Paying for Hospital Services
Paying for Hospital Services
Patients can pay for hospital services in Maryland in a number
of ways. Although the rates for these services are set
by the state, rates do differ between hospitals.
Some common ways to pay for hospital services
- Private insurance
- Personal funds
If you have private insurance or insurance through your employer,
you should review your insurance information before being
admitted to a hospital. Check to see whether:
- You need pre-authorization for admission to the hospital
when it is not an emergency.
- The hospital to which you are being admitted is covered
by your insurance plan.
- Your insurance plan requires you to pay deductibles or
The Maryland Insurance Administration ensures that private
insurance companies follow state insurance laws and provides
information about the health insurance companies that operate
in the state. They also can tell you how to file complaints
against companies. Their web site is http://www.mdinsurance.state.md.us/ and
the toll-free number is 1-800-492-6116.
Medicaid and HealthChoice
Maryland provides health insurance for
residents with low income or some special health needs. All
hospitals in Maryland provide care for patients enrolled
in the Medicaid and HealthChoice programs.
How Medicaid Works
Medicaid is a program that pays the medical bills of patients
who have low income and cannot afford medical care. Medicaid
provides three types of critical health protection:
- Health insurance for low-income families, children, the
elderly, and people with disabilities.
- Long-term care for people who are older or have disabilities
- Supplemental coverage for low-income Medicare beneficiaries
(such as outpatient prescription drugs and payment of Medicare
premiums, deductibles, and cost sharing).
Medicaid is a joint federal and state
program. The Maryland Department of Health and Mental Hygiene
(DHMH) runs the state’s
Medicaid program. DHMH sets requirements for eligibility
standards, benefits packages, provider requirements, and
Marylanders who are enrolled in Medicaid
but do not qualify for HealthChoice receive Medicaid services
through a "fee-for-service" arrangement.
This means that the patient’s medical provider will
send a bill to the Medicaid program for payment.
How HealthChoice Works
HealthChoice is the name of Maryland’s
Medicaid Managed Care Program. Medicaid recipients in the
state who meet certain requirements must use HealthChoice
instead of regular Medicaid. Patients who qualify for HealthChoice
will choose a Primary Care Provider (PCP) and enroll in a
Managed Care Organization (MCO) of their choice. These MCOs
provide more free medical services than standard Medicaid
Who is Eligible for HealthChoice?
About 75 percent of all Medicaid recipients are enrolled
in the HealthChoice program. Enrolling in HealthChoice is
required for Marylanders who receive Medicaid but who are
- Receiving Medicare.
- 65 years or older.
- Eligible for Medicaid through spenddown.
- In a long-term care facility.
- Enrolled in the Model Waiver.
- Enrolled in limited coverage categories of Medicaid,
such as women who receive family planning services through
the Family Planning Waiver.
For more information, the web site for HealthChoice is http://www.dhmh.state.md.us/mma/healthchoice/index.html.
You can also call HealthChoice toll-free at 1-800-977-7388.
To learn more about all types of health
care that the State of Maryland offers, visit the Maryland
Medical Programs web site at: http://www.dhmh.state.md.us/mma/
Medicare is the federal government's health insurance program
for persons who are 65 years and older, who are permanently
disabled, or who require kidney dialysis or transplantation.
Most persons become eligible for Medicare when they turn
65. All Maryland hospitals provide care for persons enrolled
in Medicare. To learn more about enrolling in Medicare or
about the types of coverage available through Medicare, visit
their web site at http://www.medicare.gov/ or
call toll-free 1-800-633-4227.
Unlike most other states, uninsured persons in Maryland are
not charged more for hospital services than they would be
charged if they had insurance. If you believe that it may
be difficult to pay all of your hospital charges immediately,
you should discuss repayment options with the hospital as
soon as you can.
All hospitals in Maryland will treat
persons who are having a medical emergency, regardless of their
ability to pay. If you have a complaint about a hospital that
has refused to treat you in an emergency situation, you should
contact the Maryland Office of Health Care Quality at http://www.dhmh.state.md.us/ohcq/ or
call toll-free 1-877-402-8218.