Individual Health Insurance:
In Maryland, your ability to buy an individual health insurance policy may depend on your health status. Insurers that sell individual health insurance in Maryland are free to turn you down because of your health status and other factors. If this happens, you can buy health insurance from the Maryland Health Insurance Plan (MHIP).
If you buy an individual health insurance policy from an HMO, you will not face a pre-existing exclusion period. HMO’s cannot impose pre-existing exclusion periods.
If you buy a non-HMO individual health insurance policy, there might be an elimination rider on any medical condition that you currently have or had in the past. In addition, if you make a claim during the first 24 months of the policy, the insurer can refuse that claim and others related to the condition if it determines the condition was present within 7 years of the time of application.
If you have an expensive health condition, your individual health insurance premiums may be very high.
Maryland has a risk pool program called the MHIP. It offers health coverage for persons who are HIPAA eligible (Health Insurance Portability and Accountability), for people eligible for HCTC (Health Coverage Tax Credit), and for people with expensive health conditions who are unable to buy individual coverage.
You can also buy coverage from MHIP if you have moved to Maryland from another state’s high risk pool. The high risk pool offers both individual and family policies, so dependents are also eligible for coverage under the high risk pool. To be eligible for MHIP, you must be a Maryland resident and not be eligible for employer-sponsored group health coverage, Medicaid or Medicare.
The Women’s Breast and Cervical Cancer Health Program is a Medicaid program which provides coverage for medical assistance services for women who have been screened through the Breast and Cervical Cancer Program (BCCP) and diagnosed with breast or cervical cancer.
In order to be eligible you must meet the income requirements for the BCCP, be a woman between the age of 40 and 64, be a Maryland resident, be uninsured or underinsured, be in need of medical treatment, and not be eligible or pending eligibility for other Medicaid coverage.
The Maryland Children’s Health Program is a federal/state program that gives full health benefits for children up to age 19, and pregnant women of any age who meet the income guidelines.
The Maryland Pharmacy Assistance Program can help low income people buy prescription medicine.
The Breast and Cervical Cancer Screening Program provides free clinical screening services to eligible residents of Maryland to detect breast or cervical cancer.
If you are HIV-positive or you have AIDS, and you have private health insurance, the Maryland AIDS Insurance Program may pay the cost of your health insurance premiums. For more information, please visit the Maryland Insurance Administration at
Group Health Insurance:
Under Maryland law, newborns, adopted children, and children placed for adoption must be covered under your fully insured group health plan for the first 31 days following birth, adoption, or placement, if the plan covers dependents. Children who have been placed under guardianship must be covered under your fully insured group health plan for the first 31 days following placement, if the plan covers dependents.
Under Maryland law, dependent grandchildren may also be eligible for coverage under your fully insured group health plan. Your disabled child can remain covered as a dependent under your health plan into adulthood.
HMOs in Maryland are not allowed to impose pre-existing condition exclusions on any enrollees.
Fully insured small group health plans cannot impose any pre-existing condition exclusions. Fully insured large group health plans and self-insured group health plans can impose pre-existing condition exclusions.
Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns or newly adopted children, children placed for adoption, or genetic information.
Group plans can only exclude covering for pre-existing conditions for a limited time.
Your protections may differ if you move to a group health plan that offers more benefits than your old one did.
If you have lost your group health insurance and are receiving benefits from the Trade Adjustment Assistance program, you may be eligible for a federal income tax credit to help you pay for new health coverage.
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