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Maryland Medicaid is one type of health insurance plan for which eligible Maryland residents can apply via Maryland Health Connection. This marketplace helps residents determine their eligibility and find a suitable plan for their needs.
Groups that are often eligible include pregnant women, children, people with disabilities, the elderly, and more. According to healthinsurance.org, as of February 2023, 1,700,615 Marylanders are enrolled in the medicaid program.
If you are looking to obtain medicaid in Maryland this guide discusses the qualifications for it, what plans cover, and how to participate in the application process. To find the best plan, you can compare your insurance options through Maryland Health Connection.
Exploring your options can help you determine what plans cover the essential medical and health-related services you and your family need.To prevent shouldering the debt of unexpected medical expenses, many Marylanders extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Maryland Medicaid is one type of insurance option you can pursue through Maryland Health Connection, a health insurance marketplace. Low-income individuals, children, people with disabilities, pregnant women, and the elderly often have Medicaid.
What is Maryland Health Connection coverage? Available through Maryland Health Connection, Medicaid is a program that makes healthcare accessible to Maryland individuals, children, and families who do not exceed the maximum incomes for their household sizes.
Monthly payments for Maryland Medicaid can range from $0 to $82, based on household size and income. The state of Maryland and the federal government fund this program, and the Affordable Care Act of 2013 expanded the health insurance people could qualify for.
A Maryland Medicaid card is an ID type you can use to show you have coverage. It indicates that you are a qualified medicaid beneficiary. It also shows your identification number, your first and last name, birthday information and also other key information required for medical providers. You should bring this card to your covered healthcare appointments as proof of enrollment. Depending on your plan specifics, it can help you pay for prescriptions, doctor's visits, and more.
Maryland Health Connection open enrollment is from November 1 to January 15, but qualified individuals can enroll any time of the year. A Navigator or Assister can meet with you in person to determine your eligibility for plans within Maryland Health Connection, including Maryland Medicaid. You can apply in person at a local Health Department or Department of Social Services.
Wondering how to apply for Maryland Health Connection plans, such as Maryland Medicaid? Maryland residents (of at least five years) have several enrollment options and can apply in person via the Maryland Health Connection mobile app on Apple or Android devices, by phone, or online. Other convenient ways to apply include:
Maryland residents who have five years or more of residence must meet the following Maryland Medicaid eligibility requirements:
Even if you exceed the required income or do not exactly fit the requirements, you still are potentially eligible for Maryland Health Connection Medicaid coverage. Refer to this chart to see a detailed income eligibility table. Once you mail in the required document and complete all application steps, you'll receive a notice determining whether you qualify. If you don't choose a managed healthcare organization (or MCO) within 28 days of acceptance, you'll receive an automatic assignment, so remember to choose within that window.
Keeping a detailed record of what you spend on your and your family's healthcare needs is essential. Having as much information as possible through payment records, medical documents, and more can help you receive reimbursements for your expenses.
You should receive a red and white Maryland Medicaid card (as shown above) within 14 days of enrollment. Keeping this card with you at all times can verify your membership in a plan and help you maintain access to coverage. You can sign into your Maryland Health Connection account to check your application status and see whether your MCO (managed care organization) has sent your card.
If you need to renew or replace your Maryland Medicaid card, contact Maryland Health Connection by calling (855) 642-8572. You can also visit your local Health Department or Department of Social Services for in-person assistance. While waiting for your new card to arrive in the mail, bring your photo ID to any appointments to verify who you are.
What is Maryland Health Connection coverage? Medicaid in Maryland typically covers doctor's visits, necessary prescription medications, dental care, preventative screenings, mental health supports, hospital care and maternity care. Some of the most popular health coverage benefits include the following:
The Maryland Healthy Smiles Dental Program (or MHSDP) offers dental care services to those enrolled in Medicaid. Routine teeth cleanings, checkup visits, X-rays, crowns, fillings, anesthesia, fluoride treatments, fillings, and more are among the covered services and benefits. Children under 21 may also receive orthodontic care, fluoride varnish, and sealants.
It's always a good idea to ask your dental provider whether they accept Medicaid and whether your plan covers a specific treatment. It's better to know in advance whether your insurance will pay for your treatment or if you need to pay out of pocket. However, MHSDP members should not have to pay for any of the covered services, nor will they pay for deductibles, copays, or premiums.
Although dental coverage via Maryland Medicaid is comprehensive, there are yearly limits. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Maryland is advisable.
Your Maryland Medicaid plan should cover prescription drugs through the Medicaid Pharmacy Program. Your doctor might need to provide their approval for the medication to have your insurance cover it. Refer to the Maryland Medicaid preferred drug list for a comprehensive list of covered medications. Pharmacists will limit the dosages of certain medicines within a specific timeframe to maintain quantity limits and avoid the excessive use of prescriptions.
Some prescription programs for Medicaid members to explore are as follows:
The state of Maryland supplies extended healthcare services to residents with special needs or disabilities. This can include community and home-based services for certain members of the population (e.g., the elderly and individuals with autism, TBIs, and physical or mental disabilities). MD even provides substance abuse treatment and mental health services, along with other helpful forms of care.
You can work with your Maryland Health Connection MCO to inquire about the services you need. They can help you find medical providers that accept your insurance and provide the services you're looking for. Private and third-party insurance can offer coverage when Medicaid cannot. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Medicaid insurance in Medicaid typically does not cover out-of-state medical expenses. It could cover urgent or life-threatening emergencies you cannot return to the state to treat in time. However, in most cases, you'll need private, third-party, or another state's insurance to receive medical care outside of Maryland. If you are traveling outside of Maryland for leisure, invest in proper travelers insurance.
Maryland Medicaid offers three months of retroactive coverage, which is helpful if you needed or used services before your application. Some other states may also provide retroactive care so you can receive reimbursement for the time before you become a Medicaid member. To receive the best possible reimbursement, you should organize your medical expenses and records so they're available for review.
There are specific plan perks and information regarding students and their eligibility for Maryland Medicaid. Depending on the student's age and income level, they may have eligibility as someone under 21 or as an adult with the appropriate household service and poverty level requirement.
Medicaid in MD also helps seniors obtain the long-term care resources and support they need. While Medicaid offers intermediate care services, it provides adult day care, adult foster care, assisted living residence, nursing home care services, and more. Learn more about the following benefits:
Besides providing healthcare coverage for disabled individuals, seniors, and students in Maryland, Medicaid provides care to members of the military and veterans. Depending on income level and eligibility requirements, Medicaid insurance is typically available to these groups.
Members of the military and veterans can apply for Medicaid coverage and receive free or low-cost health insurance. Maryland Health Connection can offer coverage for essential medical and healthcare services, especially if you and your family can't receive coverage from VA programs. Maryland Health Connection also provides financial assistance to make paying for insurance easier and more accessible.
Now that you have a thorough understanding of what Medicaid in MD covers, the following are some situations where you might not have coverage:
NOTE: Out-of-state medical care may be an exception, in the event of an emergency.
If you are interested in scheduling a service but aren't sure whether Medicaid covers it, talk to your MCO about your situation. Services and coverage are always updating and changing, so ask providers before booking a new service.
Burial assistance may be offered by the Maryland Medicaid to individuals who qualify under specific Medicaid categories, however this amount is quite small. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Understanding what Maryland Health Connection covers can help you realize what types of healthcare services you have coverage for. These covered services range from dental care and hospital visits to specialists and more.
| Dental | |
|---|---|
| X-Rays and Exams | Yes |
| Wisdom Teeth Extractions | Yes, if medically necessary. |
| Cavity Fillings | Yes |
| Crowns | Yes |
| Vision | |
|---|---|
| Eye Exams | Yes, twice a year. |
| Glasses | Yes, typically covers the replacement of one pair of glasses once a year. |
| Laser Eye Surgery | Yes, if medically necessary. Cosmetic laser eye surgery is not covered. |
| Surgery | |
|---|---|
| Rhinoplasty | If someone has a nasal deformity due to birth, disease, or trauma, Medicaid often covers rhinoplasty surgery when the situation is medically necessary. Insurance will not pay for the surgery if it is simply for aesthetic reasons. |
| Breast Reduction | Maryland Medicaid may cover breast reduction surgery only if your provider finds that your breast size negatively affects your health, such as if you have breast cancer. Cosmetic reduction will not receive coverage. |
| Hospital | |
|---|---|
| Hospital stays | Yes, if medically necessary. |
| Ambulance transportation | Yes, if transportation is considered as a medical emergency. |
| Giving birth | Maryland Medicaid recipients can receive postpartum care for up to twelve months. Medicaid may provide health coverage for delivery and the health of the mother and infant in the months that follow. |
| Sexual Health | |
|---|---|
| Gynecologist visits | Through your Medicaid coverage, your MCO will allow for gynecological visits and reproductive health care. |
| Erectile Dysfunction | While Maryland Medicaid doesn’t cover erectile dysfunction medications, you can talk to your healthcare provider about finding affordable solutions. Medicaid coverage typically includes medications that are a must-have for your health. |
| Birth Control | Birth Control (Including IUDs). Medicaid will cover birth control devices and contraceptives (permanent or not) that are FDA-approved. These may include IUDs, contraceptive implants, pills, and more. |
| Fertility Treatment | Fertility Treatment. Medicaid in Maryland doesn’t include coverage for fertility treatments. |
| Specialist Services | |
|---|---|
| Dermatology | Dermatologists will take a look at skin conditions like eczema and acne and address skin diseases. However, any cosmetic procedures or treatments you wish to schedule will not fall under Medicaid's covered services, as they are for aesthetic purposes. |
| Physiotherapy | If your doctor recommends it, you can receive physiotherapy services, such as physical and occupational therapy, rehabilitation services, and more. You might need physiotherapy services after suffering from a sports or workplace-related injury. |
| Massage Therapy | If your medical provider prescribes massage therapy to improve your health, Medicaid will cover it. However, you'll need to pay for luxurious and recreational massages that aren't medically prescribed. |
| Podiatry and Foot Care | You can seek podiatric care with Maryland Medicaid, especially if you have risk factors like diabetes. Any minor foot concerns or cosmetic services may require you to pay out of pocket, as they are not medically necessary. |
| Allergy Testing | Your Maryland Medicaid plan should cover allergy testing and consultations. |
| Sleep Physician Services and CPAP Machines | If you have obstructive sleep apnea, Maryland Medicaid will cover your CPAP machines and related services so long as they are necessary for your health. They may also provide a CPAP machine during your trial period. |
While Maryland Medicaid may provide valuable coverage, you may need to seek out third-party or private insurance to supplement your existing plan. It can help you save on paying for medical services your Medicaid plan doesn't cover and addresses its limitations. Some perks of enrolling in third-party or private health insurance are as follows:
At Insurdinary, we recognize that exploring your insurance options, determining eligibility, and understanding what your new plan covers is a complex process. With our team, you can compare your healthcare insurance options and discuss your needs, seeing how Maryland Medicaid or another plan through Maryland Health Connection could provide you with the highest level of care and support.
If you're ready to save on out-of-pocket costs or compare Maryland Medicaid plans with private options, we're here to help.Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing. Insurdinary and its network of partners will offer the guidance and support you need throughout the process by answering all your questions and providing easy-to-understand information about any service you wish to know more about. Receive free quotes from trusted local providers and experience high-quality care!
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
