Individuals & Families

Coverage Benefits


Protect yourself. Protect your family. 

Protection and peace of mind

protection and peace of mind through health coverageNo one plans to get sick or hurt, but most children and adults will need to be treated for an illness or injury at some point. Unexpected health care costs can add up if you don’t protect yourself. According to the Centers for Medicare & Medicaid Services, the average cost of a 3-day hospital stay is $30,000. Did you know that fixing that broken leg can cost up to $7,500? Health insurance helps pay these costs. With health coverage, you and your family are protected when you are sick, injured, or need treatment for a health condition such as heart disease, diabetes or cancer.

Being healthy, staying well

Health coverage helps pay the rising costs of medical care when you or a family member is sick or injured. But coverage plans offered in the marketplace also pay for services that may help you and your children prevent health problems. There are many benefits of health insurance. Some examples of covered services include screenings for high cholesterol, diabetes and depression; immunizations and vaccines for children and adults, mammograms and more.

Health plans provide the same Essential Health Benefits

all health plans through Maryland Health Connection provide the same Essential Health BenefitsAll plans available through Maryland Health Connection provide the same Essential Health Benefits – coverage that Marylanders and their families may need throughout their lives.
Let’s start by seeing how health insurance plans in the marketplace are the same and how they’re different. Here’s a quick look at some key facts:


All private health insurance plans in the marketplace must offer (at a minimum) the same set of core benefits, called essential health benefits. Some plans offer more benefits, but no plan can offer fewer benefits.

These essential health insurance benefits include:

  • Doctor visits
  • Hospitalization
  • Emergency care
  • Maternity and newborn care
  • Pediatric care, including dental and vision benefits
  • Prescription drugs
  • Laboratory tests
  • Mental health care
  • Substance abuse treatment
  • All plans must also cover preventive and wellness care, as well as chronic disease management, at no extra cost to you, including:
    • Flu and pneumonia shots
    • Birth control
    • Routine vaccinations
    • Screenings for cancer, such as mammograms and colonoscopies

Beginning in 2014, no plan can turn you down or charge you more money because you’ve been sick or have an on-going health issue (a pre-existing condition). This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.

Health insurance plans can differ in the types of care, treatments and services they cover that are over and above the essential health benefits.

Plans can also differ in:

  • Monthly premiums – how much the insurance coverage costs you every month
  • Coinsurance – your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.
    Example: Jane pays co-insurance of 20% (plus any deductibles she owes) of the cost for a medical test. The plan pays the remaining 80% of the allowed amount.
  • Copayments – a fixed amount you pay (for example, $20) for a covered service, such as a doctor visit.
  • Deductible – the amount you owe for covered health care services before your health insurance or plan begins to pay. For example, one plan may have a $500 deductible; another plan may have a $1,000 deductible.

For details about these health coverage terms, go to the Glossary.

You may be able to save on the cost of coverage at Maryland Health Connection

Some people may find it challenging to pay for health insurance. But here’s some good news. When you get coverage through Maryland Health Connection, you may qualify for savings on the cost of your premiums and out-of-pocket costs.

Based on your annual household income and family size, you may qualify to:

  • Pay lower costs for monthly premiums – You may qualify to pay less for your premiums each month. You’ll see the amount of savings you’re eligible for when you fill out your application. Prices shown for insurance plans will reflect the lower costs. These lower costs are provided through a federal tax credit called the Advanced Premium Tax Credit (APTC). These federal tax credits can be applied directly to your monthly premiums, so you get the lower costs immediately upon enrolling.
  • Get a cost-sharing reduction – A cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance and copayments.
  • Enroll in Medicaid – Effective in 2014, more people in Maryland than ever before will be eligible for Medicaid.

It’s good to know:

You must enroll through Maryland Health Connection to get tax credits and subsidies to lower your insurance costs. Eligible Marylanders cannot get this financial help if you enroll anywhere else.

Do you qualify for catastrophic health coverage?

People under 30 and some people with limited incomes may buy an alternative kind of coverage called a “catastrophic” health plan. A benefit of catastrophic health insurance, is that it protects you from very high medical costs in the event of an illness or injury. A catastrophic health plan differs from other plans because:

  • You will likely have to pay all of your medical costs up to a certain amount, usually several thousand dollars. Costs for Essential Health Benefits (see chart above) over that amount are usually paid by the insurance company.
  • Your monthly premiums will likely be lower than other kinds of plans, but you will be covered only if you need a lot of care. Catastrophic health plans protect you from worst-case scenarios.

In the Maryland Health Connection marketplace, catastrophic policies cover 3 primary care visits per year at no cost. They also include free preventive benefits.

Unlike other plans offered at Maryland Health Connection, with a catastrophic plan you cannot get lower costs on your monthly premiums or on out-of-pocket costs based on your income.

When you fill out a marketplace application, you’ll see catastrophic plans listed as options only if you qualify for them.