How The System Works
The Affordable Care Act mandated that states start their own health exchange systems or participate in a federal exchange. The Maryland Health Benefit Exchange (MHBE) was created on April 12, 2011, as an
independent, public corporation responsible for developing and operating Maryland Health Connection, the marketplace.
The Maryland Health Benefit Exchange’s nine-member board includes board chair Joshua M. Sharfstein, secretary of Department of Health and Mental Hygiene; vice chair Darrell Gaskin, associate professor, Johns Hopkins Bloomberg School of Public Health; Therese Goldsmith, commissioner of the Maryland Insurance Administration; Ben Steffen, acting executive director of the Maryland Health Care Commission; Georges Benjamin, executive director of the American Public Health Association;?Jennifer Goldberg, assistant director of Advocacy for Health Care and Elder Law, Maryland Legal Aid Bureau; Enrique Martinez-Vidal, vice president for State Policy and Technical Assistance, AcademyHealth and director of State Coverage Initiatives; Thomas Saquella, former president, Maryland Retailers Association; and Kenneth S. Apfel, professor of practice, University of Maryland School of Public Policy.
The Maryland Health Connection is open to all uninsured Maryland residents, including those with pre-existing conditions. All Americans 18 and older are required to have health insurance beginning in 2014 or pay a fine.
There are 216,587 uninsured residents ages 18 to 64 in Baltimore City, Baltimore County and Anne Arundel County, which is the area Health Care Access Maryland is tasked with reaching. Of those individuals, 33.1 percent have incomes below 138 percent of the federal poverty line, 48.5 percent have incomes between 138 and 400 percent of the federal poverty line, and 18.5 percent have incomes above 400 percent of the federal poverty line.
Under the Affordable Care Act, Medicaid, which is a form of free health care, was expanded to cover all adults under the age of 65 with incomes of up to 138 percent of the federal poverty line, which equates to about $32,500 annually for a family of four. Those making below 400 percent of the federal poverty line, which is about $85,000 annually for a family of four, may be eligible for subsidies.
Maryland residents will be able to use marylandhealthconnection.gov to compare plans, enroll in plans and find out if they are eligible for tax credits or public health programs.
Under the law, plans must cover a wide variety of services, including doctor visits, hospitalization, emergency care, maternity care, pediatric care, prescriptions, medical tests, mental health care and substance abuse treatment. The plans must also cover preventative care at no extra cost, including flu and pneumonia shots, birth control, routine vaccinations and cancer screenings, which include mammograms and colonoscopies.
Maryland Health Connection will offer 45 different medical plans from companies such as CareFirst, Evergreen, Kaiser Permanente and UnitedHealthcare. Of those, 36 of the plans include pediatric dental benefits and 24 offer statewide coverage. There are 20 standalone dental plans from Delta Dental, DentaQuest, Dominion Dental and United Concordia. Twelve of the plans offer family coverage, and eight of them offer pediatric dental benefits only.
According to figures provided by Maryland Health Connection, premiums can range from $73 for a 20-year-old single non-smoker to more than $2,000 for a family of four with varying deductibles. The plans will be categorized based on how costs are shared and will be known as bronze, silver, gold and platinum plans. Bronze plans will have lower premiums and higher deductibles, with silver and gold in between.