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 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 1.1 Medicare costs change every year, and the current-year amounts are published by CMS and listed on medicare.gov. To reach a person about your own coverage, call 1-800-MEDICARE (1-800-633-4227), where you can talk or live chat 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.6 Maryland SHIP counselors give free one-on-one help too.5

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 once you've gone 60 days in a row without inpatient hospital care or skilled care in a SNF; 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. Part B doesn't cover routine dental, vision, or hearing.7 Most Medicare Advantage plans offer routine dental, vision, and hearing benefits instead, so check what a specific plan actually covers before you count on it.8

• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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.9

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.8

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, though CMS says some plans may help pay all or part of it. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.8,1
• 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. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in or out of the plan's network.8
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.8
• 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. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.8

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).2,10
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 $34.50 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 are built for Original Medicare: a Medigap policy can't be used to pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums.8 Maryland offers the federally standardized plans, labeled A-D, F, G, and K-N. Carriers that sell them here file their rates with the Maryland Insurance Administration (MIA), which publishes a Medicare Supplement rate guide twice a year, for rates as of January 1 and July 1.5

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.11,12,1

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.11 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 an annual open enrollment period that includes their birthday and the 30-day period following it.3

During that window, the policyholder may change, without underwriting, to a Medigap policy of equal or lesser benefits, and does not have to stay with their current carrier.3

Three 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). The MIA publishes a chart of which plans count as equal or lesser value for each existing plan, so check it against your own plan letter before you shop.3
• Get the application in while the window is open. The application for the new policy has to be submitted during the window, though there's no requirement that it be fully processed before the window closes. A carrier may extend the window at its own discretion, but it must always cover your birthday and the 30 days after it.3

Maryland's 30-day window is shorter than California's 60-day birthday rule and Illinois's 45-day rule, but it's a yearly opening backed by state law.13,11,3 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?

They don't pair. A Medigap policy can't pay your Medicare Advantage costs, and while you're enrolled in an Advantage plan CMS says it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. That isn't a permanent lock-out: if you joined a Medicare Advantage plan for the first time and you aren't happy with it, federal law gives you a trial right to buy a Medigap policy and a separate drug plan when you return to Original Medicare within 12 months of joining. And if you had a Medigap policy before you joined and have been in the Advantage plan less than a year, you may be able to get that same policy back if the company still sells it. The converse is the trap: in most cases, if you drop a Medigap policy to join an Advantage plan, you may not be able to get it back once your trial period has passed.8 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, which MDH also calls the Medicare Buy-In Programs. The 2026 figures MDH publishes are the standard federal MSP standards, and each income limit below is the Federal Poverty Level figure plus the $20 monthly SSI income disregard, so that disregard is already built into the number your income is measured against.4

QMB is the most generous: it helps pay Part A premiums (if you don't have premium-free Part A) plus your Part B premium, deductibles, coinsurance, and copayments, and federal law bars providers from billing a QMB enrollee for that cost-sharing.4 For QMB, SLMB, and QI alike, the 2026 asset limit is $9,950 for one person and $14,910 for a couple, and it is not a simple bank-balance test; QDWI, a separate group, uses $4,000 and $6,000.4 Income limits tie to the Federal Poverty Level and go up each year. These are the federal standards rather than absolute cutoffs: some states do not count certain types or specific amounts of income or resources, so you may still qualify with more, and MDH says the best way to know if you are eligible is to apply. QI also has to be reapplied for every year; being approved one year does not carry you into the next. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D costs.4 QDWI, the fourth Medicare Savings Program, is the exception: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not confer Extra Help, so a QDWI enrollee who wants Extra Help has to apply through Social Security.4,14

To apply, submit an application in person or by mail to your local department of social services; the current form comes from the Maryland Department of Human Services. For questions, call the Medicare Savings Program at the Maryland Department of Health at 1-800-638-3403.4 A Maryland SHIP counselor can help you work through the application.5

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.14 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, the figures for the 48 contiguous states and DC (Alaska and Hawaii are higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses14
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help4

Apply through Social Security at ssa.gov.14 Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, where residents apply through their local Medicaid office instead.14 Social Security's national line is 1-800-772-1213 (TTY 1-800-325-0778).15

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.16 If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17

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.16

Free Medicare Help: Maryland SHIP

You don't have to sort through this alone. The State Health Insurance Assistance Program in Maryland is a program of the Maryland Department of Aging, with 19 local SHIP offices across the state. A certified counselor gives you one-on-one guidance, in person or virtually; the help is free, confidential, and unbiased, and SHIP does 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, and nationally SHIP services are delivered by state units on aging or state departments of insurance; Maryland's sits in the Department of Aging.5 Medigap questions, including the birthday rule, go to the Maryland Insurance Administration, which publishes the birthday rule guidance and the equal-or-lesser-value chart.3

To find your local SHIP office, use the directory on the Maryland Department of Aging SHIP page, or call the department's statewide toll-free line at 1-800-243-3425, the number CMS lists for Maryland SHIP. Every county in Maryland has a SHIP office.5

Who to Call in Maryland

Learn More

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.