In order to comply with the provisions of the 2010 Patient Protection and Affordable Care Act, all states will be modifying their insurance regulations over the next two years. Children already enjoy immunity from pre-existing condition exclusions, a protection that will extend to adults in 2014. Also, children may remain on their parents health policies up to age 26, regardless of educational or marital status.
Most states, in concert with the federal government, have established high-risk pools for people with pre-existing conditions until the required health care exchanges take effect on January 1, 2014.
General Insurance Regulations
Maryland health insurance companies must extend health insurance coverage through an available group plan to anyone who has had an insurance policy with another company over the past 12 months even if they have a pre-existing condition. There can be no waiting period restrictions.
When sending patient information and coverage determinations, Maryland health insurance companies must use the National Plan and Provider System to protect policy holders from electronic records theft. There is also no bias when a policy is being reviewed. This ensures that the only time a Maryland health insurance company has access to a patient’s medical records is when the initial application is received and is being approved for coverage.
Health Care Exchange
The Maryland Health Care Exchange was signed into law on April 12, 2011, but the working format of the exchange has yet to be determined.
Pre-Existing Condition Insurance
The state’s Pre-Existing Condition Insurance Plan program is administered by the Maryland Health Insurance Plan and offers both primary and specialty care as well as hospitalization and prescription drug coverage. Premiums run from $127 to $685 a month with deductibles of $500 and $1500 depending on plan level chosen. The out-of-pocket expense limits are $3000 and $1500 respectively.
Medicaid eligibility is determined by income level and expressed as a percentage of the Federal Poverty Level. The same formula is used to determine benefits distributed under the Children’s CHIP-funded Medicaid Expansions. For infants under 1 year of age the percentages are 185 and 300 respectively; the age 1-5 group qualifies at 133 and 300; and the 6-19 group at 100 and 300.
Pregnant women can receive Medicaid at 250% FPL, parents at 36, adults at 116, the employed disabled at 300, and non-elderly disabled Social Security recipients at 74%.
Approximately 13 percent of Maryland residents are enrolled in Medicare, with 748,000 receiving prescription drug coverage. Per enrollee the annual benefits average $8,535.