Maryland has approximately 1.1 million Medicare enrollees and Medicare Advantage penetration in the mid-40s percent range — slightly below the national average.1The state’s most distinctive Medicare feature is the Maryland Medicare Waiver, which most adult-child caregivers don’t need to think about directly but which shapes the hospital cost environment in Maryland.
The Maryland Medicare Waiver: what it means for your parent
Since 1977, Maryland has operated under a CMS waiver that allows the state to set hospital rates for all payers — Medicare, Medicaid, and commercial insurers — rather than letting each payer negotiate separately.2 The Health Services Cost Review Commission (HSCRC) sets rates; the most recent version, the Total Cost of Care model, has been in place since 2019.
For a Medicare beneficiary, the practical effect is small: your parent still has the same Medicare coverage, the same deductibles, the same Medigap options. The waiver mostly affects hospital pricing transparency and the way Maryland hospitals are paid — not member benefits.
What Medicare covers, and what it doesn’t
Medicare is health insurance. It is not long-term-care insurance. This is the most expensive misconception in caregiving, and it’s common everywhere — Maryland included.
What Medicare does cover:
- Part A.Inpatient hospital, skilled nursing rehab for up to 100 days after a qualifying hospital admission (full coverage for first 20 days; copay ~$204/day for days 21–100 in 2025), hospice, limited home health.
- Part B. Doctor visits, outpatient procedures, durable medical equipment, mental health, preventive care.
- Part D. Prescription drug coverage, either standalone or bundled into a Medicare Advantage plan.
What Medicare does not cover:
- Assisted living (any state, any setting)
- Memory care
- Custodial nursing-home care beyond the 100-day rehab window
- Long-term in-home aide hours
- Dental, vision, or hearing in Original Medicare
Original Medicare vs. Medicare Advantage in Maryland
Every Medicare-eligible American chooses between two broad structures:
- Original Medicare (Parts A and B, usually paired with Medigap and a standalone Part D plan), or
- Medicare Advantage (Part C, a private plan bundling A, B, and usually D, plus extras).
Maryland’s Advantage penetration is around 45% , slightly below the national average. The DC suburbs (Montgomery and Prince George’s counties) have the most plan competition and the most aggressive marketing each AEP.
When Original Medicare + Medigap usually beats Advantage
- Your parent travels frequently or spends part of the year out-of-state. Original Medicare works nationally with any Medicare-accepting provider; Advantage plans have networks.
- Your parent has a serious or complex condition and wants unrestricted specialist access.
- Your parent can afford the Medigap premium — typically $160–$290/month for Plan G in Maryland — in exchange for predictable out-of-pocket costs.
When Advantage usually beats Original Medicare
- Your parent lives in one Maryland county year-round and is generally healthy.
- A $0-premium Advantage plan with their preferred providers is available (common in MoCo and PG County).
- Your parent values the dental, vision, hearing, or fitness extras most Advantage plans bundle.
Medigap in Maryland
If your parent chooses Original Medicare, they almost certainly also want a Medigap policy. Plans are federally standardized— Plan G in Maryland is identical to Plan G in Virginia — but Maryland’s pricing and enrollment rules have specifics:
- Maryland is an age-rated state. Medigap premiums rise as your parent ages.
- Guaranteed issue during the 6-month Initial Enrollment Period beginning the month your parent turns 65 (or first enrolls in Part B). Outside that window, insurers can use medical underwriting.3
- Maryland does not guarantee annual Medigap switching without underwriting. Once your parent picks a plan, switching can require medical requalification.
Medicare Savings Programs (MSPs) in Maryland
If your parent has limited income, they may qualify for the federal Medicare Savings Programs, administered in Maryland by the Department of Health Medical Assistance:4
- QMB. Pays Part A and Part B premiums, deductibles, and coinsurance. Income limit ~$1,255/month individual (2026).
- SLMB. Pays Part B premium only. Income limit ~$1,506/month individual.
- QI. Pays Part B premium. Income limit ~$1,695/month individual.
Many eligible Marylanders never apply. A SHIP counselor at a Maryland AAA can help.
Annual Enrollment Period (AEP) in Maryland
Medicare AEP runs October 15 through December 7 each year. During this window your parent can:
- Switch from Original Medicare to Medicare Advantage (or vice versa)
- Switch from one Advantage plan to another
- Add, drop, or switch a standalone Part D plan
The DC suburbs see intense AEP marketing — TV ads, direct mail, in-person seminars at every senior center in Montgomery and PG County. The most important thing to know: most ads are designed to drive enrollment in a specific plan, not to help your parent compare. Use Medicare.gov’s Plan Finder, which ranks every plan in your parent’s ZIP by total annual cost for their specific prescriptions and providers.5
There is also a Medicare Advantage Open Enrollment Period (MA OEP) from January 1 through March 31 each year for Advantage enrollees to switch.
Where to get free help in Maryland
SHIP(State Health Insurance Assistance Program) is Maryland’s federally-funded SHIP, housed at the Maryland Department of Aging. Counselors work through the 19 Area Agencies on Aging covering every Maryland county and Baltimore City. SHIP counselors don’t sell plans, take commissions, or represent insurers. Call 1-800-243-3425 or visit aging.maryland.gov to find a counselor near your parent.
For specific Medicaid-related questions where Medical Assistance and Medicare interact (dual-eligibility, long-term-care benefits), see our Maryland Medicaid guide.