Welcome back to HCAM’s Educational Series! In our last post, we covered Medicaid — what it is, who qualifies, and what the upcoming 2027 changes mean for Prince George’s County residents. This week we’re focusing on another important option for Prince George’s County residents who need health coverage: Qualified Health Plans and the financial assistance that may be available to help you afford one. You might be more surprised than you think!
What is a Qualified Health Plan?
A Qualified Health Plan (QHP) is a private health insurance plan available through the Maryland Health Connection — Maryland’s official health insurance marketplace. If you don’t qualify for Medicaid, a QHP is likely your best path to getting covered. These plans are required to cover a comprehensive set of essential health benefits, including:
- Doctor and specialist visits
- Emergency and hospital care
- Prescription medications
- Mental health and substance use services
- Preventive care and screenings
- Maternity and newborn care
QHP’s are available in different levels — Bronze, Silver, Gold, and Platinum — each with different monthly costs and out-of-pocket expenses. Choosing the right plan for your situation can feel overwhelming, but that’s exactly what HCAM’s specialists are here to help with.
What financial assistance is available?
One of the biggest misconceptions we hear from Prince George’s County residents is that health insurance is simply too expensive. And while we understand why it can feel that way, the reality is that many residents qualify for significant financial assistance that can make a Qualified Health Plan much more affordable. Here’s how it works:
Advance Premium Tax Credits
The financial help you can get to lower your monthly payment is called Advance Premium Tax Credit (APTC)
You can use the tax credit in two different ways:
- Save money now: get the financial help in advance to lower your monthly premiums
- Save money later: Wait until you file your taxes to get a premium tax credit added to your tax refund
You are not eligible for a tax credit if you are eligible for Medicaid or have access to affordable coverage through your job.
You must file taxes to get the tax credit, even if you would not usually file. You can file taxes this year, even if you didn’t file taxes last year.
If the household or income information in your Maryland Health Connection application isn’t correct, and you receive more tax credit than you’re due, you will have to pay that money back to the IRS when you file your taxes. This is called reconciling the advance payments of the premium tax credit based on your actual yearly income.
Cost-Sharing Reductions
If you enroll in a Silver-level plan and your income falls within a certain range, you may also qualify for cost-sharing reductions. These lower your out-of-pocket costs when you actually use your insurance — things like copays, deductibles, and coinsurance. This means less out of pocket when you visit a doctor or fill a prescription.
How do I know what I qualify for?
Figuring out your eligibility for financial assistance doesn’t have to be complicated — especially when you have HCAM in your corner. Our certified specialists will review your income, household size, and situation to help you understand exactly what you qualify for and which plan makes the most sense for you. And as always, our help is completely free.
Don’t count yourself out before talking to us. We’ve helped countless Maryland residents discover they qualify for far more assistance than they expected.
How do I enroll?
Enrollment in a Qualified Health Plan happens through the Maryland Health Connection during the open enrollment period, which runs November 1 through January 15. Outside of open enrollment, you may still be able to enroll if you experience a qualifying life event such as losing a job, getting married, or having a baby.
HCAM’s specialists in Prince George’s County can walk you through the entire enrollment process — from comparing plans to submitting your application to confirming your coverage. Call us at (410) 500-4710 or visit health-coverage choose-a-plan – marylandhealthconnection for more information.
Stay tuned for Part 4 of our Educational Series, where we’ll walk you through exactly what to expect when you connect with HCAM — and how easy it is to get started!
