Medicare in Maryland
Key Takeaways
- Medicare in Maryland is health insurance available to all legal U.S. residents aged 65 and older. The federal government partially funds it through taxes.
- Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). helps cover hospital and medical costs. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Maryland combines Parts A and B and often bundles Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other services.
- The price of Medicare in Maryland starts with standard costs but is adjusted based on details like your work history and income.
Of all the state nicknames, Maryland’s “America in Miniature” may be among the most fitting; whether you prefer urban life, shorelines or quiet country living, you can find it within state lines. Maryland has something for everyone.
Medicare in Maryland provides ways to maintain your health and keep enjoying everything the state has to offer. If you’re approaching 65 or already there, it’s essential to understand your Medicare options and find a plan that works for you. At GoHealth, we can help you answer some critical questions like what are the different kinds of Medicare plans in Maryland? What do they cost? Can I get Medicare Advantage in Maryland?
To help you get started, here’s our guide to Medicare in Maryland.
Who Qualifies for Medicare in Maryland?
To be eligible for Medicare in Maryland, you must be at least 65 years old, and a legal U.S. citizen, or have been a legal resident for five years. There are occasions when you may be eligible before 65, including:
- You’ve received retirement benefits for 24 months from the Railroad Retirement Board (RRB).
- You’ve drawn disability-based Social Security benefits for 24 months.
- You have end-stage renal disease (ESRD).
- You have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease.
Can I bundle multiple benefits into one plan?
How Do I Apply for Medicare in Maryland?
If you’re approaching 65, your first chance to enroll in Medicare is known as your Initial Enrollment Period. There are several ways to sign up at this time:
- Through the Social Security Administration (SSA) website.
- In-person at a local SSA office.
- Call the SSA at 1-800-325-0078.
- If you worked for a railroad, you might need to apply through the Railroad Retirement Board (RRB). Give the RRB a call at 1-877-772-5772.
- Call GoHealth. Our insurance agents know the ins and outs of Medicare in Maryland. Let them help you through the enrollment process.
- Initial Enrollment Period (IEP): seven months around the month you turn 65.
- Medicare’s Open Enrollment Period: October 15 to December 7.
- Medicare Advantage Open Enrollment Period: January to March 31.
- General Enrollment Period: January 1 to March 31.
What Medicare coverage is right for my specific situation?
Who is Eligible for Medicaid in Maryland?
Medicaid is a separate program from Medicare. Some people can qualify for both Medicare and Medicaid. Medicaid is partly run by the states and provides health insurance to people with limited resources. In Maryland, there are several eligibility requirements you’ll need to meet.
What Are the Parts of Medicare?
There are two main types of Medicare plans in Maryland: Original Medicare (Parts A and B) or Medicare Advantage (Part C). If you choose Original Medicare, you can also sign up for Medicare Supplement Insurance (Medigap) and Medicare Prescription Drug Plan (Part D) to round out your coverage. Medicare Advantage, on the other hand, bundles a lot of these services together. Here’s how they work:
Original Medicare (Parts A and B)
Parts A and B help cover hospital, preventive and medically necessary services, and you can see any doctor that accepts Medicare. But out-of-pocket costs can be high, and you’ll need separate coverage for prescription drugs, hearing, vision, and dental.
Medicare Advantage (Part C)
Medicare Advantage (Part C) replaces Original Medicare (Part A and B), offering the same coverage. Along with Part A and B benefits, Medicare Part C usually bundles additional services like dental, hearing, vision, and prescription drug coverage.
As we mentioned, enrolling in Original Medicare in Maryland means you can enroll in Medigap and Part D separately. Here’s a rundown of what to expect from each:
Medicare Prescription Drug Plan (Part D)
Medicare Part D is standalone prescription coverage that private insurance companies sell. If you have Original Medicare, you’ll need to enroll in and pay for your Part D separately. Medicare Advantage in Maryland often includes Part D coverage.
Medicare Supplement Insurance (Medigap)
Though technically not a “Part” of Medicare, Medigap is a valuable and widely-used resource for people enrolled in Original Medicare in Maryland. Medigap has several options that help cover costly copayments, coinsurance, and deductibles. Like Part D, enrollment and payment for Medigap are separate.
Is Medicare Free After You Turn 65?
Probably not. Despite this misleading Medicare myth, you’ll likely have to pay for healthcare after you’ve turned 65. There are some standard Medicare costs to know about, but your amount will depend on your needs, details and the plan you choose.
Looking to build your budget for Medicare in Maryland? Here’s what you can expect to pay for Original Medicare and Part D in 2025:
Medicare Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $285 a month if you worked between 7.5 and 10 years
- $518 a month if you worked fewer than 7.5 years
Deductible:
- $1,676 for each hospital benefit period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up (income-based)
Deductible:
- $257 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & coinsurance:
- Plan- and drug-specific
Find the Medicare Plan that works for you.
Is Medicare Advantage Available in Maryland?
There are several options for Medicare Advantage in Maryland. To find the right plan for you, consider details such as your health needs, medications, options and budget. If you need help looking through the different plans available, give GoHealth a call. Our licensed insurance agents will discuss your needs and see how Maryland’s Medicare plans stack up.
What are the Types of Medicare Advantage Plans?
There are four main types of Medicare Advantage plans. If you or a loved one are shopping for Medicare Advantage in Maryland, keep an eye out for these key plan types:
- Health Maintenance Organization (HMO) plans use primary care physicians to manage care and refer other providers within a network.
- Preferred Provider Organization (PPO) plans allow some out-of-network care but still use primary care physicians.
- Private Fee-for-Service (PFFS) policies pay providers for each service they provide.
- Special Needs Plans (SNPs) help enrollees living with specific health conditions. D-SNP assists dual-eligible individuals, and C-SNP is for people with chronic diseases.
What Is the Best Medicare Plan?
The answer here depends on your needs and available options. A plan that perfectly fits one person may be wrong for someone else. The key is to find a plan that works for you and your needs. That starts by understanding what those are and how the different plans can help — or not. Here are some resources to get you started.
- Enrollment Checklist: Get prepped for enrollment.
- Medicare Star Rating System: Learn what others think of their plans, and why.
- Pro Tips: Little-known tips to make Medicare easier.
- Pros & Cons: What you need to know about Original Medicare vs. Medicare Advantage in Maryland.
- GoHealth: Our licensed insurance agents will go through your needs and details. Then, they’ll shop for Medicare plans in Maryland that fit you.
What Are the Advantages and Disadvantages of Medicare Advantage Plans?
The answer here can be pretty personal. There are a few comparison points you can start with when evaluating Medicare Advantage in Maryland, especially when compared to Original Medicare. They are:
- Original Medicare allows you to see any doctor that accepts Medicare, but out-of-pocket costs can be high. Many enrollees add Medicare Supplement Insurance (Medigap) and Part D to help with costs and prescription drugs.
- Medicare Advantage often features lower costs, but you’re typically restricted to a local provider network. Medicare Advantage plans often include prescription drug coverage through Part D.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 940,731 people are enrolled in Medicare Part A and B in Maryland. The total number of beneficiaries enrolled in Medicare Advantage increased from 136,780 to 147,883 year over year. Medicare Advantage participation in Maryland went from 14.87% to 15.72% year over year. If you’d like to dive deeper into how Medicare in Maryland breaks down across the state, we provide a glance at who is using Medicare and how.
940,731 Beneficiaries with Part A & Part B
147,883 Medicare Advantage Beneficiaries
15.72% Medicare Advantage Participation Rate
57.06% Female
42.94% Male
65.87% Non-Hispanic White
24.35% African American
2.71% Hispanic
7.07% Other/Unknown
17.33% Eligible for Medicaid
0.98 Average HCC Score
$12,105.97 Actual Per Capita Costs
19.73% Hospital Readmission Rate
25.52% % of Beneficiaries with an Emergency Department Visit
136,780 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
14.87% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Maryland Department of Health
1-877-463-3464
https://health.maryland.gov/pages/home.aspx
What should I know about the Maryland Department of Health?
Obtain birth certificates, file complaints, and connect with local treatment options.
Maryland Prevention and Health Promotion Administration (PHPA)
https://www.marylandhealthconnection.gov/
What should I know about the Prevention and Health Promotion Administration?
Connect with local initiatives designed to reduces the occurrence and burden of chronic illnesses like cancer and diabetes, among others.
Maryland Behavioral Health Administration
2-1-1 (Substance Use Disorder help)
https://health.maryland.gov/bha/Pages/HELP.aspx
What should I know about the Maryland Behavioral Health Administration?
Find local inpatient and outpatient mental health treatment.
Maryland Department of Aging
1-800-243-3425
https://aging.maryland.gov/Pages/default.aspx
What should I know about the Maryland Department of Aging?
Report elder abuse, find caregiver resources, and see if you qualify for financial assistance for your Medicare costs.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Maryland about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Medicare costs at a glance. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.