advantage in Maryland?

To help you get started, here’s our guide to Medicare in Maryland.

Who Qualifies for Medicare in Maryland?

To be eligible for Medicare in Maryland, you must be at least 65 years old, and a legal U.S. citizen, or have been a legal resident for five years. There are occasions when you may be eligible before 65, including:

  • You’ve received retirement benefits for 24 months from the Railroad Retirement Board (RRB)
  • You’ve drawn disability-based Social Security benefits for 24 months
  • You have End Stage Renal Disease (ESRD)
  • You have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrigh’s Disease

How Do I Apply for Medicare in Maryland?

If you’re approaching 65, your first chance to enroll in Medicare in Maryland is known as your Initial Enrollment Period. There are several ways to sign up at this time:

  • Through the Social Security Administration (SSA) website [1]
  • In-person at a local SSA office [2]
  • Call the SSA at 1-800-325-0078
  • If you worked for a railroad, you might need to apply through the Railroad Retirement Board (RRB). Give the RRB a call at 1-877-772-5772.
  • Call GoHealth. Our insurance agents know the ins and outs of Medicare in Maryland. Let them help you through the enrollment process.

Medicare in Maryland has several different enrollment periods. Here are the dates to circle on your calendar:

  • Initial Enrollment Period (IEP): seven months around the month you turn 65.
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

Who Is Eligible for Medicaid in Maryland?

Medicaid is a separate program from Medicare. Some people can qualify for both Medicare and Medicaid. Medicaid is partly run by the states and provides health insurance to low-income children, families and adults. In Maryland, there are several eligibility requirements you’ll need to meet. [3]

What Are the Different Plans of Medicare?

There are two main types of Medicare plans in Maryland: Original Medicare (Parts A and B) or Medicare Advantage (Part C). If you choose Original Medicare, you can also sign up for Medicare Supplement Insurance (Medigap) and Medicare Prescription Drug Plan (Part D) to round out your coverage. Medicare Advantage, on the other hand, bundles a lot of these services together. Here’s how they work:

Original Medicare (Parts A and B)

Parts A and B help cover hospital, preventive, and medically necessary services, and you can see any doctor that accepts Medicare. But out-of-pocket costs can be high, and you’ll need separate coverage for prescription drugs, hearing, vision, and dental.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

 

As we mentioned, enrolling in Original Medicare in Maryland means you can enroll in Medigap and Part D separately. Here’s a rundown of what to expect from each:

Medicare Prescription Drug Plan (Part D)

Medicare Part D is stand-alone prescription coverage that private insurance companies sell. If you have Original Medicare, you’ll need to enroll in and pay for your Part D separately. Medicare Advantage in Maryland often includes Part D coverage.

Medicare Supplement Insurance (Medigap)

Though technically not a “Part” of Medicare, Medigap is a valuable and widely-used resource for people enrolled in Original Medicare in Maryland. Medigap has several options that help cover costly copayments, coinsurance and deductibles. Like Part D, enrollment and payment for Medigap are separate.

Is Medicare Free After You Turn 65?

Probably not. Despite this misleading Medicare myth, you’ll likely have to pay for healthcare after you’ve turned 65. There are some standard Medicare costs to know about, but your amount will depend on your needs, details, and the plan you choose.

Looking to build your budget for Medicare in Maryland? Here’s what you can expect to pay for Original Medicare and Part D in 2021:

Medicare in MD: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 for each hospital benefit period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in MD: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in MD: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

Is Medicare Advantage Available in Maryland?

Yes, there are several options for Medicare Advantage in Maryland. To find the right plan for you, consider details such as your health needs, medications, options and budget. If you need help looking through the different plans available, give GoHealth a call. Our licensed insurance agents will discuss your needs and see how Maryland’s Medicare plans stack up.

What Are 4 Types of Medicare Advantage Plans?

Many people think Medicare Advantage is just one plan. In actuality, there are four main types of Medicare Advantage plans. If you or a loved one are shopping for Medicare Advantage in Maryland, keep an eye out for these key plan types:

  • Private Fee-for-Service (PFFS) policies pay providers for each service they provide.
  • Special Needs Plans (SNPs) help enrollees living with specific health conditions. [4] D-SNP assists dual-eligible individuals, and C-SNP is for people with chronic diseases.

What Is the Best Medicare Plan for 2021?

The answer here depends on your needs and available options. A plan that perfectly fits one person may be wrong for someone else. The key is to find a plan that works for you and your needs. That starts by understanding what those are and how the different plans can help — or not. Here are some resources to get you started.

  • Pro Tips: Little-known tips to make Medicare easier
  • Pros & Cons: What you need to know about Original Medicare vs. Medicare Advantage in Maryland
  •  GoHealth: Our licensed insurance agents will go through your needs and details. Then, they’ll shop for Medicare plans in Maryland that fit you.

What Are the Advantages and Disadvantages of Medicare Advantage Plans?

The answer here can be pretty personal as an advantage for one person may be a disadvantage for another. There are a few comparison points you can start with when evaluating Medicare Advantage in Maryland, especially when compared to Original Medicare. They are:

  • Original Medicare allows you to see any doctor that accepts Medicare, but out-of-pocket costs can be high. Many enrollees add Medicare Supplement (Medigap) and Part D to help with costs and prescription drugs.
  • Medicare Advantage often features lower costs, but you’re typically restricted to a local provider network. Medicare Advantage plans often include prescription drug coverage through Part D.

Still, need help with Medicare? Give GoHealth a call. Our licensed insurance agents will offer impartial advice and guidance to help your journey to Medicare in Maryland easier.

Medicare in Maryland by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 901,565 people are enrolled in Medicare in Maryland. The total number of beneficiaries enrolled in Medicare Advantage in Maryland is 133,043. The previous year, 120,578 enrolled in Medicare Advantage. Medicare Advantage participation in Maryland went from 14.76% to 13.68% year over year. If you’d like to dive deeper into how Medicare in Maryland breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Maryland
901,565
Beneficiaries with Part A & Part B
133,043
Medicare Advantage Beneficiaries
14.76%
Medicare Advantage Participation Rate
57.05%
% Female
42.95%
% Male
0.99
Average HCC Score
$12,244.12
Actual Per Capita Costs
18.00%
% Eligible for Medicaid
31.20%
% of Beneficiaries with an Emergency Department Visit
19.87%
Hospital Readmission Rate
66.83%
% Non-Hispanic White
24.01%
% African American
2.59%
% Hispanic
6.57%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Maryland Medicare Resources & Contacts

Beneficiaries spend an average of $12,244.12 each year on Medicare in Maryland. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Maryland-based resources, like these, may be able to help:

Maryland Department of Health

1-410-767-6500

1-877-463-3464

https://health.maryland.gov/pages/home.aspx

What should I know about the Maryland Department of Health?

Obtain birth certificates, file complaints and connect with local treatment options

Maryland Prevention and Health Promotion Administration (PHPA)

1-855-642-8572

https://www.marylandhealthconnection.gov/

What should I know about the Prevention and Health Promotion Administration?

Connect with local initiatives designed to reduces the occurrence and burden of chronic illnesses like cancer and diabetes, among others

Maryland Behavioral Health Administration

1-800-888-1965

2-1-1 (Substance Use Disorder help)

https://bha.health.maryland.gov/Pages/HELP.aspx

What should I know about the Maryland Behavioral Health Administration?

Find local inpatient and outpatient mental health treatment

Maryland Department of Aging

1-410-767-110

1-800-243-3425

https://aging.maryland.gov/Pages/default.aspx

What should I know about the Maryland Department of Aging?

Report elder abuse, find caregiver resources and see if you qualify for financial assistance for your Medicare costs

Nationwide Resources

Speak with an insurance agent that is licensed in Maryland about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in MD, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.