BALTIMORE – Health insurance policies (including HMO plans) issued in Maryland are not impacted by a recent ruling by a federal judge in Texas that health plans do not have to cover certain preventive services.
In Braidwood Management, Inc. v. Becerra, Judge Reed O'Connor of the Federal District Court for the Northern District of Texas decided that the federal government cannot enforce a part of the Affordable Care Act (ACA) that requires health plans to cover certain preventative services recommended by a special federal task force without any patient cost-sharing. The task force recommendations addressed by the ruling include a range of services including screening tests, immunizations, behavioral counseling, and medications such as PrEP that can prevent the development or worsening of diseases and health conditions. The ruling, issued on March 30, 2023, took effect against the federal government immediately nationwide.
This ruling does not affect you if you get your health coverage under an insurance policy (or HMO contract) issued by a health insurance company in Maryland. The ACA is a federal law. Maryland has its own health insurance laws and those state laws require Maryland health insurance companies to provide the same coverage for those recommended preventative services as the ACA provided. So, if you have health coverage under an insurance policy issued in Maryland, nothing has changed for you. State law protects you and requires the insurance company to continue to cover the preventive services offered under your policy.
To find out if your health coverage is provided under a Maryland health insurance policy, start by looking at the membership card sent to you by your health plan. If the card has “MIA" on it, you have insurance coverage that is subject to Maryland law and your preventative services are still covered.
All health plans sold on the Maryland Health Benefit Exchange (Maryland Health Connection) are insurance policies issued by Maryland insurance companies. If you bought your coverage through Maryland Health Connection, your coverage is health insurance subject to Maryland law and your preventative services are still covered.
If your card does not say “MIA" or you have questions about what type of health coverage you have, please call the toll-free number on the back of your insurance card. Many employers have self-funded or self-insured health plans that are not subject to state law, even if the plan is being administered by an insurance company for the employer. Employers with headquarters in other states may purchase health insurance for employees under a policy issued in another state, in which case Maryland law does not apply.
About the Maryland Insurance Administration
The Maryland Insurance Administration is an independent State agency charged with regulating Maryland's $46 billion insurance industry.