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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Maryland. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do – or do not – protect you as a Maryland resident.

How am I protected?
In Maryland, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however the laws protect you in the following ways.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All group health plans in Maryland must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new group health plan will begin to pay for care for that condition. Generally, if you join a new group health plan, your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your health insurance cannot be canceled because you get sick. Most health coverage is guaranteed renewable.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA or state continuation coverage. For example, it can help when you are between jobs, or when you retire early and are not yet eligible for Medicare. There are limits on what you can be charged for this coverage.

• If you lose your group health insurance and meet other qualifications, you will be federally eligible. If so, you can buy an individual health insurance policy from the Maryland Health Insurance Plan (MHIP) or from any insurance company that sells individual health insurance policies. You will not face a new pre-existing condition exclusion period if you are federally eligible. There are limits on what you can be charged for a high risk pool policy and, sometimes, for an individual policy.

• If you are not federally eligible and have had difficulty obtaining an affordable individual health insurance policy because of your health condition, you may also be eligible under MHIP. If you qualify for MHIP and you have had no previous health coverage, you may face a new pre-existing condition exclusion period. There are limits on what you can be charged for a high risk pool policy, too.

• If you are a small employer buying a small group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All fully insured health plans for small employers must be sold on a guaranteed issue basis. However, the insurance carrier can turn down the small employer if the small employer does not meet the participation requirements.

• If you are a small employer buying a group health plan, you cannot be charged more due to the health status of those in your group. You can, however, be charged higher premiums, within limits, based on where your business is located and the age and family composition of people in your group. This is called modified community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Maryland Medicaid program (called HealthChoice for some people who enroll in it) offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes. Maryland’s Children Health Program is a part of the Medicaid program that provides health insurance to some low-income children and pregnant women.

• If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal incomes tax credit to help pay for new health coverage. This credit is called the Health Care Tax Credit (HCTC), and it is equal to 65% of the cost of qualified health coverage, including COBRA and coverage under the Maryland Health Insurance Plan (MHIP).

• If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC.