Comparing Medicare plans in Maryland
Medicare Part A serves as the foundation of the federal health insurance program for older adults and those with qualifying disabilities. Often referred to simply as “hospital insurance,” Part A is designed to protect you from the catastrophic costs of facility-based medical care. If you are a resident of Maryland approaching age 65 or managing a qualifying disability, understanding the mechanics of Part A is the absolute first step in building a complete healthcare strategy.
However, the term “hospital insurance” is somewhat misleading. While inpatient hospital stays are the centerpiece of Part A, it also governs your coverage for skilled nursing facilities, hospice care, and specific types of home healthcare. More importantly, Part A operates under a unique set of cost-sharing rules—driven by “benefit periods” rather than the standard calendar-year deductibles you might be used to from employer-sponsored health insurance.
Because Medicare is a federal program managed by the Centers for Medicare & Medicaid Services (CMS), the fundamental rules for Part A are the same in Maryland as they are anywhere else in the country. What changes locally is how you choose to receive and supplement those benefits—whether through Original Medicare paired with a Medigap plan, or through one of the 60 Medicare Advantage plans available across the state from carriers like UnitedHealthcare, CareFirst BlueCross BlueShield Medicare Advantage, Humana, and Johns Hopkins Advantage MD.
This guide breaks down exactly what Part A covers, what it excludes, how its complex billing mechanisms function, and how to position yourself for optimal coverage in Maryland.
To understand Medicare, you must mentally separate the facility from the professional.
When you enter a hospital, two different distinct financial systems go into effect. First, you are occupying a bed, eating hospital food, using hospital electricity, and receiving care from the hospital’s employed nursing staff. Second, you are being examined, diagnosed, and operated on by physicians, surgeons, and specialists.
Medicare Part A pays the facility. It covers the room, the board, the general nursing, and the drugs administered to you by the hospital staff during your stay. Medicare Part B pays the professionals. It pays the doctor who visits your hospital room, the surgeon who operates on you, and the anesthesiologist who assists the surgeon.
If you have Part A but decline Part B, Medicare will pay for your hospital room, but you will be personally billed by every doctor who walks into that room. This separation is why Part A and Part B are almost always taken together to form what is known as “Original Medicare.”
Before detailing the specific types of care Part A covers, you must understand how Part A measures time and calculates your costs. It is the most counterintuitive part of Original Medicare.
Under standard health insurance, you have an annual deductible. You meet it once between January 1 and December 31, and then your insurance pays its share for the rest of the year. Medicare Part A does not use calendar years for its hospital and skilled nursing deductibles. It uses a concept called the Benefit Period.
A benefit period begins the exact day you are formally admitted to a hospital or a skilled nursing facility as an inpatient. Upon admission, you are immediately responsible for the Part A deductible. (CMS updates this standard deductible figure annually; it typically runs well over a thousand dollars per occurrence.)
The critical detail is how a benefit period ends. A benefit period does not end when you are discharged from the hospital. It ends only when you have gone 60 consecutive days without receiving any inpatient hospital care or skilled nursing facility care.
If you go into the hospital in February, you pay the Part A deductible. If you are discharged, stay home for 20 days, and have a relapse requiring readmission, you are still in the same benefit period. You do not pay the deductible again.
However, if you are discharged, stay home for 65 days, and then require a new hospital admission in May, a new benefit period begins. You will owe the Part A deductible a second time. There is no limit to the number of benefit periods you can have in a single calendar year. If you suffer a year of intermittent, spaced-out health crises, you could easily pay the Part A deductible three or four times.
| Days in the Benefit Period | What Part A Pays | What You Pay (Cost-Sharing) |
|---|---|---|
| Days 1 through 60 | Full coverage for eligible facility costs | The standard Part A Deductible (paid once per period) |
| Days 61 through 90 | Full coverage for eligible facility costs | A daily coinsurance amount (set annually by CMS) |
| Days 91 and beyond (Lifetime Reserve Days) | Full coverage, up to 60 lifetime maximum days | A higher daily coinsurance amount (set annually by CMS) |
| After exhausting Reserve Days | Nothing | 100% of all costs |
(Note: The structure above applies to Original Medicare. If you enroll in a Medicare Advantage plan in Maryland, such as a plan from Aetna Medicare or Kaiser Permanente, the carrier replaces this benefit period structure with its own cost-sharing rules, typically charging a fixed daily copay for the first 5 to 7 days of a hospital stay.)
When you are admitted to a hospital, Part A covers a specific array of services designed to treat your acute condition.
To trigger Part A coverage, you must be formally admitted to the hospital as an inpatient by a physician’s order. Simply staying overnight in a hospital bed does not automatically make you an inpatient.
Hospitals frequently place patients under “Observation Status.” Under observation, you are physically in a hospital bed, receiving nursing care, eating hospital food, and staying overnight—sometimes for multiple days—while the medical staff runs tests to decide whether you need to be formally admitted.
If you are under Observation Status, you are technically considered an outpatient. Therefore, Medicare Part A does not apply. Instead, Part B covers your care, subjecting you to Part B’s deductibles and 20% coinsurance for every individual test and service. More dangerously, because Part B does not cover routine self-administered drugs in the hospital, you may be billed out-of-pocket for your standard daily medications while under observation.
CMS enforces a guideline known as the Two-Midnight Rule. Generally, if an admitting physician expects you to require hospital care that spans at least two midnights, you should be formally admitted as an inpatient. If you are in the hospital, you or your family should explicitly ask the staff: “Am I formally admitted as an inpatient, or am I here under observation?” If you are under observation for more than 24 hours, the hospital is required by law to give you a Medicare Outpatient Observation Notice (MOON) explaining your status.
After a severe illness, surgery, or injury, you may be stable enough to leave the hospital but not well enough to go home. You might require daily physical therapy, intravenous injections, or complex wound care. This level of treatment takes place in a Skilled Nursing Facility (SNF).
Part A will cover SNF care, but only if you meet incredibly strict criteria established by CMS.
To qualify for Part A SNF coverage, you must have a prior qualifying inpatient hospital stay of at least three consecutive days (72 hours). The three days do not include the day you are discharged, and—crucially—time spent in the hospital under Observation Status or in the Emergency Room before formal admission does not count toward the three days.
If you spend two days under observation, are finally admitted as an inpatient for two more days, and are then transferred to a SNF, Medicare Part A will deny your SNF coverage entirely because your formal inpatient stay was only two days long.
Part A only pays for skilled care. This means care that can only be safely and effectively performed by licensed medical professionals, such as registered nurses or physical therapists. Examples include changing sterile dressings, administering IV antibiotics, or managing complex rehabilitation protocols.
Part A explicitly does not cover custodial care. Custodial care refers to help with the Activities of Daily Living (ADLs)—things like getting out of bed, bathing, dressing, using the bathroom, and eating. If your primary need for being in a nursing home is custodial care, Medicare will not pay for it.
If you meet the medical criteria and the three-day rule, Part A covers SNF care on a benefit period basis:
Keep in mind that Medicare Advantage plans in Maryland (like those from Alterwood Advantage, HealthSpring, or UnitedHealthcare) have the authority to waive the three-day hospital stay rule for SNF admissions, which can be a significant advantage. However, MA plans still adhere to the strict medical requirement that the care must be skilled, not custodial.
Hospice care is a specialized approach for individuals facing a terminal illness, focusing on comfort, pain management, and quality of life rather than curative treatment.
Medicare Part A offers remarkably comprehensive coverage for hospice care. To qualify, a hospice doctor and your regular doctor must certify that you are terminally ill, meaning you have a medical prognosis of six months or less to live if the illness runs its normal course. You must also sign a statement choosing to receive palliative (comfort) care instead of curative treatments for your terminal illness.
Medicare Part A (and sometimes Part B) provides coverage for specific Home Health Services, allowing you to receive medical care in the comfort of your own home in Maryland.
To qualify, you must be under the care of a doctor who establishes and regularly reviews your plan of care. The doctor must certify that you need one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.
Crucially, you must be certified as homebound. Under CMS rules, homebound does not mean you are physically chained to your bed. It means that leaving your home requires a considerable and taxing effort, and you generally need the help of another person or medical equipment (like a wheelchair or walker) to do so. You are still allowed to leave home for medical appointments, religious services, or short, infrequent non-medical trips (like attending a grandchild’s graduation or getting a haircut) without losing your homebound status.
When you qualify, Part A covers the home health care at 100%, with no deductible or coinsurance required for the services themselves. (If your care requires durable medical equipment, like a hospital bed for your home, that falls under Part B, which requires a 20% coinsurance).
If you require blood transfusions while in the hospital, the way Part A handles the cost is highly specific. The hospital gets blood in two ways: either it receives donated blood for free, or it has to buy the blood from a blood bank.
If the hospital receives the blood for free, you pay nothing. If the hospital has to buy the blood, Medicare Part A rules state that you are responsible for paying the cost of the first three pints of blood you receive in a calendar year. This is known as the “blood deductible.” After the first three pints, Part A pays the cost of the blood for the rest of the year.
You can entirely avoid this cost by having the blood donated by someone else on your behalf, or by donating the blood yourself ahead of a scheduled surgery.
Most Maryland residents do not pay a monthly premium for Part A. Review the checklist below to see if you qualify automatically.
| Alternative Qualifying Status (Under 65) | Requirement |
|---|---|
| Disability Status | You have received Social Security Disability Insurance (SSDI) benefits for 24 months. |
| Amyotrophic Lateral Sclerosis (ALS) | You have a formal diagnosis of Lou Gehrig's disease (coverage begins the month SSDI benefits begin). |
| End-Stage Renal Disease (ESRD) | You require regular dialysis or have had a kidney transplant. |
Your path to enrolling in Part A depends on your work history and when you choose to claim your Social Security benefits.
If you are already receiving Social Security retirement benefits when you turn 65, your enrollment in Medicare Part A (and Part B) is automatic. The government will mail your red, white, and blue Medicare card to your Maryland address about three months before your 65th birthday. Your Part A coverage will begin on the first day of the month you turn 65. (If your birthday is on the first of the month, coverage starts the first day of the prior month).
If you are planning to delay taking Social Security retirement benefits until your full retirement age or later, you will not be automatically enrolled in Medicare. You must proactively contact the Social Security Administration to enroll during your Initial Enrollment Period.
Your Initial Enrollment Period (IEP) is a seven-month window that revolves around your 65th birthday. It includes the three months before your birth month, your birth month, and the three months after. If you are eligible for premium-free Part A, there is no penalty for enrolling late. You can sign up for premium-free Part A at any time after your IEP ends, and coverage will retroactively apply up to six months back (but no earlier than your 65th birthday).
What if you did not work 40 quarters? If you are a newer citizen, an immigrant, or someone who spent their life outside the formal taxed workforce without a qualifying spouse, you do not get Part A for free. You must buy it.
CMS scales the Part A premium based on your work history:
If you have to buy Part A, two strict rules apply: First, you are legally required to buy Part B as well; you cannot buy just Part A. Second, you are subject to late enrollment penalties if you do not sign up during your Initial Enrollment Period. The Part A late enrollment penalty adds 10% to your monthly premium for twice the number of years you were eligible but did not enroll.
Many Maryland residents choose to continue working past age 65. If you have active health insurance through your employer (or your spouse’s employer), you have a decision to make regarding Part A.
For most people, because Part A is premium-free, it makes sense to enroll in it at 65 anyway. It acts as secondary insurance. Your employer plan pays the hospital first, and Part A may pick up some of the facility costs that your employer plan leaves behind.
However, there is one major exception: Health Savings Accounts (HSAs). Under IRS regulations, you cannot contribute tax-free money to an HSA if you are enrolled in any part of Medicare. If you have a high-deductible health plan at work and want to continue making HSA contributions past age 65, you must delay enrolling in both Part A and Part B. If you choose to do this, make sure to stop your HSA contributions six months before you eventually do apply for Medicare, because Part A enrollment is retroactively applied up to six months for those who delay.
Furthermore, the size of your employer matters. If your company has 20 or more employees, the employer plan pays first, and Medicare pays second. If your company has fewer than 20 employees, Medicare pays first, and the employer plan pays second. If you work for a small company, you absolutely need Part A (and Part B) at age 65, or you will have severe gaps in your hospital coverage.
Part A is rarely used entirely on its own. Because of its massive benefit-period deductibles, lack of a maximum out-of-pocket cap, and exclusion of doctor services, relying solely on Original Medicare (Parts A and B) exposes you to devastating financial risk if you experience a prolonged illness.
In Maryland, you have two primary ways to protect yourself:
You can stay on Original Medicare and purchase a Medicare Supplement (Medigap) policy from a private insurance company. Medigap plans are specifically designed to pay the deductibles and coinsurance that Part A and Part B leave behind.
For example, Medigap Plan G will pay your entire Part A hospital deductible, completely eliminating the risk of paying that deductible multiple times in a year across different benefit periods. Plan G will also pay the daily coinsurance for skilled nursing facility stays and cover an additional 365 days of hospital care over your lifetime once Part A benefits are exhausted. With this setup, your hospital costs are highly predictable, and you can use any hospital in the United States that accepts Medicare.
Alternatively, you can choose to receive your Part A and Part B benefits through a private Medicare Advantage plan. Maryland has a robust Medicare Advantage market, with roughly 60 real plans available across the state from carriers like Aetna Medicare, Alterwood Advantage, Humana, Kaiser Permanente, and UnitedHealthcare.
By law, every Medicare Advantage plan must provide coverage that is at least as good as Original Medicare Part A and Part B. However, they completely restructure the costs. Instead of the confusing “benefit period” deductible, most Maryland MA plans utilize a simpler copayment structure.
For instance, an MA plan might charge a $250 daily copay for days 1 through 6 of a hospital stay, and $0 thereafter. This creates predictability. The tradeoff is that MA plans utilize provider networks (HMOs and PPOs). You must use the hospitals and skilled nursing facilities that are in the carrier’s network in Maryland, or face higher out-of-pocket costs (or no coverage at all, in the case of an HMO).
Medicare Advantage plans also introduce an annual Maximum Out-of-Pocket (MOOP) limit, providing a safety net that Original Medicare inherently lacks. Once your hospital copays and doctor costs reach that annual limit, the plan covers 100% of your eligible medical costs for the remainder of the year.
A licensed producer can help you compare Original Medicare, Medigap, and Medicare Advantage options to protect against Part A hospital costs.
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