Medicare Advantage Plans in Maryland

Fact Checked
Published: 2/23/2021

If you are enrolled in Original Medicare, you already know the basics of Parts A (hospital care) and B (doctor visits and outpatient care) and the limitations of its coverage. Medicare Advantage Plans, known as Part C, were designed to offer the same coverage as Original Medicare Part A and Part B while expanding on its benefits. The end result is that many services not covered under Original Medicare, including vision, dental, fitness plans, and prescription drugs, are covered under Medicare Advantage.

  • In 2019, there were 26 Medicare Advantage Plans available in Maryland
  • 11% of the total Medicare population in Maryland was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, which is the same as the national average.
  • Available Medicare Advantage Plans range from one to 24 across Maryland’s 24 counties.

Medicare Advantage Plans aren’t all the same and can vary widely on coverage, which doctors you can see, and out-of-pocket expenses, such as deductibles and copays. Fortunately, the wide variety of options makes it easy to find a good fit for your medical needs, as long as you understand the difference between each of the major types of Medicare Advantage Plans.

Medicare Advantage Plans in Maryland

Types of Medicare Advantage Plans

The four main types of plans available in Maryland’s Medicare Advantage program include HMOs, PPOs, PFFSs, and SNPs. Each of these offers different options for your out-of-pocket costs, coverage, and network, although the plans all must provide the same basic coverage as Original Medicare Parts A and B.

Health Maintenance Organizations (HMO)

If you are looking for an affordable Medicare Advantage Plan that allows you to receive services from a single primary care doctor, an HMO plan may be a good choice. These plans are generally the least expensive of the four options but come with a few restrictions, such as having to find a doctor within a preapproved network and requiring a referral when seeing a specialist. In most cases, prescription drug costs are covered.

Preferred Provider Organizations (PPO)

What sets PPO plans apart is you can see doctors that are outside of the network. While PPOs still prioritize in-network doctors with the lowest rates, these plans supply much-needed flexibility for those who, for example, need to find a doctor while out of town. PPO plans include prescription drug coverage and allow you to see a specialist without a doctor’s referral.

Private Fee-For-Service Plans (PFFS)

PFFS plans can vary, depending on the specifics set by the managing private insurance company. While some have networks and others don’t, you’ll always save the most money when choosing a doctor that is within the network. Not all PFFS Plans offer drug coverage, although if you have a plan that doesn’t, you can supplement your coverage with Medicare Part D.

Special Needs Plans (SNP)

SNP Plans are different from the other options and are not available to everyone. Designed for those with specific diseases and conditions, SNPs provide unique services to plan members, with specialized formularies and coverage benefits. While all SNP Plans offer drug coverage, most require you to choose a primary care physician and get a referral when seeing a specialist.

Enrollment and eligibility for Medicare Advantage Plans in Maryland

You are eligible for a Maryland Medicare Advantage Plan if you are at least 65 years old or have a disability, qualify for Parts A and B of Original Medicare, and aren’t currently enrolled in a Medigap plan. You can apply during three enrollment periods.

  • Initial Coverage Election Period. This period is specific to everyone and includes the three months prior to your 65th birthday, the month of your birthday, and the three months following your birthday.
  • Open Enrollment Period. Each year, there is an open enrollment period between October 15th and December 7th when you are able to enroll in a Medicare Advantage Plan. Whether you are starting an entirely new plan or switching between plans, your new coverage begins on January 1st of the following year.
  • Medicare Advantage Enrollment Period. During this period, you can switch from your current Medicare Advantage Plan to a new one, or you can switch back to Original Medicare. This period runs from January 1st to March 31st each year.

In addition to the above options, you may enroll in a Medicare Advantage Plan under special circumstances. These include moving to a new address, losing your current coverage, or either gaining or losing eligibility for an SNP.

Prescription drug coverage

Under Original Medicare, drug coverage is offered through Part D. This coverage can be used to supplement Original Medicare or added to certain PFFS Plans. Under Medicare Advantage, you can find drug coverage bundled with the specific plans. When enrolling in any of these options, it is a good idea to check which drugs are covered by reviewing the plan’s formulary.

Medicare Advantage Resources in Maryland

When choosing your insurance plan, it’s crucial that you get the coverage that will best support your long-term health. While understanding the general types of plans and benefits is helpful, the next step is to learn what options are available in your area that fit your personal needs. Luckily, Maryland is home to a variety of organizations dedicated to supporting Medicare recipients.

Baltimore Department of Aging

The Baltimore Department of Aging runs most of the state’s senior centers, offering programs and services designed to help seniors. The Maryland Access Point program can provide you with regular brochures mailed to your door and counseling on different topics. You can learn more about Medicare through the online portal or schedule an appointment with a counselor.

Contact Information: Website | 410-887-2594

Maryland Department of Human Services

The Maryland Department of Human Services offers a range of resources, including helpful information on Medicare. You can use its website to learn whether you’re eligible for Medicare, how to apply, how to save money, and other benefits you may qualify for.

Contact Information: Website | 800-332-6347

Maryland Senior Health Insurance Program

Maryland’s Senior Health Insurance Program has trained staff and counselors who help state residents understand their Medicare benefits. Through an in-person or telephone counseling session, you can discuss topics such as billing issues, assistance for low-income families, health care fraud, and more. All of MSHIP’s services are free.

Contact Information: Website | 410-764-3460

Maryland Senior Medical Patrol

The Maryland Senior Medicare Patrol helps protect Medicare beneficiaries from fraud, waste, abuse, and error. The organization’s volunteers offer free, confidential counseling sessions to provide you with the tools necessary to stay protected. Information services are available online, and for those unable to visit the SMP’s office, home visits can be arranged.

Contact Information: Website | 1-800-243-3425

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