Maryland Medicare Guide

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Below you’ll find useful information to help you understand the basics of Medicare in Maryland, including your options and average pricing of some types of plans.

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A Snapshot of Medicare in Maryland

There are over a million Maryland Medicare beneficiaries, making up 17% of the state’s total population. The majority of beneficiaries are on Medicare due to their age, but about 11% are on Medicare due to being disabled. 14% of Maryland’s Medicare enrollees also receive full or partial Medicaid benefits, which are intended to help those with low income and resources.

One big decision you need to make when you enroll in Medicare (which we’ll explore more later on) is whether or not you want to stick with Original Medicare or switch to a Medicare Advantage plan. In Maryland, 84% of Medicare beneficiaries choose to remain on Original Medicare and 16% choose to move to a Medicare Advantage plan (source).

Maryland Medicare Eligibility and Enrollment Steps

Eligibility is the same for all US citizens. If you’re 65 or older, you are eligible for Medicare. You’re also eligible if you have certain disabilities like ALS or End-Stage Kidney Disease.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

If you’re enrolling in Medicare by way of turning 65 and are not automatically enrolled, you are able to enroll during your Initial Enrollment Period (IEP). Your IEP is a seven-month window unique to your birth month. It starts three months before the month you turn 65 and extends until three months after it. In some cases, you may choose to delay Part B enrollment, and you can learn more about if that’s the right decision for you here.

2. Compare additional coverage options

Once you’ve signed up for Medicare, you have an option to stay on Original Medicare or switch to a Medicare Advantage plan. If you stay on Original Medicare, you have the option to add a Medicare Supplement (Medigap) plan to help cover the 20% of costs that Medicare doesn’t. You can also enroll in a Part D (prescription drug coverage) plan. If you switch to a Medicare Advantage (Medicare Part C) plan, your Medicare will be more “all-in-one,” meaning Part A, Part B, and oftentimes, Part D will all be included in your one plan. Whether you choose Original Medicare or Medicare Advantage is a personal choice you should make based on the pros and cons of each and your specific health and financial situation.

3. Set yourself up for success

Once you’ve chosen your Medicare coverage, you should find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage. We also encourage those on Medicare Advantage and Part D plans to review their needs and plan benefits every year during Medicare’s Open Enrollment Period to be sure you’re always getting the most value from Medicare.

Maryland Medicare Advantage Plans

There are 35 Medicare Advantage plans in Maryland, but pricing and availability vary by county. For example, Montgomery County has 24 Medicare Advantage plans from seven different insurance carriers and Talbot County has nine plans offered by three insurance carriers.

Advantage plans must provide at least the same coverage as Original Medicare, and often provide additional benefits, including:

Dental, vision, and hearing services
Prescription coverage
Flex cards
Fitness perks
Transportation services

With all these extras, you may be wondering why everyone doesn’t move to Medicare Advantage. These plans also have their disadvantages, including:

Limited networks
Preauthorization requirements for covered services
Higher out-of-pocket costs when compared to coverage through Original Medicare + Medigap

To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our Maryland Medicare Advisors.

Maryland Medicare Supplement Plans

Across the US, Medicare beneficiaries have access to ten types of Medicare Supplement (Medigap) plans. Each plan of a type (e.g., every Medigap Plan G) provides the exact same coverage—even though pricing may vary from one insurance company to another. Plan G is the most comprehensive Medigap plan. It covers almost all of your out-of-pocket costs (you just have to meet your Part B deductible).

Medigap plans pair with your Original Medicare to help cover the 20% of costs that Original Medicare doesn’t pay for covered services. These plans significantly reduce your Medicare out-of-pocket costs! Compared to Medicare Advantage plans, Medigap plans have some key benefits:

You can see any doctor that accepts Medicare (about 90% of doctors nationwide)
You don’t need prior authorization for covered services
Your out-of-pocket costs are significantly reduced

The best time to enroll in a Medigap plan is during the Medigap Open Enrollment Period, which occurs during the first six months that you have Part B coverage. During this time, you are guaranteed acceptance into any Medigap plan without any additional charges or fees, regardless of your health history. Outside of guaranteed issue periods, insurance companies can ask you questions about your health history and deny you coverage.

Maryland Part D Plans

Original Medicare does not include prescription drug coverage, which is why we have Medicare Part D. Medicare beneficiaries can receive Part D benefits by either enrolling in a Medicare Advantage plan that includes them or enrolling in a stand-alone Part D plan. There are 22 stand-alone Part D plans available in Maryland, but your specific plan pricing and availability will depend on the county you live in.

If you aren’t currently taking any prescriptions, you may consider skipping prescription drug coverage. In this case, we still recommend you enroll in one of the lower-premium options to avoid the Part D penalty.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Maryland Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in Maryland

Healthcare services are one of the top expenses for older Americans, and they can add up! There are three programs that may help those with low income and resources pay for Medicare-related expenses.

Maryland Medicaid

Medicaid is a joint federal and state program that each state operates a little differently. Medicaid eligibility is determined by your available income and resources.

If you are disabled over the age of 65 and receive SSI and Medicare benefits, you will receive full Medicaid benefits. These benefits wrap around Medicare to provide more comprehensive coverage. You’re also eligible for Medicaid benefits if you meet the eligibility and financial criteria.

Medicare Savings Programs

Individuals on Medicare and Medicaid may also be eligible for Maryland Medicare Savings Programs. These programs help Medicare beneficiaries with low income and resources to pay their Medicare premiums, copays, and deductibles. There are two types of Medicare Savings Programs in Maryland:

The Qualified Medicare Beneficiary Program (QMB) pays for beneficiaries’ Medicare premiums, copayments, and deductibles.
The Specified Low-Income Medicare Beneficiary Program (SLMB) pays for your monthly Medicare Part B premium.

Learn more about Maryland Medicaid eligibility and enrollment for those who are 65 and older here.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Maryland
Maryland pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Maryland Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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