Comparing Medicare plans in Maryland
Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your federal Medicare benefits. Instead of the government paying your doctors directly through Original Medicare, you enroll in a plan offered by a private, Medicare-approved insurance company. In Maryland, there are 60 real Medicare Advantage plans available on the market for the 2026 plan year, operating through networks of local doctors and hospitals.
If you are approaching age 65 or otherwise qualifying for Medicare, deciding between Original Medicare and a Medicare Advantage plan is the single most important choice you will make regarding your healthcare coverage. This guide breaks down exactly how Medicare Advantage functions in Maryland, the specific carriers and plans available, the costs you can expect, and the step-by-step logic to determine if this coverage model is the right financial and medical fit for your specific situation.
To understand Medicare Advantage, you must first understand the baseline it replaces: Original Medicare.
Under Original Medicare, the federal government manages your coverage. You have Part A (hospital insurance) and Part B (medical insurance). You can see any doctor in the country who accepts Medicare, and the government pays its share (usually 80% for Part B services) directly to the provider. However, Original Medicare has no cap on your out-of-pocket spending, does not cover prescription drugs, and does not cover routine dental, vision, or hearing care.
Medicare Advantage (Part C) changes this mechanism entirely.
When you enroll in a Medicare Advantage plan in Maryland, you are still in the Medicare program. You still have Medicare rights and protections, and you must continue to pay your Part B premium. However, the federal government pays your chosen private insurance carrier a fixed monthly amount to manage your care. In exchange, the carrier must provide you with all Part A and Part B services.
Because the private carrier is now managing your risk and your network, they can bundle additional services into the plan. They can add prescription drug coverage, roll in routine dental cleanings or eyeglasses allowances, and mandate an absolute cap on what you can spend on medical care in a calendar year. The trade-off for these extra benefits and cost protections is that you must abide by the private carrier’s rules, which usually means staying within a specific network of Maryland healthcare providers and obtaining permission (prior authorization) before undergoing certain elective procedures.
Maryland is a highly competitive market for Medicare Advantage. For 2026, there are 60 distinct Medicare Advantage plans operating in the state. Because Medicare Advantage plans are regulated and priced at the county level, your exact options depend entirely on your permanent residential ZIP code.
The carriers offering plans in Maryland include:
These carriers offer a mix of plan architectures to suit different medical and financial needs. A carrier might offer a tight, highly restrictive network with zero monthly premium, while simultaneously offering a flexible, broad-network plan with a higher monthly premium.
For example, Aetna Medicare offers both the Aetna Medicare Eagle Giveback (PPO) and the Aetna Medicare Elite (PPO). Alterwood Advantage fields a deep roster of plans, including the Alterwood Advantage Choice (HMO), the Alterwood Advantage Freedom (HMO), and highly specialized plans for specific populations like the Alterwood Advantage Dual Secure (HMO D-SNP).
Maryland is unique in the United States because of its all-payer hospital rate-setting system, known as the Total Cost of Care (TCOC) model. In Maryland, every hospital charges the exact same rate for the same service, regardless of whether you have Original Medicare, Medicare Advantage, or employer-sponsored insurance.
While this system heavily impacts how hospitals are paid, as a Medicare Advantage enrollee, your daily experience is still dictated by your specific plan’s benefits document (the Evidence of Coverage). If your Alterwood Advantage or Johns Hopkins Advantage MD plan states that your inpatient hospital copay is $350 per day for days 1-5, that is what you will pay at an in-network Maryland hospital, regardless of the state’s underlying billing waivers.
Not all Medicare Advantage plans function the same way. When reviewing the 60 plans available in Maryland, you will notice acronyms attached to the plan names. These denote the network structure and the rules you must follow to get care covered.
An HMO requires you to use doctors, specialists, and hospitals that are directly contracted with the plan. If you go outside the network for non-emergency care, the plan will pay nothing, and you will be responsible for 100% of the bill.
Most HMOs require you to select a Primary Care Physician (PCP). This doctor coordinates your care. If you need to see a cardiologist or a physical therapist, you must get a referral from your PCP first. Because they tightly control the network and the utilization of care, HMOs—such as the Alterwood Advantage Select (HMO)—often feature the lowest premiums and copays on the market.
A PPO offers more flexibility. You can see any doctor or specialist in the network without needing a referral from a primary care physician. Furthermore, you are allowed to see out-of-network providers, provided those out-of-network doctors are willing to accept the plan’s terms and treat you.
The catch with a PPO is cost. While you have the freedom to go out of network, you will pay a significantly higher copay or coinsurance percentage to do so. An example is the Aetna Medicare Eagle Giveback (PPO). PPOs are highly popular for Maryland residents who spend part of the year living in other states (like Florida or South Carolina) and need the ability to see doctors outside of the local Maryland network.
Special Needs Plans are precisely targeted Medicare Advantage plans limited to individuals who meet specific criteria. In Maryland, the most common type is the Dual-Eligible Special Needs Plan (D-SNP), designed for individuals who qualify for both Medicare and Maryland Medicaid.
Plans like the Alterwood Advantage Dual Value (HMO D-SNP) and the Alterwood Advantage Dual Secure (HMO D-SNP) coordinate the benefits of both federal Medicare and state Medicaid. These plans often feature $0 premiums, $0 copays for medical care, heavily subsidized prescription drugs, and substantial allowances for over-the-counter health items or healthy groceries. You cannot enroll in a D-SNP unless you have verified Medicaid eligibility.
Other types of SNPs include Chronic-Condition SNPs (C-SNPs) for people with severe or disabling chronic conditions like diabetes or end-stage heart failure, and Institutional SNPs (I-SNPs) for people living in nursing homes.
| Feature | Original Medicare (Parts A & B) | Medicare Advantage (Part C) | Maryland Context |
|---|---|---|---|
| Provider Choice | Any doctor in the U.S. who accepts Medicare. | Must generally use local network providers (HMO or PPO). | Maryland networks vary widely. Johns Hopkins or CareFirst plans have strong local footprints. |
| Referrals | Never required to see a specialist. | Often required in HMO plans; not required in PPO plans. | Check your specific HMO details; some modern HMOs are dropping referral requirements. |
| Out-of-Pocket Maximum | None. You pay 20% of Part B costs with no limit. | Yes. Federal law requires a strict annual cap on medical spending. | Caps vary by plan but provide critical protection against catastrophic illness costs. |
| Prescription Drugs | Not included. Must buy a standalone Part D plan. | Usually included automatically (MA-PD). | Most of the 60 MD plans bundle Part D coverage at no extra premium. |
| Extra Benefits | None. Only covers medically necessary care. | Often includes dental, vision, hearing, and fitness benefits. | Highly competitive in MD. Many carriers offer allowances for OTC items or glasses. |
Evaluating a Medicare Advantage plan requires looking past the monthly premium. The total cost of your healthcare will be determined by how often you use medical services and how your specific plan structures its cost-sharing.
Regardless of which Medicare Advantage plan you choose in Maryland, you must continue to pay your Medicare Part B premium to the federal government. For most people, this is automatically deducted from their Social Security check.
Some plans offer a “Part B Giveback” or Part B Premium Reduction benefit. For example, a plan might advertise a $50 monthly giveback. This means the carrier will pay $50 of your Part B premium on your behalf, effectively leaving more money in your Social Security check each month. These giveback plans—often structured as PPOs like the Aetna Medicare Eagle Giveback (PPO)—are popular for healthy individuals who do not anticipate high medical usage and want to maximize their monthly cash flow.
Many Medicare Advantage plans in Maryland advertise a $0 monthly premium. This is not a scam or a trick. The carrier is receiving a monthly capitation payment from the federal government to manage your care. If they can manage their network efficiently, they can afford to charge you zero additional premium while still turning a profit. However, there are also plans with monthly premiums (e.g., $30 or $80 a month). Plans with a monthly premium typically offer lower copays when you actually go to the doctor, or they offer richer dental and vision benefits.
When you use medical services, you will pay a portion of the cost.
This is the most critical financial safety net in a Medicare Advantage plan. Every plan has a MOOP limit for covered medical services. If a plan’s MOOP is $4,500, that means once you have spent $4,500 out of your own pocket on copays and coinsurance for medical care in a single calendar year, the plan steps in and pays 100% of your covered medical costs for the rest of the year.
Note: The MOOP only applies to Part A and Part B medical services. It does not include what you spend on prescription drugs, nor does it include your monthly premiums.
The vast majority of Medicare Advantage plans in Maryland are “MA-PD” plans, meaning Medicare Advantage plus Prescription Drugs. When you enroll in an MA-PD plan, such as the Alterwood Advantage Choice Plus (HMO) or the Aetna Medicare Elite (PPO), you cannot and should not buy a separate standalone Medicare Part D plan. If you attempt to buy a standalone Part D plan while enrolled in an MA-PD plan, Medicare will automatically disenroll you from your Medicare Advantage plan and kick you back to Original Medicare.
Every MA-PD plan has a “formulary,” which is the official list of medications the plan covers. The formulary is divided into tiers.
It is entirely possible that UnitedHealthcare and CareFirst both cover your specific blood pressure medication, but UnitedHealthcare places it on Tier 1 ($0 copay) while CareFirst places it on Tier 3 ($45 copay). This is why checking your specific drug list against the plan’s formulary is mandatory before enrolling.
As a result of recent federal legislation (the Inflation Reduction Act), starting in recent plan years, Medicare Part D out-of-pocket costs are capped strictly at $2,000 annually. This cap applies to the prescription drug side of your MA-PD plan, providing a hard ceiling on what you will pay for medications at the pharmacy counter. This $2,000 drug cap is completely separate from the medical Maximum Out-of-Pocket (MOOP) limit discussed earlier.
Because Original Medicare does not cover routine maintenance of the teeth, eyes, or ears, Medicare Advantage plans use these benefits to compete heavily for your enrollment. In Maryland, it is common to find plans that include:
It is vital to read the fine print on these benefits. A dental allowance might require you to use a specific network of dentists, which is completely separate from the plan’s medical doctor network.
One of the most profound operational differences between Original Medicare and Medicare Advantage is the concept of Prior Authorization.
Under a Maryland Medicare Advantage plan, the insurance carrier manages the medical necessity of your care. For routine visits and standard treatments, you do not need permission. However, for high-cost or elective procedures—such as an MRI, a knee replacement, specialized physical therapy, or the administration of a Part B physician-administered drug—the doctor must request approval from the insurance carrier before performing the service.
The carrier’s medical directors will review the request against clinical guidelines. If they determine the service is medically necessary, they approve it. If they deem it unnecessary or prefer you try a less expensive therapy first (a practice known as “step therapy”), they can deny the request.
If a service is denied, you have a formal right to appeal the decision, known as an Organization Determination appeal. Medicare enforces strict timelines on carriers to respond to appeals, especially if your health is in immediate jeopardy.
To enroll in a Medicare Advantage plan in Maryland, you must meet all three of the following federal requirements.
| Condition | Eligibility Impact |
|---|---|
| Pre-existing medical conditions | Eligible. Plans cannot deny you or charge more based on health history. |
| End-Stage Renal Disease (ESRD) | Eligible. As of 2021, ESRD patients can enroll in any Medicare Advantage plan. |
| Enrolled in a Medigap plan | Ineligible. You must drop your Medigap policy to use a Medicare Advantage plan. |
You cannot buy or change a Medicare Advantage plan whenever you want. The federal government strictly dictates the windows during which you can alter your coverage. Missing these deadlines can mean being locked into an unworkable plan for an entire year.
When you first become eligible for Medicare (usually when turning 65), you have a 7-month window to enroll. This period includes the three months before your birthday month, your birthday month, and the three months after. If you choose a Medicare Advantage plan during this window, coverage typically begins on the first day of your birthday month.
This is the most critical window of the year. During the Fall AEP, anyone on Medicare can:
Any changes made during AEP take effect on January 1 of the following year.
This window is strictly for people who are already enrolled in a Medicare Advantage plan on January 1. If you started the year in an MA plan and realize it is a bad fit (e.g., your doctor left the network, or the drug costs are too high), you have one opportunity during this quarter to:
You cannot use this period to move from Original Medicare into a Medicare Advantage plan; it is only a correction window for those already in Part C.
Life events can trigger a special window to change your plan outside of the normal annual periods. Common SEPs in Maryland include:
With 60 plans available statewide, picking a plan simply based on brand name or a television commercial is a mistake. The best plan for your neighbor may be financially disastrous for you. Use this step-by-step logic to evaluate a Medicare Advantage plan:
Medicare Advantage is not inherently “better” or “worse” than Original Medicare paired with a Medigap supplement; it is a fundamentally different financial architecture.
Medicare Advantage makes sense if:
Medicare Advantage may not make sense if:
Speak with a licensed producer to compare networks, check your prescriptions, and find the right Medicare Advantage plan for your exact situation.
Get a Free Consultation