Eligibility and Enrollment
Resources for Consumers & Those Who Assist Them
There is a lot more to getting health care than just having an insurance card. Consumers need to be sure they have the "right" one:
- Is it affordable?
- Do the benefits address one's specific health needs?
- What happens once one gets the card?
Please let us know if there is other information you could use. View a comprehensive list of resource materials created by Consumer Health First.
Medicaid recipients must renew their eligibility once every 12 months. This process is also known as getting a “redetermination”. Renewals for most Medicaid recipients will now be processed in Maryland Health Connection. Recipients who must renew their eligibility using Maryland Health Connection, will receive a letter in the mail with instructions on how to renew their benefits. To help them prepare for that process, Medicaid has issued this useful Medicaid Redetermination Fact Sheet, and here is one for SUD providers.
Selecting the Right Insurance Plan: This isn't easy. Consumers must understand the language of insurance, the financial implications of their choice and their individual needs related to the benefits offered. Vulnerable populations and those with unique health needs need specific information. For example, those with disabilities, members of the LGBT community, those living with HIV, and those with mental health or substance use disorder challenges.
Maryland Health Connection - Here consumers can determine their eligibility for Medicaid or financial assistance for private insurance, compare plans and find out where to get in-person assistance. Useful fact sheets from Maryland Health Connection include: What To Expect After You Enroll and Reporting Your Household Size and Income.
Navigator Resource Guide - This includes a Q & A organized into sections that address how individuals may present themselves to Navigators, based on their insurance status and coverage options. Developed in collaboration with the Center on Budget and Policy Priorities, Georgetown University Center for Children and Families, and Kaiser Family Foundation.
The “My Smart Choice Workbook”- a useful tool, particularly for those providing assistance to consumers as they select a plan.
The Marketplace Plan Comparison Worksheet, by the Center on Budget and Policy Priorities, This tool is intended for use by Marketplace enrollment assisters when helping consumers compare Marketplace Qualified Health Plans and select the plan that best meets their needs. This worksheet allows you to compile important plan details side-by-side in a user-friendly way to help the consumer walk through the pros and cons of each plan. View the Spanish version.
From Coverage to Care is an initiative to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them, so they can live a long and healthy life. CMS has developed written resources and videos in multiple languages.
Families USA has developed a whole set of terrific tools and resources in their Enrollment Resource Center, such as brochures, fact sheets and consumer health insurance FAQs.
Health Insurance Plan Rates and Financial Assistance
2017 Health Insurance Plan Rates - approved by Maryland Insurance Administration
Consumer's Union Tax Credit brochure is a useful brochure in English and Spanish.
Get Financial Help With Your Plan in 2017 - Maryland Health Connection FAQ.
Get Help with Prescription Drug Affordability for Seniors: The Senior Prescription Drug Assistance Program (SPDAP) is a subsidy program established by the Maryland General Assembly in 2005 to provide financial assistance to moderate-income Maryland residents who are eligible for Medicare and are enrolled in a prescription drug plan.
Kaiser Health News answers the question: If I Don’t Use All My Subsidy Credit, Will I Get It When I Do My Taxes? Find the answer.
Parity & Consumer Protections: What To Look For?
Terrific FAQ for health care reform with a special section for Substance Use Disorder developed by our partners at the Drug Policy and Public Health Strategies Clinic at the University of Maryland Carey School of Law.
Special: Information for Health Care Professionals
Enroll America has created a presumptive eligibility toolkit for health care providers. With presumptive eligibility (PE), an individual can be temporarily enrolled in Medicaid immediately if it appears they are eligible. When an individual provides a hospital with a few basic pieces of information (about their income and household size), a PE determination can be made.
Check out these simple tips for talking to your patients about their new health coverage options.
We hosted a webinar for the Maryland Chapter of the American Academy of Pediatrics entitled The Affordable Care Act: Getting it Right for Maryland's Kids. View the visual presentation, listen to the audio recording.
Special: Information for Small Business Owners
The SHOP Direct Enrollment program is open. Learn More.