Update (1/21/25)

Proposed 2026 Plan Certification Standards – please submit comments by 2/07/25 to mhbe.publiccomments@maryland.gov

These will be considered for a final vote at the February 18, 2025 meeting of the MHBE Board of Trustees.

Update (12/18/24)

Proposed 2026 Value Plan Designs – please submit comments by 1/10/25 to mhbe.publiccomments@maryland.gov

These proposed plans were designed in consultation with the MIA, MHBE’s contracted actuaries, and the Value Plan workgroup. They will be considered at the January 21, 2025 meeting of the MHBE Board of Trustees.

Update (12/22/22)

Proposed Standard Plan Design Revision (please submit comments by 1/27/23 to mhbe.publiccomments@maryland.gov)

Following release of the federal proposed 2024 Actuarial Value Calculator, MHBE re-analyzed the standard plan designs recommended by the Affordability Workgroup for 2024.

During the workgroup, the plans’ actuarial value was calculated using the available 2023 AV calculator. Running the plan designs through the recently released 2024 AV calculator yields actuarial values that exceed the federally-allowed maximum AV in the Silver CSR 73% and 94% plans, and the Bronze plan.

In order to try to bring these plans within the allowable AV range, as recommended by the Affordability Workgroup, MHBE first increased the medical and drug out of pocket maximums (MOOP). The federal government sets maximum allowable MOOPs. We increased the Silver CSR 73% and Bronze MOOPs to the maximum allowed levels. This reduced these plans’ AV, but not enough. The CSR 94 plan MOOP can be as high as $3,150 but we achieved what we felt was a reasonable AV by increasing the MOOP to a combined $2,000 ($1,750 medical + $250 drug). This meant only the Silver CSR 73% and Bronze required additional adjustment to bring them into AV range.

MHBE, in consultation with MIA, explored multiple options for further reducing the AVs for the Silver CSR 73% and the Bronze plan. In addition, we made the changes proposed to the Silver 73% plan to the Base Silver plan as well, in keeping with the principle that copays should be the same or higher in plan designs with lower AVs, so as to clearly signal to consumers that lower AV plans typically will result in higher out-of-pocket costs.

Ultimately, we developed two options. The first is to increase the specialist copay in the three plans at issue from $80 to $90, and to increase the generic drug copay from $20 to $25. This is MHBE staff’s recommended option. (Note, MD law states that the copay for a prescription drug may not exceed the retail price of the drug, so if the retail price of a generic drug is less than the $25, the consumer would pay the lower retail price.) The second option shown below is to increase the specialist copay from $80 to $110 in the two silver plans at issue, and to $125 in the bronze plan, and keep the generic copay at the originally proposed $20 in the three plans. We invite comment on these options.

Other changes we considered for these three plans, but that are not proposed because they did not yield sufficient AV reductions on their own, included further increasing the generic drug copay, making X-rays and Diagnostic Imaging and Laboratory Outpatient and Professional Services subject to the deductible, increasing the Primary Care copay to $40, and, for the Silver plans, changing the balance between the drug and medical MOOPs. Ultimately, we feel that the two options we identified best minimize changes to the original plan designs, which were carefully developed by the Affordability Workgroup, and minimize impact to consumers.

Revised standard plan designs

Update (11/21/2022)
Proposed 2024 Plan Certification Standards

Update (9/24/2021)
Proposed 2023 Plan Certification Standards

Update (9/30/2020) 
Proposed 2022 Plan Certification Standards

Update (3/5/2025)
2026 State Reinsurance Program Estimated Parameters
Comments will be accepted through April 7, 2025.

Update (6/10/2024)

MHBE’s draft 1332 Waiver Amendment Application, pursuant to MD SB705/HB728 of 2024, is available for review here. If approved, this amendment would allow Maryland residents to qualify to enroll in private plans on-Exchange, regardless of immigration status. MHBE will hold two public hearings to give the public an opportunity to provide meaningful comment on this application. Please use this form to request accommodations or sign up to comment, if desired.

Waiver Amendment Hearing #1
Tuesday, June 18 · 1:00 – 2:00pm
Presentation Slides

Waiver Amendment Public Hearing #2
Wednesday, July 3 · 1:00 – 2:00pm
Time zone: America/New_York
Google Meet joining info
Video call link: https://meet.google.com/mjn-mzcb-ygb
Or dial: ‪(US) +1 252-922-0052‬ PIN: ‪331 679 290‬#

July 16, 2024 Sixth Annual Reinsurance Forum
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange will afford the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP) on Tuesday, July 16, 12:00 – 1:00pm
Video call link: https://meet.google.com/szm-xbey-kkt
Or dial: ‪(US) +1 502-791-5281‬ PIN: ‪173 936 390‬#

Update (5/10/2024)

MHBE will hold a public hearing 1-2pm on June 18, 2024 to give the public an opportunity to provide meaningful comment on its 1332 waiver amendment application. MHBE is submitting a 1332 waiver amendment application pursuant to Maryland Senate Bill 705 / House Bill 728. If approved, the amendment would allow all Maryland residents to qualify to enroll in private plans on-Exchange, regardless of immigration status. To request accommodations, please contact becca.lane@maryland.gov.

Waiver Amendment Hearing #1
Tuesday, June 18 · 1:00 – 2:00pm
Time zone: America/New_York
Google Meet joining info
Video call link: https://meet.google.com/mvf-amcw-yey
Or dial: ‪(US) +1 507-690-2033‬ PIN: ‪921 706 284‬#

MHBE will hold its sixth annual Reinsurance Forum 1-2pm on July 3rd, 2024. This forum, pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), will be an opportunity for the public to provide meaningful comment on the progress of the 1332 State Innovation Waiver and State Reinsurance Program in general, as well as a second opportunity for the public to comment on the waiver amendment application. To request accommodations, please contact becca.lane@maryland.gov.

July 3, 2024 Combined Waiver Amendment Public Hearing #2 + Annual Forum
Wednesday, July 3 · 1:00 – 2:00pm
Time zone: America/New_York
Google Meet joining info
Video call link: https://meet.google.com/mjn-mzcb-ygb
Or dial: ‪(US) +1 252-922-0052‬ PIN: ‪331 679 290‬#

Update (3/26/2024)
2025 State Reinsurance Program Estimated Parameters
Public comments will be accepted through April 25, 2024.

Update (3/1/2023)
2024 State Reinsurance Program Estimated Parameters
Public comments were accepted until March 31, 2023.

Update (2/1/2023)
Notice of Public Hearing and Intent to Apply for 1332 Waiver Extension

MHBE held a public hearing on the 1332 Waiver Extension Application on February 15, 2022. Written comments on the draft application were due by Tuesday, March 7th, 2023.

Final 1332 Waiver Extension Application
Draft 1332 Waiver Extension Application
1332 Waiver Extension Application Public Hearing Presentation
1332 Waiver Extension Letter of Intent to CMS
Waiver Extension LOI Response from CMS

Update (3/1/2022)
2023 State Reinsurance Program Estimated Parameters
Public comments were accepted until March 31, 2023.

Update (2/26/21)
2022 Estimated State Reinsurance Parameters

Update (6/5/20)
Estimated 2021 Reinsurance Payment Parameters
Proposed “Hybrid” Dampening Approach
Dampening Factor Comparisons
Summary of Comments and MHBE Response

Update (08/1/19)
Draft Affordability Work Group Report  

More information on the Affordability Work Group and its progress.

Updated 2/10/2025
Draft 2026 Letter to Issuers
Public comments may be submitted to mhbe.publiccomments@maryland.gov through March 12, 2025; however, issuers are encouraged to submit comments early if possible.

Updated 12/20/2023
Draft 2025 Letter to Issuers
Proposed 2025 Value Plan Designs
Public comments may be submitted to mhbe.publiccomments@maryland.gov through January 22, 2024; however, issuers are encouraged to submit comments early if possible.

Updated 2/23/2023
Draft 2024 Letter to Issuers
Public comments may be submitted to mhbe.publiccomments@maryland.gov through March 24, 2023.

Updated 12/10/2021
Draft 2023 Letter to Issuers

Update (1/15/21)
2022 DRAFT Letter to Issuers

Update (12/20/19)
2021 Letter to Issuers seeking to participate in Maryland Health Connection.

Update (9/26/19)
Proposed 2021 Plan Certification Standards

Update (06/13/19)
In the 2020 Final Letter to Issuers Participating on Maryland Health Connection, MHBE was tasked to create a work group to help determine whether the current benchmark plan meets the needs of the individual market. The work group concluded its work on April 26, 2019, and drafted recommendations to be presented to the MHBE Board of Trustees on whether to leverage new state flexibility to modify the State Benchmark Plan. State Benchmark Plan Work Group Draft Report More information about the State Benchmark Plan Work Group and their progress.

Update (02/01/19)
MHBE finalized the 2020 Annual Letter to Issuers Seeking to Participate in Maryland Health Connection. We thank all who provided feedback and responses to the Draft.

Update (4/8/22)
The Maryland Health Benefit Exchange has drafted regulatory updates to align the annual open enrollment period with 45 CFR §155.410(e), and to clarify certain SEPs and add new SEPs in compliance with 45 CFR §155.420. The proposed action includes SEPs for the Maryland Health Insurance Easy Enrollment Program in accordance with Md. Code, Ins. §31.202 and for pregnancy in accordance with Md. Code, Ins. §15-1316(c)(2); it also brings COMAR into alignment with Exchange operations.

These updates were finalized as proposed. The draft regulations were published in the Maryland Register and comments were accepted until May 9, 2022.

COMAR 14.35.07

Update (09/10/21)
The Maryland Health Benefit Exchange (MHBE) drafted regulations to set forth the structure, implementation, and eligibility standards for the Young Adult Health Insurance Subsidies Program, as required under Insurance Article, §31-117, Annotated Code of Maryland, as well as alter existing regulations to accommodate the Young Adult Health Insurance Subsidies Program. These updates were finalized as proposed. The draft regulations were published in the September 10, 2021 Issue of the Maryland Register and comments were accepted until October 10, 2021.

Young Adult Subsidy Program Proposed Regulations

Update (07/19/19)
The Maryland Health Benefit Exchange (MHBE) drafted regulations that pertain to the Small Business Health Options Program (SHOP). MHBE has authority to regulate these areas under Parts 155 and 156 of Title 45 of the Code of Federal Regulations and Title 31 of the Maryland Insurance Article, Annotated Code of Maryland. The regulations were posted in the July 19th Issue of the Maryland Register.

MHBE previously invited preliminary comments on the draft regulations from key stakeholders. MHBE’s responses to those comments are available here.

Update (8/26/24)
The federal government determined that Maryland’s application to amend its 1332 waiver to allow all qualified residents, regardless of immigration status, to enroll in private plans, is complete. The public may submit comments to stateinnovationwaivers@cms.hhs.gov through September 20, 2024.

Update (4/17/24)
Young Adult Subsidy Proposed Parameters for 2025
The MHBE Board voted to approve Option 2 shown in the slides as the proposed Young Adult Subsidy parameters for 2025. MHBE is accepting public comment on the proposed parameters through May 17th, 2024.

Update (1/16/24)
Adding Sexual Orientation and Gender Identity Questions to the MHC Application
MHBE and Maryland Department of Health are working to begin collecting data on sexual orientation and gender identity on the Maryland Health Connection application for Medicaid and private health plans as part of health equity efforts. Stakeholders are encouraged to send feedback on the proposed question design/format to Becca Lane, Senior Health Policy Analyst (becca.lane@maryland.gov) by March 15, 2024.

Update (10/05/23)
MHBE is seeking input on Small Business employee choice model metal tier offering (please submit comments by 11/10/23 to mhc.smallbiz@maryland.gov).

MHBE values your input as we continuously strive to improve our services. We are currently seeking public comments and feedback on our proposed Small Business employee choice model. Your insights are instrumental in helping us make informed decisions that benefit the small business community in Maryland.

Based on stakeholder feedback, MHBE is considering allowing all metal tiers to be made available for small business employers to select from through the employee choice model. Under this model, employers would have the option to choose one specific metal tier or have the flexibility to select from all available metal tiers. This would give employers the option to make all health plans offered by issuers accessible to employees, ensuring a wider range of choices.

Current state regulations regarding the employee choice model allows qualified employers to select two consecutive metal levels of coverage (see COMAR 14.35.18.06). Federal regulations do not define any specific requirements for state-based SHOPs offering the employee choice model (see 45 CFR 155.706(b)(3)). These proposed updates to the employee choice model would therefore require modifying the referenced state regulations.

Your timely input is greatly appreciated.  

Update (5/19/23)
Young Adult Subsidy Proposed Parameters for 2024
The MHBE Board voted to approve option 3 as shown in the slides as the proposed Young Adult Subsidy parameters for 2024. MHBE is accepting public comment on the proposed parameters through June 9th, 2023.

Update (5/25/22)
Young Adult Subsidy Proposed Parameters for 2023

Update (4/20/21)
Proposed Young Adult Subsidy Pilot Program parameters

Update (10/2/20)
MHBE analyzed the potential impact of subsidies on the individual market using the analysis completed by Lewis and Ellis Actuaries and Consultants.

Update (05/10/19)
The Maryland Health Benefit Exchange received applications for the Maryland Easy Enrollment Health Insurance Program (MEEHP) Advisory Group. The workgroup was established as required under § 31–203 of the Insurance Article. The advisory workgroup’s input will help the effectiveness of the Maryland Health Insurance Option Easy Enrollment Health Insurance Program and provide recommendations as to whether implementing an individual responsibility amount or implementing automatic enrollment of individuals in a qualified health benefit plan in the individual market is feasible and in the best interest of the state. 

Update (02/05/19)
MHBE received applications for the 2019 State Benchmark Plan work group and the Affordability work group.