FAQ

Insurance Questions? We Have Straight Answers.

Insurance is confusing — and that's by design. We're changing that. Here are honest, plain-English answers to the questions our clients ask most.

Maryland-Specific Answers

What Marylanders Always Ask —
Answered Plainly.

The seven questions we hear in nearly every Maryland Health Connection consultation — answered without the carrier marketing spin.

Maryland operates its own state-based marketplace called Maryland Health Connection — it does not use HealthCare.gov. That means Marylanders shop, compare, and enroll through the Maryland portal, and eligibility for Medical Assistance (Maryland Medicaid) is determined through the same system. Plans, prices, and subsidies are Maryland-specific. Our advisors are Maryland Health Connection–certified and walk you through the entire MD Connection application end-to-end.

It depends almost entirely on where you live and which providers you want to keep. CareFirst BlueCross BlueShield has the broadest network across all 24 Maryland counties and the strongest hospital relationships with Johns Hopkins, the University of Maryland Medical System, MedStar, and LifeBridge. Kaiser Permanente runs an integrated-care model concentrated in the DC suburbs (Montgomery County, Prince George's County, and parts of Howard and Anne Arundel) — if you live near a Kaiser facility and like having your doctor, lab, and pharmacy under one roof, Kaiser is hard to beat. We map your ZIP, your doctors, and your medications against both networks before recommending one.

Maryland expanded Medicaid under the ACA, and eligibility is generous compared to many states. As a rough guide, single adults earning under approximately $20,000 and families of four earning under approximately $41,000 typically qualify — but the rules vary by household composition, pregnancy status, disability, and age. Maryland Health Connection screens you for Medical Assistance automatically when you apply for marketplace coverage. If you qualify, enrollment is year-round (no Open Enrollment window required), and your coverage is essentially free.

For most federal employees, FEHB is the better deal because the federal government pays a large share of the premium. But there are real cases where Maryland Health Connection wins: if you have a non-working spouse who qualifies for ACA subsidies, if you're a contractor or term employee with limited FEHB access, if you're nearing retirement and want to bridge to Medicare, or if your preferred Johns Hopkins or University of Maryland specialists are not well-covered by your FEHB plan. We compare your FEHB option against the best Maryland marketplace match side by side and tell you the honest answer.

Most CareFirst PPO and HMO plans in Maryland include Johns Hopkins and UMMS as in-network providers, but coverage tiers and out-of-pocket costs differ significantly across CareFirst products. Kaiser uses its own integrated provider network and only covers Hopkins or UMMS in emergencies or via referral. United and Cigna marketplace plans in Maryland have narrower hospital networks — always confirm before enrolling. We pull the live network directory for any plan we recommend and confirm your specific Hopkins or UMMS doctor is in-network for that specific plan, not just the carrier.

Yes, the Eastern Shore (Talbot, Dorchester, Wicomico, Worcester, Somerset, Caroline, Queen Anne's, Kent, and Cecil counties) has a narrower carrier mix than the I-95 corridor. CareFirst is the dominant marketplace carrier east of the Bay Bridge, and Kaiser has no Eastern Shore presence. Many Eastern Shore residents qualify for enhanced subsidies due to lower median incomes, and rural networks can require longer travel for specialists. We know which Eastern Shore hospital systems (Peninsula Regional, Atlantic General, Easton Memorial) are in which networks and help you pick a plan that works for waterfront life.

Maryland Health Connection's Open Enrollment for 2026 coverage runs from November 1, 2025 to January 15, 2026. Outside that window, you need a Qualifying Life Event (job loss, marriage, baby, move, loss of FEHB) to trigger a Special Enrollment Period. Maryland also recognizes loss of Medical Assistance eligibility as a qualifying event. Medical Assistance enrollment itself is year-round. If you missed Open Enrollment and don't have a qualifying event, we'll tell you straight — and walk you through short-term and supplemental options that may bridge the gap until November.