Overview:
There is more to shopping than just finding the lowest premium. What you pay each month for health insurance (the premium) is important, but you also need to understand what the policy covers. A policy with a lower premium seems like a better deal, but a lower premium could mean less coverage or that you will pay more out-of-pocket for your health care. Keep reading for helpful information on how to shop for health insurance coverage.
Know the Details When You Shop for Health Insurance Coverage
Shopping for ways to pay for medical treatment can be confusing. Before you make your purchase, it is important that you understand:
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What you are buying. Are you purchasing insurance, a discount plan or some other type of arrangement;
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How much the coverage will cost. The fees you pay can include any combination of the following expenses: program fee, premium, deductibles, copays, mandatory and/or voluntary contributions, administrative fees, and/or coinsurance;
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How much the coverage you are buying will cover. This includes limits on amounts it will pay, when it will pay, and any other restrictions, and the rights you have if it does not pay. You’ll also want to know which providers, medical devices/equipment and hospital services will be covered.
If you are looking for health insurance, you may be able to purchase it through your employer (or your spouse’s or parents’ employer), a private insurer, an insurance producer, or the
Maryland Health Connection.
You can compare and enroll in private health plans, Medicaid, or dental coverage through the
Maryland Health Connection, the state’s health insurance marketplace under the Affordable Care Act (ACA). The
Maryland Health Connection is also the only place to qualify for financial help to make coverage more affordable. If you have questions about your application, call the
Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573) or find free, in-person help near you. You can also download the free Enroll MHC mobile app to shop, enroll, find local help, view notices and upload documents.
Find out the Details
Your health plan may not cover all of the health care services that you may need. For example, there may be limits on the number of visits for physical therapy, or the number of days covered in a skilled nursing facility. Even if your doctor says you still need these services, if your health plan has a limit, it will not pay for the treatment beyond the limits specified in your policy. Also, covered services may require cost sharing such as a copay, co-insurance, and/or deductible. You can avoid unexpected costs for health services by becoming familiar with the specifics of your health insurance plan and planning a budget. When planning a budget, make sure to consider premium payments, co-payments and any charges that will not be covered by your insurance, including amounts above your policy limit.
What to ask when Shopping for Health Insurance
Beware of Scams or Fake Sites Selling Health Coverage
The Maryland Insurance Administration has become aware of several entities offering unauthorized health insurance plans in Maryland.
Read more here or
watch this video.
Use caution and make sure you are shopping from official sources! Fake health insurance sites target shoppers during Open Enrollment.
Read the Consumer Advisory.
Visit our website for more information on insurance fraud and scams or to report an incidence.
What to know about prescription drug coverage?
Most health plans help you pay the cost of covered prescription medicines. These plans use a formulary a list of medications the plan covers – arranged by levels of tiers. Prescription medicines listed in one tier may cost you more than those in another tier. If your health insurance provides prescription drug coverage, typically, the amount you pay for a covered medication will count toward your annual out-of-pocket maximum.
To find out which prescriptions your plan covers, visit your insurer’s website to find your online health plan formulary, . You can find a link to your plan’s formulary in the plan’s “Summary of Benefits Coverage” under “Common Medical Events” in the row labeled “if you need drugs to treat your illness or condition.” You can always call the number on the back of your insurance card for assistance.
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Tier 1 — Generic drugs. These are lower-cost drugs.
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Tier 2 — Preferred, brand-name drugs. These drugs cost more because they’re unique, and just one drug company makes them.
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Tier 3 — Non-preferred, brand-name drugs. These are also brand-name drugs, but they may cost you more than other brand name drugs that treat the same condition.
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Tier 4 — Some plans use this tier for specialty drugs. Other plans have a separate “specialty” tier. These are high-cost drugs that treat rare or complex diseases.
It’s a good idea to talk with your providers about the best, affordable medications for you, based on your plan. If the pharmacy says that your plan doesn’t cover a prescription drug you’ve been taking, you may want to check with your insurer to confirm. If your request for a medication is denied work with your to ask your health plan for an exception. You may need to ask the health plan for an exception, when other drugs the plan covers haven’t worked or won’t work as well as the drug the provider prescribed, or when all other drugs the plan covers have caused or could cause harmful side effects.
Before You Buy That “Low Cost” Health Insurance
Know What You’re Buying. Get Advice from a Trusted Source!
Open Enrollment to purchase health insurance through the Maryland Health Connection for 2026 coverage is from November 1 to January 15. You may still be able to enroll in comprehensive coverage outside of these dates if you have a qualifying life event, like losing other health coverage, moving, getting married, or having a child. Medicaid is always open to those who qualify.
Financial Help May Be Available
If you purchase a policy through the
Maryland Health Connection, financial help (such as tax credits, premium subsidies, and cost sharing) may be available to you. L
earn if you qualify for financial help, or if you qualify for low or no‐cost coverage through Medicaid.
To buy insurance that will cover a wide range of conditions, start with the
Maryland Health Connection or talk to an insurance producer (agent or broker) that is licensed in Maryland. If you have questions, call the Maryland Insurance Administration at 800-492‐6116.
If you are looking to buy a new health plan to save money, here are some questions you may want to ask before you buy.
For help, call the Maryland Insurance Administration at 800‐492‐6116:
- Is it a Short‐Term, Limited Duration plan, a Sharing Ministry plan, or other limited‐coverage plan? If so, the plan may offer limited benefits and/or may not be regulated by the State of Maryland.
- Is it sold through an association that requires a membership fee? If so, it could cover less than Maryland Health Connection plans.
- Is the person selling the plan licensed in Maryland? If so, ask for his/her state license number and call the Maryland Insurance Administration at 800-492-6116 to confirm.
- Who is the carrier and is it licensed in Maryland?
- Does the plan cover your pre‐existing conditions? Does it cover your medications?
- What are the deductibles? There may be different deductibles for different services.
- What services DOESN’T the plan cover?
- For services that ARE covered, how much will the plan actually pay? Is there a limit on the total amount the plan will pay per person, per service, or per year?
- How long will the coverage last? Will you be able to keep or renew your coverage if you get sick?
- Does the plan have a provider network?
- If yes, how do you access information about it? Is your doctor or hospital in the network?
- If not, will you have to pay any part of the provider’s fees?
You can also ask for a written example of how coverage works if you visited a physician and needed diagnostic tests and follow‐up care, or had a hospital stay for several days, and had testing and scans, surgery, and saw several specialists.
Before you buy, it is a good idea to always ask for the plan’s details in writing and take the time to review the materials carefully. Don’t feel rushed to make a decision. Remember, there is free help available to you. You can call the Maryland Insurance Administration at 1‐800‐492‐6116.
Buying health insurance online or over the phone
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Make Informed Choices:
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Don’t be rushed into a decision
- You have the right to review plan terms and get plan descriptions in writing
- Don’t provide banking information or a Social Security number before receiving and reviewing plan materials
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Verify: Check with the MIA that the agent and insurance carrier are licensed.
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Confirm:
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Be sure to get coverage information in writing before you buy. It is a good idea to ask about:
- Coverage of key benefits like prescriptions drugs and preventative care
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Coverage limits per service, per person, per year
- Coverage for conditions you already have (pre-existing conditions)
- The amount you pay before the plan pays (deductible)
Get free help with your health coverage!
The Maryland Insurance Administration has a
Health Coverage Assistance Team (H-CAT) to assist consumers. If you have questions or concerns about health coverage for you or your loved ones, the H-CAT staff is here for you.
- Get answers to your health insurance questions.
- Address health insurance problems or concerns.
- File a complaint about your health insurance issue or concern.
- Connect you to resources.
Phone: 410-468-2442
To learn more about our consumer education and advocacy initiatives, read our Consumer Publications. These materials provide information about most types of insurance from auto, homeowners, health and life policies to annuities, title insurance and coverage for boats.
If your community group, HOA or organization is interested in a virtual or in-person presentation or speaker, contact Associate Commissioner Patricia Dorn at patricia.[email protected] or click here.
