Qualified Health Plans FAQs

What is a Qualified Health Plan?

An insurance plan offered by a commercial insurance company that is certified by Maryland Health Connection and meets the requirements of the Affordable Care Act, such as providing essential health benefits, limiting cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and other requirements.

If I signed up for a QHP last year, what do I have to do to keep my plan?

Anyone who purchased a QHP last year will need to come back to Maryland Health Connection to complete a new application and select a plan for 2018. Open enrollment begins on November 1 and you will have until December 15 to select a plan that will begin coverage on January 1, 2018. If you do not complete this process, your insurance company will renew your insurance policy, but your January bill will not reflect any tax credits. In order to receive your tax credits, you must visit Maryland Health Connection to apply and enroll again in a plan.

How will I know how much a plan will cost?

You will be able to see what your monthly premium, deductibles, and out-of-pocket costs will be before you enroll. Plans with larger deductibles (bronze plans) will have smaller monthly premiums, but you will have to pay higher out-of-pocket costs before the benefits of your plan will kick in. Plans with small or no deductibles (gold or platinum plans) will have higher monthly premiums, but lower out-of-pocket costs when you seek medical care.

What kind of help is available to lower the cost of insurance?

You may qualify for help paying for your health care costs, depending on your income and family size. The online application process will help you determine if you qualify for financial assistance to reduce the cost of your monthly insurance premiums through tax credits. If you meet certain income guidelines, you may also be eligible for plans with reduced cost sharing, which would lower the deductible, co-payments, or co-insurance associated with your selected plan.

What kind of benefits will I get under the insurance plans offered through Maryland Health Connection?

The core benefits that all health plans must offer include doctor visits, hospitalization, emergency care, maternity care, pediatric care, prescriptions, medical tests, mental health care, substance use treatment, and more. These are known as Essential Health Benefits. Plans must cover preventive care at no extra cost to you, including flu and pneumonia shots, birth control, routine vaccinations, and cancer screenings such as mammograms and colonoscopies.

What if I have an illness, disability, or other pre-existing condition? Can I still get health insurance?

Yes, under federal law, no one can be denied health coverage because of a pre-existing condition. Insurance monthly premium rates are based only on your age, where you live, and the number of people covered under your plan.

Do I have to purchase health insurance? Is it required?

Yes. By law, under the Affordable Care Act, most people over age 18 must have health insurance or pay a fine. If you have Medicaid or Medicare coverage, you meet the requirements under the law.

My employer offers health insurance, but it is too expensive. Can I apply through Maryland Health Connection?

You can always apply for health insurance through Maryland Health Connection. However, if your employer offers you insurance and it meets minimum value health coverage as well as the requirements for affordability that the employer must meet (no more than 9.5% of your income), you will not be eligible for financial assistance through Maryland Health Connection.

For more information, call 410-500-4710.

I am an undocumented immigrant but my household members would like to enroll in coverage. How does my immigration status affect my household’s eligibility?

We know that many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Some families may have members who can’t buy health insurance through the Marketplace, alongside other family members who are eligible to use the Marketplace, like lawfully present immigrants. Click here for Maryland Health Connection's guide on Eligibility and Enrollment Information for Immigrant Families.