Since 2003, Maryland has offered a health insurance program, The Maryland Health Insurance Plan (MHIP), to residents who are considered uninsurable either because they are high risk or have a history of medical problems that makes it difficult for them to find affordable insurance coverage in the individual market. Thirty-three states offer similar high-risk pools that provide comprehensive health insurance benefits to uninsurable individuals, especially those who suffer from serious medical conditions and lack access to employer-based group health insurance.
In December 2005, MHIP introduced a special premium subsidy program for low income enrollees. Called MHIP+, the program offers discounted premiums and deductibles to individuals with incomes under 225 percent of the federal poverty level (FPL).
MHIP+ offers three tiers pegged to income level: for enrollees with incomes at or below 150 percent of FPL, 200 percent of FPL, and 225 percent of FPL. Monthly premiums range from $190 to $379 and represent discounts from 17 to 58 percent off standard MHIP rates. MHIP+ enrollees with incomes at or below 150 percent and 200 percent of FPL have access to a $200 deductible and no Rx deductible product with a $1,000 out-of-pocket maximum for individual coverage ($2,000 for family). Enrollees with incomes at or below 225 percent of FPL are eligible for a discounted premium on MHIP’s $500 deductible Preferred Provider Organization (PPO) or its Exclusive Provider Organization (EPO) plan.
MHIP now has more than 9,500 enrollees and offers a successful model of a high risk insurance pool that serves as a critical safety net to individuals who cannot find affordable health coverage. MHIP also serves as the “fallback” option under the federal Health Insurance Portability and Accountability Act’s (HIPAA) guaranteed portability requirement for those individuals transitioning from group to individual coverage.
Maryland’s risk pool is funded by assessments on Maryland hospitals’ net patient revenues, a subsidy mechanism that distributes the cost of the risk pool broadly.
To learn more about MHIP, click on www.marylandhealthinsuranceplan.state.md.us/
