What’s the Difference Between Maryland Health Connection and Maryland Physicians Care?
Figuring out healthcare and all the options can be overwhelming. In Maryland, various programs and services help different people with different needs.
Two parts of Maryland’s healthcare system include:
- Maryland Health Connection
- Managed care organizations, like Maryland Physicians Care
Knowing the differences between these organizations can help people looking for healthcare in Maryland.
The Difference Between Maryland Health Connection and Maryland Physicians Care
Maryland Health Connection (MHC)Maryland Health Connection is a health insurance marketplace that helps people find the right healthcare coverage. People can compare and enroll in private health plans or Medicaid through the marketplace. Maryland Health Connection is also the only place to qualify for financial help.
Maryland Physicians Care (MPC)Maryland Physicians Care is a managed care organization, or MCO. MPC provides health services. It is owned by four hospitals: Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland. MPC is a Medicaid provider. MPC is focused on helping Medicaid members get the care they need, such as doctor visits, prescription medications, and preventive services.
What is a Health Insurance Marketplace?
A health insurance marketplace is available in each state. The online marketplace supports many different people. In a marketplace, people can buy health insurance or apply for Medicaid.
What do people do when visiting the marketplace?
Maryland residents can:
- Apply for Medicaid
- Apply for Medicaid for Maryland Children’s Health Program
- Compare different private health plans if they are not eligible for Medicaid
What is a Managed Care Organization?
A managed care organization is a health plan offered through a network of providers. MCOs aim to lower healthcare costs while maintaining high-quality care for their members. Members and their families can get health services through their MCO.
What healthcare services can members get through their MCO?
- Doctor visits
- Specialist appointments
- Pregnancy care
- Family planning and birth control
- Prescription medicines
- Hospital and emergency services
- Primary mental health services through your doctor
How Do I Know If I Qualify for Medicaid or a Marketplace Plan?
Applying is the only way to know if you are eligible for Medicaid. Even if you didn’t qualify before, you might qualify now.
Eligibility is based on:
- Where you live
- Your household size
- If you are a U.S. citizen or qualified non-citizen
- If you are pregnant
- Your income
Everyone is eligible to enroll in a private marketplace plan. You can compare plans, get an estimate, and see if you qualify for financial assistance.
Frequently Asked Questions
- Medicaid: Enrollment is open year-round. You can apply at any time, and coverage starts from the first day of the month you apply.
- Private Plans: Open enrollment periods are limited. Check the MHC website for details.
If you enroll in Medicaid for the first time, you can still choose your MCO within the first 90 days.
If you are already enrolled in Medicaid, you can select your MCO. Here is a chart with your MCO options in Maryland.
Sources
https://www.marylandhealthconnection.gov/after-you-enroll/medicaid/what-medicaid-covers/
https://insurance.maryland.gov/Consumer/Pages/HealthCoverage.aspx
https://www.marylandphysicianscare.com/about/
https://www.cdc.gov/nchs/hus/sources-definitions/managed-care.htm
https://www.marylandhealthconnection.gov/how-to-enroll/medicaid/
https://www.marylandhealthconnection.gov/how-to-enroll/private-plan/
https://www.marylandhealthconnection.gov/faqs/#healthplans
