Medicare Advantage Plans Baltimore

If you’re seeking information on Medicare Advantage plans in Baltimore, you want clear, concise details about your options. How do these Medicare Advantage Plans in Baltimore differ, what benefits do they offer, and at what cost?

This article dives into each of these questions, providing thoughtful comparisons and essential insights to guide Baltimore residents through the complexities of Medicare Advantage, including plan types like HMO and HMO-POS, additional benefits, and enrollment guidelines.


Key Takeaways



  • Enrollment in Medicare Advantage plans is subject to eligibility requirements and specific enrollment periods, with options available for financial assistance through programs like MSPs and the Medicare Rx Extra Help program.

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Exploring Medicare Advantage Plans in Baltimore


Medicare Advantage Plans Baltimore 2025, Exploring Medicare Advantage Plans in Baltimore


Medicare Advantage, also known as Medicare Part C, is a unique alternative to Original Medicare. It’s offered by private insurance companies and provides the core benefits of Original Medicare, often with additional benefits.

In Maryland, Medicare Advantage plan types include HMO, PPO, PFFS, and SNP. However, in Baltimore City County, the two distinct Medicare Advantage plan types available are HMO and HMO-POS.

With 64 Maryland Medicare Advantage plans available as of 2024, you’re spoilt for choice.


Understanding Plan Types

HMO and HMO-POS plans are the primary Medicare Advantage plan types available in Baltimore.

Here are some key features of these plans:

  • HMO plans typically come with lower monthly payments


  • Members are required to select a primary care physician


  • The primary care physician is responsible for providing referrals to specialists


  • Both HMO and HMO-POS plans have a restricted provider network


On the contrary, PPO plans usually feature higher monthly premiums compared to HMOs but provide greater flexibility, allowing members to access any doctor or specialist without the need for referrals, and include coverage for out-of-network care. A thorough comprehension of these plan types greatly aids in the comparison of Medicare Advantage plans in Baltimore.


Coverage and Benefits

Medicare Advantage plans in Baltimore often offer additional benefits not included in Original Medicare. These include dental, vision, and hearing services. The bundling of dental and vision coverage in these plans provides potential cost savings compared to receiving these services outside of Original Medicare.

Moreover, most Medicare Advantage plans in Baltimore include prescription drug coverage, a benefit not provided by Original Medicare. These extra benefits make Medicare Advantage plans an attractive option for Medicare beneficiaries in Baltimore.


Navigating Plan Networks

Skillful navigation of a Medicare Advantage plan’s network is key to sidestepping extra costs, such as those associated with out-of-network services. Before seeing a specialist, a referral from your primary care physician (PCP) may be required.

To ensure access to medical services without additional costs, check if your preferred medical provider participates in the plan’s network.

This careful navigation ensures you maximize the benefits of your Medicare Advantage plan by understanding the Medicare rules.


Comparing Baltimore’s Best Medicare Advantage Plans


Medicare Advantage Plans Baltimore 2025, Comparing Baltimore's Best Medicare Advantage Plans


With a plethora of Medicare Advantage plans available in Baltimore, it’s essential to compare Medicare Advantage plans to find the best fit for your needs. A thoughtful assessment of factors like star ratings, quality measures, and supplementary perks and programs will enable you to make an informed decision tailored to your health needs.

CareFirst’s HMO plans, for instance, offer a broader network of doctors compared to many HMOs, contributing positively to member satisfaction and choice. Their PPO plans provide an even wider range of in-network healthcare providers.


Star Ratings and Quality Measures

CMS star ratings are a reliable measure of the quality of health and drug services received by beneficiaries in Baltimore.

They reflect the performance and quality of health plans. Approximately 51% of Medicare Advantage with prescription drug (MA-PD) contracts have earned 4 stars or higher. Weighted by enrollment, around 72% of MA-PD enrollees are in contracts awarded 4 or more stars.

Hence, a plan with a higher star rating frequently signals top-notch performance.


Additional Perks and Programs

Apart from the standard health benefits, many high-rated Medicare Advantage plans offer additional perks like:

  • Gym memberships



  • Vision coverage


  • Fitness coverage


  • Wellness programs


  • Over-the-counter allowances


These extra benefits can lead to significant healthcare cost savings for beneficiaries. Therefore, while comparing plans, don’t overlook these additional perks.

Prescription Drug Coverage in Baltimore Medicare Advantage Plans


Medicare Advantage Plans Baltimore 2025, Prescription Drug Coverage in Baltimore Medicare Advantage Plans


A significant feature of Medicare Advantage plans in Baltimore is the inclusion of prescription drug coverage. These plans often bundle Medicare Part D, offering prescription drug coverage through various plans that define their own premiums, deductibles, and co-payments.

Erickson Advantage and Johns Hopkins Advantage MD plans in Baltimore provide $0 drug deductibles, enhancing prescription drug coverage to beneficiaries.

Additionally, residents have access to Part D plans like those provided by Humana, Aetna, and Wellcare, with varying costs and ratings.


Importance of Medication Coverage

For Medicare beneficiaries, especially those with chronic conditions necessitating regular medication, prescription drug coverage is indispensable. Financial assistance programs like Extra Help and Maryland’s SPDAP can help eligible residents with prescription drug costs.

This assistance can greatly decrease out-of-pocket expenses and provide a safety net for those with limited resources.


Evaluating Formularies

Formularies, the lists of drugs covered by a plan, can greatly affect your healthcare costs. Reviewing a plan’s formulary to verify the inclusion of your needed medications is an essential step.

Understanding the tier in which medications are placed within the plan’s formulary is essential to determining cost-sharing responsibilities.

Thus, assessing the plan’s formulary is a critical step in budgeting your healthcare costs.

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Eligibility and Enrollment for Baltimore Residents


Medicare Advantage Plans Baltimore 2025, Eligibility and Enrollment for Baltimore Residents


Every Baltimore resident contemplating Medicare Advantage must be conversant with the eligibility requirements and enrollment periods. Medicare Advantage plans in Baltimore are available to individuals enrolled in both Medicare Part A and Part B, covering residents in all areas including Baltimore City County.

Eligible residents can join or switch Medicare Advantage plans during key enrollment periods like the Annual Enrollment Period or during Special Enrollment Periods triggered by specific life events.


Who Qualifies?

Eligibility for Medicare Advantage in Baltimore includes residents of specific areas such as:

  • Baldwin


  • Baltimore


  • Catonsville


  • Other regions of Baltimore County


Beneficiaries with disabilities in Baltimore are entitled to free aid and services to ensure compliance with federal civil rights laws.

With approximately 1 in 6 residents of Maryland being 65 or older, a significant demographic is potentially eligible for Medicare Advantage.


Enrollment Periods

Baltimore residents have several periods during which they can enroll in or switch Medicare Advantage plans. These include:

  • Annual Election Period


  • Medicare Advantage Open Enrollment Period


  • Individual Election Period


  • 5-Star Special Enrollment Period


  • Enrollment opportunities tied to exceptional circumstances


Grasping these enrollment periods will enable you to fully utilize the available Medicare Advantage plans.

Alternatives to Medicare Advantage in Baltimore

While Medicare Advantage plans offer a comprehensive coverage package, some Baltimore residents may find that alternatives better suit their needs. These alternatives include Original Medicare with Medigap policies and standalone Part D drug plans.


Understanding Original Medicare Plus Supplements

Original Medicare, consisting of Part A and Part B, can be complemented with Medigap policies. These policies cover additional healthcare costs not covered by Original Medicare, such as coinsurance, copayments, and deductibles.

They are standardized into plans A through N, each offering a different set of benefits to accommodate various health needs and budgets.

Hence, combining Original Medicare with Medicare supplements can serve as a practical alternative to Medicare Advantage.


Standalone Prescription Drug Plans

Standalone Part D prescription drug plans (PDPs) are another option for Baltimore residents who require prescription coverage in addition to Original Medicare. Since Medigap plans in Baltimore do not offer prescription medication coverage, many beneficiaries choose standalone Part D plans to manage their medication expenses.

It’s crucial to note that the information on Part D plans provided by organizations may be limited to the plans they offer.

Financial Considerations for Choosing a Medicare Advantage Plan


Medicare Advantage Plans Baltimore 2025, Financial Considerations for Choosing a Medicare Advantage Plan


The selection of a Medicare Advantage plan necessitates the evaluation of numerous financial factors. In 2024, the average monthly premium for a Medicare Advantage plan in Maryland is $35.50.

This makes it an affordable option for many residents. However, the cost of a plan is not solely determined by the premium. Other factors such as copayments, coinsurance, and deductibles also contribute to the overall cost of a plan.


Assessing Costs

It’s vital to evaluate the total projected annual costs when contemplating a Medicare Advantage plan. These include:

  • Premiums


  • Deductibles


  • Copayments


  • Coinsurance rates


Deductibles are the amounts that beneficiaries must pay out-of-pocket before the plan begins to cover costs. Copayments or coinsurance are the shares of costs that beneficiaries are responsible for after deductibles are met. By understanding these costs, you can create a realistic healthcare budget.


Financial Assistance Options

Eligible Baltimore residents can benefit from financial assistance programs to help with the costs of Medicare Advantage plans. Programs like Medicare Savings Programs (MSPs) and the Maryland Medical Assistance Program help with paying Medicare premiums and other costs.

For those with limited income, the Medicare Rx Extra Help program can assist with prescription drug coverage costs. These programs can significantly reduce the financial burden of healthcare.

Baltimore-Based Medicare Resources

Several local resources offer assistance and information for Medicare beneficiaries in Baltimore.

Here are some options:

  • The Senior Health Insurance Assistance Program (SHIP), offered by the Maryland Department of Aging and Area Agencies on Aging, provides Medicare information and assistance.


  • provides customized information on Medicare services.


  • Local SHIP Counselors offer guidance during Medicare Open Enrollment.


Local Counseling Services

In Baltimore, SHIP provides complimentary, personalized counseling to Medicare-eligible individuals. This includes guidance on Medicare Advantage enrollment, understanding Medicare Parts A, B, C, and D, and support during Medicare Open Enrollment.

The Senior Medicare Patrol (SMP) Program empowers residents to detect, report, and prevent healthcare fraud, errors, and abuse in Medicare and Medicaid programs.


State Website and Contact Information

For more information about Medicare Advantage plans, Baltimore residents can visit the Maryland Department of Aging website and use 211 Maryland services for both Medicare Advantage and Medicaid services.

For personalized counseling regarding Medicare Advantage Plans, individuals can contact a Licensed Sales Agent at 833-641-4938 (TTY: 711).


In conclusion, navigating the world of Medicare Advantage in Baltimore can seem complex, but with the right information and resources, it’s entirely manageable.

By understanding the different plan types, coverage options, and enrollment periods, you can make an informed decision that best suits your health needs. Remember, financial assistance programs and local resources like SHIP are available to help you along your journey.


Frequently Asked Questions


  Why do people say not to get a Medicare Advantage plan?

People advise against Medicare Advantage plans due to their restrictive networks, which may result in higher costs or lack of coverage when seeing out-of-network doctors, especially for those who travel frequently.


  What is the most highly rated Medicare Advantage plan?

Humana has consistently led the industry in the percentage of members in Medicare Advantage plans rated four stars or higher for the last six years, with nearly 94% of its members enrolled in such plans for 2024.

This makes Humana one of the most highly rated Medicare Advantage plans available.


  What are the different Medicare Advantage plan types available in Baltimore?

In Baltimore, the primary Medicare Advantage plan types available are HMO and HMO-POS plans. These are the main options to consider when choosing a Medicare Advantage plan.


  What additional benefits do Medicare Advantage plans in Baltimore offer?

Medicare Advantage plans in Baltimore offer additional benefits such as dental, vision, and prescription drug coverage, making them a comprehensive option for healthcare needs.


 How can I ensure my preferred doctor is within my plan’s network?

You can ensure your preferred doctor is within your plan’s network by checking with your medical provider or your plan’s network list before enrolling.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.