Maryland Health Insurance Exchange

Marylanders will have two options, Private and Exchange Plans. All plans effective Jan 1,2014 will have Essential Health Benefits. This site is not the Health Exchange, but a Broker website where you can talk to, shop and quote plans and discuss your options. First you should contact a broker and get help creating an account on the exchange. Second is to complete the identity proofing procedures. Then you can shop, assign a broker, view plans and then enroll. We are here to help and are Certified Maryland Health Insurance Brokers as depicted by the seal below. Call or email anytime.

Platinum Level Plans in Maryland 90% Coverage

Platinum Level Plans in the exchange are offered by carriers specific to Maryland. Federal level and other state level plans may or may not match benefits. The Platinum Level is defined as 90% coverage. That means the insurance company is willing to collect monthly premiums, provide EHB (Essential Health Benefits), and cover 90% of expenses. That means that you the consumer will be liable for the other 10%.

Gold Level Plans in Maryland 80% Coverage

Gold Level Plans in the exchange are offered be carriers specific to Maryland. Federal level and other state level plans may or may not match benefits. The Gold Level is defined as 80% coverage. That means the insurance company is willing to collect monthly premiums, provide EHB, and cover 80% of expenses. That means that you the consumer will be liable for the other 20%.

Silver Level Plans in Maryland 70% Coverage

Silver Level Plans in the exchange are offered by carriers specific to Maryland. Federal level and other state level plans may or may not match benefits. The Silver Level is defined as 70% coverage. That means the insurance company is willing to collect monthly premiums, provide EHB, and cover 70% of expenses. That means that you the consumer will be liable for the other 30%.

Bronze Level Plans in Maryland 60% Coverage

Bronze Level Plans in the exchange are offered by carriers specific to Maryland. Federal level and other state level plans may or may not match benefits. The Bronze Level is defined as 60% coverage. That means the insurance company is willing to collect monthly premiums, provide EHB, and cover 60% of expenses. That means that you the consumer will be liable for the other 40%.

Catastrophic Level Plans in Maryland

Catastrophic Level Plans in the exchange are offered by carriers specific to Maryland. Federal Level and other state level plans may or may not match benefits. The Catastrophic Level is defined as protection against catastrophic costs. Similar to HDHP or High deductible health plans, all costs are out of pocket until you reach your deductible. Limited to those under age 30 and deemed exempt from the Individual mandate. These plans do cover EHB but will not cover the first 3 visits to primary care.

Individual Mandate

The ACA requires every U.S. citizen and legal resident to have health insurance. Individuals without health insurance coverage will be required to pay a tax penalty. The penalty will be a flat fee or percentage of income, whichever is higher. Tax penalties will be phased out hopefully after 2016. In 2014 $95 flat fee or 1% of income. In 2015 $325 flat fee or 2% of income. In 2016 $695 flat fee or 2.5% of  income.

Employer Mandate

Effective January 1st, 2015 the ACA requires employers with 50 or more full-time employees must offer minimum essential coverage or pay a tax penalty.

Minimum essential coverage is basic health coverage thats meets minimum standards, including minimum value and affordability. A plan provides MEC if it meets 60% of the benefits covered by the plan. A plan is considered affordable if the person covered contributes 9.5% or less of their income to pay for the plan.

There are severe tax penalties for employers failing to provide coverage that have been changed and pushed back so we will provide further updates to the site at a later date.

If you have applied to the Maryland Health Exchange and you have been deemed ineligible for exchange plans, but eligible for Medicaid, please see this GUIDE.

Background

The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange.  Maryland’s Health Benefit Exchange (Exchange) will allow Marylanders to compare rates, benefits, and quality among plans to help individuals and small employers find an insurance product that best suits their needs.

The Exchange will also be the entity that calculates and provides tax credits to eligible small employers and advanceable tax credits for individuals below 400 percent of the federal poverty level.  Private insurers will compete in this open marketplace, creating an even playing field and providing transparent and accurate information so that Marylanders can make important decisions about their health care options.

Enabling Legislation 

Because of the state’s strong desire to show leadership and self-determination, Maryland chose to operate its own Exchange, rather than join a multi-state Exchange or default to a federal Exchange. On April 12, 2011 Governor O’Malley signed into law the Maryland Health Benefit Exchange Act of 2011.  This legislation lays the foundation for the development of Maryland’s Exchange in three parts.

• Framework and Governance Structure:  The bill creates the Exchange as an independent public entity.  Specific provisions promote transparency, accountability, flexibility and coordination with a range of partners.
• ACA Provisions:  The bill establishes those functions and duties that are required as part of the ACA.  Other provisions, which are subject to state discretion, will be added at a later time.
• Study and Recommendations:  The bill directs the Exchange to conduct a study and make recommendations in several important policy areas, and it directs the Exchange to submit the report and recommendations to the legislature prior to proceeding with decisions in these areas.  In general, the study will address how best to operate the Exchange within Maryland’s unique health care and health insurance delivery systems.

Next Steps 

The Exchange Board held its first meeting on June 3.  Over the next year, the Exchange will hire initial staff, establish advisory committees, and analyze key strategic decisions for Maryland’s Exchange, including whether to create a separate exchange for the small group market; whether to engage in selective contracting; and how to design the navigator program. The Exchange will also evaluate how to build upon existing resources in the state, including insurance producers, third-party administrators, health care advocates, and other relevant entities, to execute the required functions of the Exchange.  The Exchange will make recommendations on these issues and others by early 2012.

For Questions email: jack@comradefinancialgroup.com

source:http://dhmh.maryland.gov/exchange/SitePages/Home.aspx