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 include:

• Private insurance
• Medicaid/HealthChoice
• Medicare
• Personal funds
• Emergencies

Private insurance

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 co-payments.

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 payment rates.

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 providers.

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 NOT:

• 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

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.

Personal Funds

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.

Emergencies