Maryland Individual Health Insurance
Health insurance is a significant protection that every person and every family should consider. If you don?t get group health insurance through your employer, then you should look into purchasing Maryland individual health insurance from a private insurer. As a Maryland resident, you should educate yourself on the state laws and regulations that affect these individual health insurance plans.
Eligibility: How Am I Evaluated?
Generally, a health insurer has the flexibility to decide how applications are handled and who gets accepted for a policy. Many insurers use factors such as health status, age, and lifestyle habits to decide who they will cover. There are no real regulations on why an applicant can be turned down and an insurer can deny you for almost any reason.
In accordance with HIPPA Group-to-Individual Portability Coverage regulations, Maryland guarantees coverage under the Maryland Health Insurance Plan for HIPPA eligible consumers who have been turned down by private insurers.
Maryland Guaranteed Benefits & Pre-Existing Conditions
For the most part, your Maryland individual health insurance policy will cover benefits depending on what type of plan you choose. Insurers in Maryland are not required to carry any standardized policies and can decide which plans and benefits to offer to residents. However, there are a few benefits that must be offered to all residents who purchase health insurance, including mammograms and prostate cancer screenings.
There are several Maryland laws and regulations regarding pre-existing conditions:
- First, HMO plans cannot be subject to elimination riders or exclusion periods.
- Second, non-HMO policies can include any pre-existing conditions on the policy?s elimination rider, which will usually exclude that condition from coverage for the life of the policy.
- Lastly, if you make a claim for treatment of a specific condition within the first 2 years of your policy, the insurer can look back in your medical history for the past 7 years to determine whether it is something that should have been diagnosed before your policy began. If so, your claim can be denied.
- Additionally, insurers do not have to give you credit for prior continuous health insurance coverage.
Maryland Individual Health Insurance Premiums
Premiums for Maryland individual health insurance policies are determined at the discretion of the insurer and are usually based on individual factors, such as age, health status, and family size. There are no Maryland laws that state what you can or cannot be charged for a policy. Essentially, an insurer can charge you what they want to and if you are older or have a medical condition, you will likely pay more for your insurance coverage.
Lastly, in Maryland you are guaranteed the opportunity to renew your health insurance policy at the end of your plan?s term, regardless of your health status. On the flip side, your insurer can also review your policy rates and charge you a higher premium if your health has declined since. This helps to protect both the consumer, from being without protection when in declining health, and the insurer, from paying costly medical expenses on their own dime.