Before you start

Maryland residence
Income information for subsidy or Medicaid eligibility
An SSN or ITIN for the marketplace application
A qualifying life event, if enrolling outside the annual open-enrolment window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date, and missing it can mean waiting for the next open enrolment. Compare the deductible and out-of-pocket maximum, not just the premium.
Via employerWho: YouFirst 30 days of employment
2
Check Maryland Medicaid eligibility first
Maryland expanded Medicaid, covering adults up to 138% of the federal poverty level. Newcomers on modest early incomes frequently qualify, and Medicaid enrolment runs year-round rather than in a window. Apply through Maryland Health Connection, which handles both Medicaid and marketplace plans in one application.
OnlineWho: You
3
Without an employer plan, use Maryland Health Connection — not HealthCare.gov
Maryland runs a state-based exchange. Going to the federal site will send you back. The state exchange sets its own open-enrolment dates, which have historically run longer than the federal window, and it operates its own special-enrolment provisions. Check the current dates on the state site rather than assuming the federal calendar.
OnlineWho: You
4
Choose the plan by hospital system, not only by premium
Johns Hopkins Medicine and the University of Maryland Medical System dominate care in and around the city, and plan networks are drawn along those lines. Check which system your nearest clinic and preferred hospital belong to before enrolling — switching mid-year needs a qualifying life event.
OnlineWho: You
5
Register with a primary care physician in month one
Do it while you are well. An established relationship is what gets you referrals and urgent slots later, and confirming the practice is in your network before the first visit avoids an out-of-network bill for a routine appointment.
In personWho: YouMonth 1
6
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost a great deal even when insured. Urgent care handles fractures, stitches and infections far more cheaply. Baltimore has both in quantity; the difference is which door you walk through.
In personWho: You
7
If you file a Maryland tax return, look for the coverage checkbox
Maryland pioneered an 'easy enrolment' route that uses a checkbox on the state income tax return to start a coverage eligibility check for uninsured filers. If you are uninsured at filing time, it is the lowest-effort way into the system. Confirm the current mechanism on the Maryland Health Connection site.
OnlineWho: You

Documents you’ll need

Proof of Maryland residence
Income documentation for subsidies or Medicaid
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Maryland runs its own marketplace, so the federal deadlines are the wrong deadlines.

Most states in this app use HealthCare.gov. Maryland does not — Maryland Health Connection is a state-based exchange with its own enrolment calendar, its own special-enrolment rules and its own tax-return-linked entry route. People arriving from a federal-marketplace state routinely diary the wrong date.

Source: Maryland Health Connection

Maryland is the only state that sets hospital prices for every payer.

Under a long-standing federal waiver, Maryland's Health Services Cost Review Commission sets the rates hospitals may charge, and everyone — insurer, Medicare, uninsured patient — is charged the same for the same service at the same hospital. It does not make care cheap, but it removes the wild price variation by payer that dominates the rest of the country, and it means an uninsured bill here is not the multiple of the insured price it would be elsewhere.

Source: Maryland Health Services Cost Review Commission

Your plan picks your hospital system for the year, and here there are essentially two.

Johns Hopkins and the University of Maryland Medical System between them account for most serious care in the city. Enrolling without checking which system your local clinic sits in is how people end up driving across town for routine appointments, or out of network at the hospital nearest their house.

Source: community-reported

Medicaid expansion means no coverage gap here.

Maryland expanded Medicaid, so an adult earning below the subsidy floor is covered rather than falling into the hole that persists in non-expansion states like Texas. For a newcomer whose first months are lean — a spouse not yet working, a contract not yet started — that is a real safety net, and it enrols year-round.

Source: Maryland Department of Health

Common mistakes to avoid

Going to HealthCare.gov instead of Maryland Health Connection and losing time.
Assuming the federal open-enrolment dates apply in Maryland.
Missing the 30-day new-hire enrolment window at a new employer.
Choosing a plan without checking which hospital system your local clinic belongs to.
Missing a Medicaid renewal and losing coverage you still qualified for.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.