Health Insurance - Physical Therapy - Copayments, Coinsurance, and Deductibles
HB 367 would amend Maryland insurance law to regulate cost-sharing for covered physical therapy services. Specifically, it prohibits insurers, nonprofit health service plans, and health maintenance organizations from charging a copayment, coinsurance, or deductible for physical therapy that is higher than the cost-sharing required for an annual physical or wellness visit under the same plan or contract. The bill also requires these entities to clearly disclose in each plan or contract the coverage requirements, limitations, conditions, and exclusions related to physical therapy services.
The bill applies to individual, group, and blanket health insurance policies and contracts issued or delivered in Maryland, as well as HMO contracts. It would take effect on January 1, 2027, and apply to policies, contracts, and health benefit plans issued, delivered, or renewed on or after that date. In practical terms, the bill would create a new parity-style limit on out-of-pocket costs for physical therapy, potentially making treatment more affordable for covered patients and standardizing plan disclosures.
HB 367 would add a new section to the Insurance Article, Section 15-864, creating a state-level restriction on how much insurers and HMOs may charge for covered physical therapy services. It would affect insurers, nonprofit health service plans, and health maintenance organizations that offer physical therapy coverage in Maryland, while also requiring clearer plan language about physical therapy benefits and exclusions. The bill would not mandate coverage where none exists, but it would limit cost-sharing for covered services and apply prospectively to new, delivered, or renewed plans beginning in 2027.
The available record suggests limited public debate, but the bill’s subject matter indicates a consumer-protection and access-to-care rationale. Because there are no committee transcripts or recorded votes, there is no evidence of formal support or opposition in the provided materials. The sponsor’s later withdrawal of the bill in the House suggests it did not advance, but the reason for withdrawal is not stated.
The main policy issue is whether physical therapy should receive the same cost-sharing treatment as an annual physical or wellness visit, which would likely be viewed favorably by patients and physical therapy advocates seeking lower out-of-pocket costs. Potential concerns for insurers and health plans would center on increased utilization, higher plan costs, and the precedent of tying cost-sharing for one service to another type of visit. Another possible point of contention is that the bill regulates only covered physical therapy services, so it does not expand coverage itself but instead limits cost-sharing for existing benefits.