Maryland Small Business
Health Insurance Plans 2023

The average price of a standard Maryland small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

In the State of Maryland, there are specific laws regarding small group health insurance. According to the laws that have been established by state government, all qualifying small businesses must be sold small group health insurance.

Furthermore, small businesses that employ more than 2 but fewer than 50 employees must be offered the same small business health insurance policies that all small businesses are offered.

If Maryland health insurance companies choose to, they are legally allowed to impose two requirements. One of those requirements is that health insurance companies may opt to impose minimum enrollment requirements, which requires small businesses have a minimum amount of group members purchase the policy.

If this requirement is imposed and a small business does not meet the enrollment requirement established by the health insurance company, the Maryland small business health insurance plans can be rescinded.

Secondly, health insurance companies in Maryland can require employers to pay a certain amount of their employees' health insurance premiums prior to agreeing to sell a small business a small group health insurance policy.

While companies that sell small business health insurance can regulate which small businesses are eligible to purchase policies, as per Maryland law, it is illegal for any health insurance company to charge higher premiums because of the health status of a group.

With that said, however, the cost of premiums can vary and be based on certain key factors, such as the age and family size of the group. Furthermore, it is illegal for health insurance companies to cancel the policies of any Maryland small business if one of the insured becomes ill.

According to Maryland Insurance Administration, Marylanders have a number of options available to help cover the cost of health care, depending upon their employment status, coverage needs and ability to pay:

1. Coverage through an Employer's Plan - Ask your employer whether it offers health insurance benefits and whether you are eligible to participate in your employer's group plan. Some employers only offer this benefit to full-time employees; others offer it to part-time employees as well. Some employers also pay a portion of their employees' health insurance premiums.
2. Individual Health Insurance - You can purchase an individual policy for yourself or your family during the annual "open enrollment period," when everyone is eligible to apply for new health insurance, or within 60 days of certain qualifying life events.
3. A Family Member's Policy - If you are married and your spouse has health insurance, you may be able to be added to that policy. Similarly, if you are under the age of 26, you may be eligible for coverage under a parent's policy.
4. COBRA or Maryland Continuation of Coverage - If you are enrolled in your employer's group plan and you lose your coverage, you may be eligible to continue your existing coverage under COBRA, which is a federal law that gives some employees the ability to continue health insurance coverage after leaving employment or under Maryland's Continuation of Coverage law.
5. Medicare - Depending upon your age or health status, you may qualify for Medicare. Medicare is the federal health insurance program for people: (1) age 65 or older, (2) under 65 with certain disabilities, and (3) of any age who have end-stage renal disease.
6. Medicaid - Depending on your household income, you may be eligible to receive Medicaid benefits. You can enroll in Medicaid at any time.
7. Maryland Children's Health Program - f you are pregnant or have a child under age 19, you may be able to obtain coverage through the Maryland Children's Health Program (MCHP).

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in MD:

• Illegal aliens
• Jailed individuals
• Religious objections
• The cost of health insurance coverage is higher than 8% of your household income
• Those who aren't covered for less than three months during the calendar year
• Those who have hardship waivers
• Your income level is blow the 100% poverty level

If you're a small business owner in Maryland, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Maryland small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Maryland small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
2. Emergency services
3. Hospitalizations, such as overnight stays and surgical procedures
4. Lab services
5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
7. Pregnancy, maternity, and newborn care, including before and after birth
8. Prescription pharmaceuticals
9. Preventative and wellness services, as well as management for chronic diseases
10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Maryland

Not only do small businesses need to offer their employees' health insurance policies that cover the 10 ACA standardized essential benefits, but policies must also include health benefits that Maryland government requires. These additional benefits include the following:

• Bariatric surgery for morbid obesity
• Blood services and product
• Chiropractic care
• Clinical trials
• Congenital anomaly for cleft lip/palate
• Diabetes care management, including equipment, supplies, and self-management training
• Durable medical equipment, including hair prosthesis
• Emergency transportation/ambulance services
• Hearing aids for children
• Home health care services
• Home health care services for additional home visits post-testicle removal
• Hospice care services
• Infertility treatment, including in-vitro fertilization
• Infertility services
• Reconstructive breast surgery
• Outpatient rehab services
• Second opinion coverage for outpatient services
• Skilled nursing facility services
• TMJ disorder diagnosis and treatment

Standardized Maryland Small Business Health Insurance Plans

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Maryland small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Maryland small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

• Age of the individual
• Whether or not the individual uses tobacco
• Where the individual lives, based on a rating area
• The number of family members who will be enrolling

While there are several types of health insurance plans to choose from, the following plans are the most popular among MD small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Maryland small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.