Medicare in Maryland: Plans and Coverage (2026)

Medicare in Maryland runs on federal rules, but the state adds one hook worth knowing: a 30-day annual birthday window to switch your Medigap policy without medical underwriting. This guide covers Medicare in Maryland for 2026: what each part costs, your plan options, and how to get help paying.

Maryland's program landscape is shaped by two distinct geographies: a dense Baltimore and DC-suburb corridor with wide plan selection, and a rural Western Maryland and Eastern Shore where options narrow. Free counseling from the Maryland SHIP at the Department of Aging is available in all 19 local offices across the state.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Maryland (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Maryland
• Help Paying for Medicare in Maryland
• Medicare Enrollment Periods
• Free Medicare Help: Maryland SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Maryland SHIP through the Department of Aging.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government. The costs below apply in Maryland exactly as they do in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025. A benefit period begins the day you're admitted and ends 60 days after you leave; get readmitted after that gap and the deductible applies again.1

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.1

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the IRMAA income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services1

Delaying Part B enrollment past your window without other creditable coverage triggers a 10% penalty for every 12 months you could have had it, and that penalty stays for as long as you keep Part B.6

Medicare Advantage in Maryland (Part C)

Medicare Advantage plans are sold by private insurers approved by Medicare. They bundle Part A and Part B coverage (hospice stays with Original Medicare), and most include Part D drug coverage plus extras like dental, vision, and hearing.7

Geography matters in Maryland. The Baltimore metro and the DC-suburb corridor (Montgomery, Prince George's, Howard, Anne Arundel counties) support a wide range of plan choices from multiple insurers. Western Maryland and the Eastern Shore are more rural, and beneficiaries there typically find fewer plans and narrower networks. Plan availability, premiums, and networks change every year and differ by county, so compare what's actually offered at your ZIP code before deciding.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.7,1
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll, especially if you use Johns Hopkins, University of Maryland Medical System, or other large hospital groups in the state.
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap.7

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. If you want help reading the results, a Maryland SHIP counselor will go through them with you at no cost.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap (the donut hole) starting in 2025.2 Part D now has three phases:

1. Deductible: you pay full drug cost until you meet your plan's deductible (up to $615 in 2026).2,8
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.2

The $2,100 cap is the number that matters most. The projected average standalone Part D premium for 2026 runs roughly $40 to $50 a month, though plans vary.1 Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into monthly payments across the year instead of paying the full amount at the pharmacy.2 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Maryland

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They pair only with Original Medicare, not with Medicare Advantage. Maryland offers the federally standardized plans, labeled A through N, and they're regulated by the Maryland Insurance Administration (MIA).

Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.9,1

The Federal Open Enrollment Period

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that start when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health, with no medical underwriting.9 Outside that window, Maryland insurers may use underwriting: they can review your health history, charge more, or decline you.

Maryland's 30-Day Birthday Rule

Maryland added a second window that gives existing policyholders a regular chance to reassess. Under Maryland law, effective July 1, 2023, any Medigap policyholder with a policy issued in Maryland receives a 30-day annual open enrollment period beginning on their birthday.3

During that window, the policyholder may switch to a different Medigap policy with equal or lesser benefits, and the insurer cannot deny or condition the new policy based on health status, claims history, or medical condition. The rule is regulated by the Maryland Insurance Administration.

Two details matter for planning:

• Insurer notice required. Maryland law requires your insurer to send you written notice of this right at least 30 days, but no more than 60 days, before your birthday. If you haven't received that notice before your birthday, contact your insurer or MIA directly.3
• Equal or lesser, not any plan. You can move to a plan with the same or fewer benefits, not a richer one. So you can downgrade (say, from Plan G to Plan N to save on premium) but cannot upgrade without medical underwriting outside the federal OEP.

Maryland's 30-day window is shorter than California's 60-day birthday rule and Illinois's 45-day rule, but it exists and is enforceable.10,11 Many Maryland beneficiaries don't know about it, which means many are paying more than they need to for the same or similar coverage. If you're already on a Medigap plan and your birthday is coming up, our Maryland Medicare Supplement guide walks through the birthday rule step by step, including how to compare plans before your window opens.

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and often a lower upfront cost. For a side-by-side comparison, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Maryland

If you're on a fixed income, two programs can lower your Medicare costs significantly.

Medicare Savings Programs

Maryland runs its Medicare Savings Programs through the Maryland Department of Health Medicaid program. Maryland uses the standard federal income tiers and resource limits, not higher state-set ones.4

QMB is the most generous: it covers your Part B premium plus all Medicare deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.4 For all three programs, the 2026 resource limit is $9,950 for one person and $14,910 for a couple.4 Income limits tie to the Federal Poverty Level and update each April. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D costs.4

To apply, contact Maryland Medicaid through Maryland Health Connection or visit your local Maryland SHIP office for help with the application.

Extra Help for Part D

Extra Help (the Low-Income Subsidy) pays Part D premiums, deductibles, and copays for people with limited income and resources.12 Since 2024, the partial-subsidy tier is gone and everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
• Resource limits: $16,590 for an individual, $33,100 for a married couple
• Enroll in any Maryland MSP and you're automatically enrolled in Extra Help12

Apply through Social Security at ssa.gov or call 1-800-772-1213.12

Medicare Enrollment Periods

Miss a deadline and you may face coverage gaps or permanent late penalties. These windows are federal, the same in Maryland as everywhere else.13,14

Changes made during Annual Open Enrollment take effect January 1. If you're already collecting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security.13

Free Medicare Help: Maryland SHIP

You don't have to sort through this alone. Maryland runs the State Health Insurance Assistance Program through the Maryland Department of Aging, with 19 local SHIP offices across the state. Counselors are trained volunteers who give free, unbiased help and do not sell insurance.5

A Maryland SHIP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage and Part D plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Work through the Maryland birthday rule and whether switching Medigap makes sense for you
• Sort out claims, denials, and billing problems

Maryland SHIP is part of the national network, but it's housed in the Department of Aging rather than the Insurance Administration. Medigap issues, including the birthday rule, are regulated separately by the Maryland Insurance Administration.5

To find your local SHIP office, visit the Maryland Department of Aging SHIP page or contact your local Area Agency on Aging.

Who to Call in Maryland

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.