New Maryland Health Insurance Exchange – 10 Facts

I attended the producer training this week for Maryland Health Connection, the state’s marketplace for individuals and small businesses (50 or fewer employees) to purchase health insurance beginning in 2014.    Here are the top 10 facts learned:

  1.  No more denials for preexisting conditions! – Beginning January 1, 2014, any individual with a pre-existing condition cannot be denied coverage when applying for health insurance.  This eliminates the entire medical underwriting process our individual clients have endured.  However, you must purchase the coverage during the annual open enrollment period or at the time of a loss of existing coverage.
  2. Premiums can only be based on your age, tobacco use, geographic location and family composition (that’s new!)  Health status of an individual or of employees of a small group cannot be used.
  3. Family composition rating:    Whether you are in a small group or an individual purchasing coverage and whether purchased from Maryland Health Connection or directly from an insurance company your rate will based on your age + age of your spouse + age of any of your covered dependents over age 21 + ages of your three oldest children.  This means that each employee in a small group will have their own rate.    Yes – those of you who have had your older dependents on your plan even though they are eligible for coverage through their own jobs as the rate was the same no matter how many children you had should reevaluate.  Give us a call to help you sort through this after October 1 when the new plans and rates will be available.
  4. Tobacco users can be charged 50% more.  This applies to individuals and well as members of groups.  It is unclear whether all insurance companies will be charging this tobacco surcharge.
  5. The rate categories have been narrowed – the buckets are individuals under age 21, those over age 64, and those between ages 21-64.   In this last category the ratio of the oldest to the youngest is 3:1.  This means that the highest rate cannot be greater than three times the lower rate.
  6. To take advantage of the small business tax credit or the advanced premium tax credit (APTC) which is financial assistance at certain income levels for individuals, coverage must be purchased through the exchange.
  7. If you are enrolled in an employer sponsored plan, regardless of the type of plan offered or cost of the plan to you, you are not eligible for the APTC.  On the contrary, if you have waived your employer’s group plan and you meet the other qualifications for the APTC, you will be eligible.
  8. Pediatric Dental must now be included in all plans that are offered outside of the exchange as an essential health benefit.  Within the exchange, the plans can exclude this benefit as it can be purchased separately.
  9. In-vitro fertilization and hair prosthesis benefits are additional essential health benefits that will be available on individual policies only.
  10. The Maryland Health Insurance Partnership premium subsidy plan for small businesses that has been available will be eliminated.  These businesses will need to apply for coverage through the exchange to see if they can qualify for the small business tax credit.  The Maryland Health Insurance Plan State Plus (MHIP+), MHIP Federal and MHIP Federal Plus will be eliminated as of December 31, 2013.  If you have any of these policies you will need to apply for coverage through the exchange.  We can help!

Please call our office if you have any questions on any of these facts and to review your individual situation.


Posted on by Melanie Epstein in Health Care Reform Leave a comment

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