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Medicare in Maryland

Medicare is a national health insurance program designed mainly for senior citizens. Medicare comes in four parts, named A, B, C and D. A and B are often referred to as Original Medicare, and is purchased from the federal government. Part C, also called Medicare Advantage, lets you buy Parts A and B from private insurance companies. Part D, also available from private companies, covers prescription drugs. The federal government controls Original Medicare but Maryland Medicare Advantage and Part D are sold by service area and differ depending on where you live.

  1. Original Medicare

    • Since Original Medicare is offered by the federal government, the plans are standardized and the benefits the same no matter where you live. Part A covers hospice, home health and inpatient hospitalizations, while Part B covers outpatient services and preventive care. Part A is premium-free if you have paid 10 years of Medicare taxes, but Part B has separate monthly premium payments. You enroll in Original Medicare through your local Social Security Administration office. You can find the nearest Maryland SSA office at the website Social Security Online.

    Maryland Medicare Advantage Plans

    • Part C Medicare, or Medicare Advantage, can be sold in Maryland as HMOs, PPOs, PFFS plans and special needs plans. PFFS policies, which stands for private fee for service, work like traditional health insurance plans. You can see any doctor who takes the plan and usually have to submit your insurance claims yourself. HMO policies have lower co-pays and premiums, but you must see doctors and other health care providers that are part of your insurance company's network. PPOs offer lower costs if you stay in a network, but you can go outside the network in exchange for paying higher fees. Special needs plans are tailored to certain health conditions. Maryland MA policies are sold by county, so if you move from one to the other, you may or may not be able to keep the same plan.

    Part D

    • Medicare Part D helps cover the costs of prescription medications. Not all Part D plans cover the same prescriptions, however. Co-pays and monthly premiums also vary by plan and by company. As of 2011, Maryland had 45 different Part D plans available to residents. Maryland Medicare users with assets less than $4,000 and monthly earnings of less than $927 also qualify for the Maryland Pharmacy Assistance Program. As of 2011, MPAP users pay only $2.50 per generic prescription and $7.50 per name-brand medication.

    Medicare Savings Programs

    • Low-income Medicare users can receive help paying their out-of-pocket costs through one of Maryland's Medicare Savings programs. In 2011, Maryland had three, with different maximum monthly income limits. Individuals with less than $928 in monthly income, or couples with less than $1,246, may be classified as Qualified Medicare Beneficiaries and get assistance with their Part A and B monthly premiums, co-payments and deductibles. Singles who make less than $1,109, or couples who make less than $1,491, qualify as Specified Low-Income Beneficiaries and can have their Part B monthly premiums paid. Couples who earn less than $1,675 per month, or singles with less than $1,246, may also qualify as a second category of Specified Low-Income Medicare Beneficiary and receive help with their Part B monthly premiums, depending on the availability of funds.

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