Navigating Benefits - Health Insurance

Applying for health insurance can be challenging due to a variety of barriers, especially for individuals unfamiliar with the system. Common difficulties include understanding complex eligibility rules, gathering required documents, navigating confusing websites or long paper forms, and meeting strict deadlines. Language barriers, limited internet access, and lack of personalized help can further complicate the process, particularly for low-income or vulnerable populations. These obstacles can cause delays in coverage or lead people to give up on applying altogether, even when they qualify for assistance like Medicaid.

Disclaimer: We strive to keep the information on this page accurate and up to date. However, programs and requirements can change, and we may not always be aware of those changes immediately. If you notice any outdated or incorrect information, or if you have suggestions for additional resources we should include, please reach out to your community's Resources and Opportunities (R&O) manager to make them aware of the changes needed.

Applying for Medicaid

What is Medicaid? Medicaid is a public health insurance program that provides free or low-cost health coverage to people with low income, including children, pregnant individuals, adults, seniors, and people with disabilities. It’s funded by both the federal and state governments, and each state runs its own version with specific rules. In Maryland, you can apply through the Maryland Health Connection and, if eligible, receive care through a Managed Care Organization (MCO).

Check Your Eligibility for Medicaid

You may qualify for Medicaid if you're a low-income adult (age 19–64), child, pregnant person, or caregiver. Eligibility is based on your household size and modified adjusted gross income (MAGI). Use the Maryland Health Connection income table to estimate eligibility.

How to Apply
You can apply for Medicaid year-round in Maryland using any of these methods:

1. Through the Maryland Health Connection website or Mobile App: "Maryland Health Connection" (Enroll MHC) on iOS or Android.

2. By Phone: Call 1-855-642-8572 (TTY: 1-855-642-8573), Monday–Friday, 8 am-6 pm.

3. In Person: Visit a local health department or Department of Social Services office.

When you create an account on the website or mobile app and provide basic information about yourself and your household, the system will automatically let you know if you are eligible. 

What You Need
You may need to upload or submit documents to verify:

You may receive an immediate decision if you're applying based on income only. Otherwise, the process may take up to 30–60 days. 

Choosing a Managed Care Organization (MCO)

Once approved for Medicaid, you’ll receive a medical assistance card by mail (usually within 14 days). It will be necessary for you to select an MCO or on will be assigned to you

What Is an MCO?

A Managed Care Organization (MCO) is a health insurance plan that contracts with the state Medicaid agency to provide health services to enrolled members for a set monthly payment.

MCOs coordinate care through a defined provider network, including primary care providers and specialists. They manage services, control costs, and may include additional benefits such as dental and vision care beyond what Medicaid traditionally offers.

Maryland Medicaid MCOs

Maryland’s Medicaid program—called HealthChoice—contracts with nine MCOs to provide physical health and traditional behavioral health services.These MCOs include:

• Aetna Better Health of Maryland

• Amerigroup Community Care (also known as Wellpoint Maryland)

• JAI Medical Systems

• Kaiser Permanente

• Maryland Physicians Care

• MedStar Family Choice

• Priority Partners

• UnitedHealthcare of the Mid‑Atlantic

• University of Maryland Health Partners 

Maryland MCOs – Strengths & Best Fit by Medical Need

Appealing Your Medicaid Decision if You are Denied

If you are denied, you have 90 days to file an appeal. You have 10 days to request that your benefits continue during the appeal process. Legal aid or navigators may help with appeals. 

Where to Get Help: Call Maryland Health Connection at 1-855-642-8572 or visit marylandhealthconnection.gov. You can also contact a local navigator or visit a local health department.

Rare and Expensive Medicine (REM) for Very Complex Needs

What is REM?

• REM (Rare and Expensive Case Management) is a special Medicaid program in Maryland for people who have certain rare or high-cost medical conditions.

• It gives extra support beyond regular Medicaid, including a nurse case manager to help coordinate care, get referrals, and manage treatment.

• People in REM don’t have to stay in a Managed Care Organization (MCO) — instead, they get fee-for-service Medicaid, which can sometimes give more flexibility in choosing doctors or specialists.

• It’s meant to make sure people with serious or complex conditions get consistent, high-quality care.

Who is REM for?

REM is for people who:

• Have one or more qualifying rare or expensive medical conditions (like cystic fibrosis, HIV, certain cancers, sickle cell disease, traumatic brain injury, severe epilepsy, and more — about 50 conditions are on the list).

• Are eligible for Maryland Medicaid and need ongoing, specialized medical care that’s hard to coordinate through regular MCOs.

What are the benefits?

• Personal nurse case manager who helps with appointments, medications, referrals, and more.

• No MCO required — you can use any doctor or specialist who takes Medicaid.

• Better access to specialty care and services that are harder to get in a typical Medicaid plan.

How do you apply?

You can’t apply directly — you have to be referred to REM. Here’s how it works:

• Get a referral from a doctor, hospital, MCO, or Medicaid provider. The referral goes to Maryland’s REM program administrator.

• Nurses and caseworkers review your medical records to decide if your condition qualifies under the REM list.

• If approved you will be enrolled in REM, and assigned a nurse case manager. You will no longer have your MCO and get fee-for-service Medicaid.

Who to contact?

Your MCO or primary care doctor can start a referral. You can also call Maryland Medicaid directly for REM info. REM Case Management line: 1-800-565-8190 or health.maryland.gov/mmcp.

Applying for Health Insurance through Your Employer

How to Apply for Employer-Sponsored Health Insurance

1. Check with Your HR Department or Employer

   • Ask if your job offers health insurance and when you're eligible to enroll (some jobs have waiting periods—like 30 or 60 days after you start).

   • Request a summary of the health plan options and costs (premiums, copays, deductibles).

2. Know Your Enrollment Period. Open Enrollment is usually only once per year where you can sign up, switch plans, or add family members. If you just got hired, lost other coverage, or had a life change (like a birth or marriage), you can apply outside the usual window.

3. Review Your Plan Options. Compare different plans (like HMO vs. PPO) based on your health needs, doctor access, and budget. Look at what's covered (e.g., prescriptions, mental health, maternity, vision/dental if offered).

4. Fill Out the Enrollment Forms: Your employer may give you paper forms or access to an online benefits portal. Provide information for yourself and any dependents you want to cover (names, birthdates, SSNs).

5. Submit Documents on Time: Turn in your forms before the enrollment deadline—missing it could mean waiting months for coverage. Keep a copy of everything you submit.

6. Wait for Confirmation & Insurance Cards. After enrollment, your insurance company will mail you a member ID card. You can then create an online account with the insurer to track your benefits and claims.

If You Decline Employer Coverage You cannot get financial help on the Marketplace (HealthCare.gov) if your employer coverage is considered affordable and meets minimum standards.

Leveraging Your MCO/Health Insurance Benefits

How to Make the Most of Your MCO or Health Insurance Benefits

1. Choose the Right Primary Care Provider (PCP): Pick a doctor in your plan’s network who you trust. Your PCP helps coordinate referrals, prescriptions, and ongoing care.

2. Use Free Preventive Services: Most plans cover annual checkups, vaccines, cancer screenings, and more at no cost.

3. Know What's Covered: Read your benefits guide or log into your MCO or insurer’s website/app. Understand what's included (mental health, dental, vision, prescriptions) and what needs pre-approval.

4. Ask About Extra Benefits: Many MCOs offer free extras like transportation to appointments, over-the-counter (OTC) allowance, and even gym memberships, care coordination, or vision/dental perks. Call your MCO’s member services (on the back of your card) to ask what's available to you.

5. Use In-Network Providers: Always check if your doctor, hospital, or pharmacy is in your plan’s network to avoid surprise bills.

6. Get Help From Member Services: If you're confused about coverage, billing, or appointments, call your MCO or insurer’s member services number on the back of your insurance card.

7. Use Your Online Portal or App: You can find doctors, schedule appointments, view claims, or request ID cards online—easy and fast.

8. Take Advantage of Case Management. If you have a chronic condition or complex health needs, ask if you qualify for a nurse case manager to help coordinate your care.

   Becoming a Home Health Care Provider for a Family Member or Loved One

Home health care through Medicaid provides support at home for people who are elderly, disabled, or have chronic health conditions that make it difficult to care for themselves. Services may include:

How to Apply (in Maryland):

Apply for Medicaid, if you haven’t already, through Maryland Health Connection.

Contact your MCO or local Department of Social Services and ask about Long-Term Services and Supports (LTSS) or the Community First Choice (CFC) program.

• A needs assessment will be scheduled to determine your eligibility and level of care needed.
• If approved, you’ll get assigned hours of care, and services can begin through a Medicaid-approved home care agency—or, in some cases, a family member can become your paid caregiver (see below).

If You Want to Become a Paid Caregiver for a Family Member (through Medicaid)

Maryland offers programs that allow certain family members to be paid caregivers for someone receiving Medicaid—you don’t always have to be a licensed nurse.

Programs:

Who Can Get Paid:

Steps to Become a Paid Caregiver:

Your family member must be enrolled in Medicaid and approved for home care services (like through CFC). During the service planning process, request to use the self-directed model (this allows the recipient to choose their caregiver).

You’ll need to:

• Fill out hiring paperwork
• Pass a background check
• Possibly complete basic training or orientation
• Once approved, you’ll track your hours and get paid through the program’s fiscal agent.

Getting Started:

• Maryland Medicaid Long-Term Services & Supports:
  https://health.maryland.gov/mmcp/longtermcare
• Local Health Department or Area Agency on Aging
• Call Maryland Access Point (MAP): 1-844-627-5465

Healthcare Resources

Get Free Help With Your Health Coverage through the Maryland Insurance Administration (MIA)

hcat.mia@maryland.gov (410)  468 - 2442 https://insurance.maryland.gov/Consumer/Pages/health-coverage-assistance-team.aspx

Contact the Maryland Insurance Administration for questions or concerns about health coverage for you or your loved ones. You can connect to a Health Coverage Assistance Team (H-CAT) member within one business day to address concerns like:

• Access to health coverage "Do I qualify for Medicaid or Medical Assistance (MA)?"
• Understanding benefits "I need help figuring out what is covered by my health plan."
• Disability Services "How long can my child with a disability stay on my plan?"
• Mental Health and Substance Abuse Care "How can I get a quicker appointment for outpatient therapy?"
• Filing a complaint "The health plan denied my claim, what do I do next?"

21st Century Cures Act - Cures Rule

Since April 5, 2021, a new rule  was enacted called the "Cures Rule" started. This rule requires doctors and hospitals to give patients access to all their health information in electronic medical records. Patients should be able to see their information quickly and for free. For more information see https://www.healthit.gov. 

Sometimes, setting up access to your health information on your phone can be found in the aftercare summary. An aftercare summary is a document that gives important information about your care after a visit or procedure, including instructions on how to access your health records.

1. HealthCare.gov provides information on health insurance options, including the Affordable Care Act, Medicaid, and the Children’s Health Insurance Program (CHIP).
2. Medicaid & the Children's Health Insurance Program (CHIP) - Medicaid & CHIP offer health coverage for low-income individuals and families. Information on eligibility for immigrants is available here.
3. Community Health Centers - Health centers across the U.S. offer low-cost healthcare services to underserved populations, including immigrants. Find local centers here.  
4. Personal Medication Record - Helps individuals keep track of their medications. This record is useful for providing accurate information to doctors or when applying for disability benefits.
5. National Immigration Law Center (NILC) - Provides resources on immigrants' rights, including healthcare and eligibility for health programs like Medicaid.
6. Refugee Health Program (CDC) - Supports the health and well-being of refugees through resources on health screenings, vaccinations, and preventive care.

Health Insurance Rights:

You Have the Right to Fair Treatment. It is illegal for healthcare providers or insurance companies to treat you unfairly because of your race, nationality, or immigration status. You have the right to be treated equally. 

Children and Pregnant Women Can Usually Get Health Insurance. In many states, children and pregnant women can get Medicaid or other health programs, even if other adults cannot. 

You Can Get Health Care in Your Language. Health programs must help you if you don’t speak English well. They should give you interpreters to help you understand what you need. You can ask for this help if you need it. You Have the Right to Emergency Care.

Everyone has the right to emergency medical care. But remember - emergency costs are expensive and should not replace be used as an exception to healthcare.