"I was denied, denied, denied," said Jamie Engels, a 29-year-old Baltimore woman with a kidney disorder, about applying for private coverage after her employer closed its doors and she lost her job and insurance in 2010.
After some searching, she found a federally subsidized state program and has a plan she can afford.
State officials want to make sure others in Engels' shoes know about the Maryland Health Insurance Plan. They're launching their biggest marketing push ever today.
The state program, which includes the federally supported plan and a state-supported one, is expected to enroll thousands more of Maryland's 720,000 uninsured — two years before federal health care reform mandates exchanges in every state for the uninsured to buy private insurance.
"We definitely want more and more Marylanders to have this culture of insurance, a culture of wellness and prevention, a culture of regularly seeing a provider and not waiting until it's too late, too expensive or too painful," said Lt. Gov. Anthony Brown, who is overseeing health care reform in the state.
An $85 million federal subsidy is offsetting the cost of the federal plan created in 2010 under the health care reform law. A tax on hospitals in Maryland subsidizes the state plan, opened in 2003.
However, both plans are underused, officials say. There are 20,100 in the state program and about 850 in the federal one.
The marketing campaign will focus on boosting enrollment in the federal plan by spending hundreds of thousands in federal dollars on radio, billboard and print advertisements, as well as social media, in five markets – Baltimore, Prince George's, Montgomery and Anne Arundel counties and Baltimore City. The blitz will target just over half the uninsured, or 376,000 state residents ages 19-64, who are not eligible for Medicare or Medicaid.
The exact number with a pre-existing condition isn't known, but past estimates are around 10 percent of Maryland's uninsured.
Brown said it wasn't unusual for public programs to be underused.
"In this case, it may very well be for some the premiums are still to high, but we believe outreach and education on the available benefits will result in us getting closer to 2,700," he said of the remaining slots in the federal program.
The campaign is likely to steer some residents to the state program as well, said Kent McKinney, executive director of the Maryland Health Insurance Plan, the agency that administers both plans.
The federal program is available only to individuals, while the state plan allows families.
There are other differences as well. The federal program requires applicants to have been uninsured for six months, while the state plan has no waiting period. The state plan, however, only covers medical needs that aren't related to pre-existing conditions for the first six months.
The programs can't be combined because they have different funding sources, but the state saves money by managing them jointly, McKinney said. CareFirst BlueCross BlueShield administers both.
"Both the state and federal program provide hope and significant relief to people who can't get insurance in the marketplace," McKinney said. "Our goal is to broadly educate everyone who could qualify for our health plans."
Engels said she said she couldn't afford to extend her coverage through the federal COBRA program after she was laid off. She'd gone about 10 months without coverage when she began calling insurers to buy a plan.
Debate over the federal health reform law was going on about the same time and she wondered if it would benefit her.
"I hoped it would," she said. "And it did."
Though she exercises and eats right, she sometimes still needs to see the doctor, especially to keep tabs on her condition. Now she has preventive care, as well as a sense of security.
The insurance enabled her to take a job as a nanny as she prepares to go to nursing school.
Her premium is $141 a month, hundreds less than the COBRA payments would have been, and even less than the private insurance for which she was denied. Premiums in the federal plan run from $127 to $354 for a high-deductible plan and $246 to $685 for a regular plan.
She believes insurance, and the preventive care it affords, is a good investment in public dollars. While she was uninsured she was not able to take care of an ovarian cyst that later necessitated removal of her ovary, an expensive procedure that could have been avoided.
But she believes many people give up finding affordable coverage and supports the new advertising campaign.
"I think a lot of people get discouraged," she said. "I think getting the word out about the program will bring a lot of benefit. …It saved my life."