Seniors Access to Healthcare in Maryland: Understanding Medicare
For older adults in Maryland, Medicare provides an essential foundation for accessing healthcare, but having Medicare coverage does not always mean that healthcare is equally accessible. Seniors may still face challenges related to provider networks, transportation, prescription costs, plan changes, healthcare navigation, and access to providers—particularly when they have complex medical needs or live outside major metropolitan areas.
These issues make Medicare literacy and access to reliable healthcare resources increasingly important for Maryland’s senior population.
Understanding Medicare in Maryland
Medicare provides health coverage primarily for people age 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. Beneficiaries generally receive coverage through Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C). Medicare Part D provides prescription drug coverage.
Medicare Advantage has become an increasingly significant part of the Medicare landscape. Nationally, 55% of eligible Medicare beneficiaries were enrolled in Medicare Advantage in 2026.
For Maryland seniors, this means that understanding the differences between Original Medicare and Medicare Advantage—and evaluating whether a particular plan provides access to their preferred physicians, hospitals, pharmacies, and medications—is an important component of maintaining continuity of care.
Provider Networks Can Affect Access
One of the most important considerations for Maryland Medicare beneficiaries is whether their healthcare providers participate in their plan. Medicare Advantage plans generally operate through defined provider networks. Changes to those networks can affect where beneficiaries receive care and what they pay for services.
Maryland's 2026 Medicare guidance illustrates how significant these changes can be. For example, UnitedHealthcare Medicare Advantage no longer includes Johns Hopkins Medicine in its network, a change that began in August 2025. Beneficiaries using affected Johns Hopkins providers, hospitals, or facilities may face higher out-of-pocket costs.
This makes annual plan review particularly important for seniors with established relationships with primary-care physicians, specialists, hospitals, and other healthcare providers.
Rural and Geographic Barriers
Healthcare accessibility is not determined solely by insurance coverage. Geography can also influence whether seniors can realistically obtain care.
CMS research has found that Medicare beneficiaries living in non-metropolitan areas experienced longer travel times to primary-care providers and lower access to telemedicine than beneficiaries living in metropolitan areas.
For Maryland seniors living in rural or less densely populated communities, transportation and provider availability can therefore become important components of healthcare access.
A Medicare plan may cover a particular service, but the practical question is whether the beneficiary can reach an appropriate provider, obtain an appointment, and afford the associated costs.
Medicare Advantage and Additional Benefits
Medicare Advantage plans may provide benefits beyond those traditionally associated with Original Medicare. Depending on the plan, these can include services or allowances related to transportation, dental care, vision, fitness, food, and other supplemental benefits.
Maryland's Insurance Administration specifically recommends that beneficiaries consider whether benefits such as transportation and food delivery would be useful when evaluating Medicare Advantage plans.
For seniors with mobility limitations or limited transportation options, these benefits can be relevant to whether healthcare is practically accessible.
However, supplemental benefits vary by plan, so seniors should evaluate the specific benefits, eligibility requirements, provider networks, and costs associated with their individual plan.
Prescription Drug Access
Medication access is another critical component of senior healthcare.
A Medicare beneficiary may have coverage for prescription drugs through a standalone Part D plan or through a Medicare Advantage plan that includes drug coverage. When evaluating coverage, beneficiaries should verify that the medications they regularly take are included in the plan's formulary and understand the applicable costs.
Maryland's 2026 Medicare guidance encourages beneficiaries to review their prescription medications when comparing Medicare Advantage plans.
For seniors managing multiple chronic conditions, even relatively small differences in prescription costs can influence whether medications remain affordable and consistently obtained.
The Importance of Medicare Savings Programs
Healthcare accessibility is also closely connected to affordability.
Some Maryland seniors may qualify for programs that help with Medicare-related costs. Maryland provides a Medicare Savings Program that can help eligible older adults with certain out-of-pocket healthcare expenses.
Maryland's State Health Insurance Assistance Program, or SHIP, provides free and unbiased Medicare counseling. The program has 19 SHIP offices throughout the state and can help beneficiaries understand coverage options, identify potential savings programs, compare plans, and navigate Medicare-related issues.
For seniors who have difficulty navigating Medicare independently, access to this type of assistance can be just as important as access to the insurance itself.
Dual Eligibility: Medicare and Medicaid
Some Maryland seniors qualify for both Medicare and Medicaid. These individuals are commonly referred to as dual-eligible beneficiaries.
For people who qualify, the two programs can work together to cover healthcare costs and services. Maryland regulations provide for Medicare "buy-in" assistance for eligible individuals receiving Medical Assistance, including assistance associated with Medicare Parts A and B.
Maryland also offers programs designed to support older adults with significant healthcare and long-term-care needs. For example, the state's PACE program provides comprehensive medical and social services to eligible individuals, and most PACE participants are dually eligible for Medicare and Medicaid.
Understanding eligibility for these programs can be particularly important for seniors who have significant healthcare needs but limited financial resources.
2026 Medicare Changes Make Annual Review Important
Medicare coverage should not necessarily be treated as a "set it and forget it" decision.
Maryland's 2026 Medicare Advantage market includes changes to plan availability, service areas, provider networks, and Dual Eligible Special Needs Plans (D-SNPs). Several insurers changed the plans they offer in Maryland for 2026.
Maryland's Medicare Open Enrollment period runs from October 15 through December 7, during which beneficiaries can review and change Medicare Advantage and Part D coverage for the following year.
For seniors, reviewing coverage annually can help identify changes that could affect physicians, hospitals, medications, premiums, copayments, and supplemental benefits.
A Broader Definition of Healthcare Access
For Maryland seniors, healthcare access extends beyond simply having a Medicare card.
True access can involve several interconnected factors:
Insurance coverage
Provider availability
Provider networks
Transportation
Prescription affordability
Out-of-pocket expenses
Access to specialists
Care coordination
Health literacy
Technology and telehealth access
Availability of Medicare assistance
Access to long-term services and supports
These factors can interact. A senior may have Medicare coverage but still experience barriers to receiving timely and appropriate care.
Improving Medicare Access for Maryland Seniors
Improving healthcare access requires attention not only to insurance enrollment but also to the systems surrounding the beneficiary.
Healthcare organizations, community organizations, policymakers, and senior-service providers can use data to identify where access barriers are occurring. Relevant analytics may include appointment availability, provider-network adequacy, geographic access, transportation barriers, utilization patterns, emergency department use, medication adherence, preventive-care utilization, and healthcare costs.
For healthcare organizations serving Maryland's Medicare population, these data can help identify communities and populations experiencing gaps in care and guide targeted interventions.
Ultimately, Medicare provides an important foundation for healthcare access among Maryland seniors, but coverage alone does not guarantee that care will be convenient, affordable, or easy to navigate. A more complete approach considers the entire patient journey—from insurance coverage and provider availability to transportation, medications, affordability, and continuity of care.
For Maryland seniors, understanding Medicare is not simply about choosing an insurance plan. It is about ensuring that the coverage they have translates into meaningful access to the healthcare they need.
SOURCES
Maryland Department of Aging — State Health Insurance Assistance Program (SHIP)
Provides information about Maryland's free, unbiased Medicare counseling and assistance for beneficiaries.
Maryland Insurance Administration — Medicare Open Enrollment & 2026 Updates
Useful for Maryland-specific information on Medicare Advantage plans, provider networks, enrollment periods, and plan changes.
Maryland Insurance Administration — Medicare Open Enrollment
Centers for Medicare & Medicaid Services (CMS) — Medicare Beneficiary Access
Provides federal data on healthcare access among Medicare beneficiaries, including differences between metropolitan and non-metropolitan communities.
KFF — Medicare Advantage in 2026: Enrollment Update and Key Trends
Provides current 2026 data on Medicare Advantage enrollment, including state- and county-level trends. KFF reports that 55% of eligible Medicare beneficiaries nationally were enrolled in Medicare Advantage in 2026.
KFF — Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
Useful for discussing how Medicare Advantage plan design, costs, supplemental benefits, and prior authorization can affect healthcare access.
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