Maryland Health Insurance Consumer Guide

To qualify for Marketplace coverage in Maryland, you must:⁴

• Live in Maryland
• Be a U.S. citizen, national, or lawfully present in the U.S.
• Not be incarcerated
• Not be enrolled in Medicare

Starting in 2026, however, Maryland plans to allow undocumented immigrants to enroll via Maryland Health Connection and obtain state-funded subsidies.⁵ Maryland will need to obtain federal permission for this, and enacted legislation in 2024 that directs the state to begin this process.⁶

(Washington was the first state to obtain federal permission to allow undocumented immigrants to use the exchange; Colorado operates a separate enrollment platform that undocumented immigrants can use. Both states provide state-funded subsidies for these enrollees.)

Whether or not you qualify for financial assistance with your premium, deductible, or out-of-pocket costs depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your zip code. 

Additionally, to qualify for subsidies, you must: 

• Not have access to affordable health coverage through an employer. If you think your employer-sponsored health plan is too expensive, use our Employer Health Plan Affordability Calculator to check if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.[efn_note]Medicare and the Marketplace, Master FAQ. Centers for Medicare and Medicaid Services. Accessed November 2023.[/efn_note]
• If married, you must file a joint tax return⁷ (with very limited exceptions)⁸
• Not be able to be claimed by someone else as a tax dependent.⁹

Maryland’s open enrollment period for individual and family health plans runs from November 1 to January 15.¹⁰

• Enroll by December 31 for coverage to start January 1.
• Enroll between January 1 and January 15 for coverage to begin February 1.

Note that the deadline to get a January 1 effective date in Maryland is December 31. This differs from most other states, where the deadline is typically December 15.¹¹

Outside of open enrollment, you generally need a qualifying life event, such as losing coverage, getting married, or permanently moving, to enroll or make changes. The qualifying life event will trigger a special enrollment period (SEP).

Note that Maryland is one of several states where pregnancy is considered a qualifying life event, giving a person 90 days from the date of the pregnancy confirmation to enroll in a health plan.¹²

Some people can enroll outside of open enrollment without a specific qualifying life event. For example:

• Native Americans can enroll year-round.
• People who utilize Maryland’s easy enrollment period can begin the process of obtaining health insurance by checking a box on their tax return.¹³

People who qualify for Medicaid, the Maryland Children’s Health Program (MCHP), or MCHP Premium can enroll anytime.¹⁰

There are several ways to enroll in an ACA Marketplace plan in Maryland:¹⁰

• Online: Go to MarylandHealthConnection.gov to create an account and apply. 
• Phone: Contact the Call Center at 855-645-8572. Those who are deaf and hard of hearing use the Relay service. Help is available in over 200 languages. 
• Talk to a broker: Get help from an authorized insurance broker through Broker Connect.¹⁴
• Talk to a navigator: Get help from one of the local navigator organizations in Maryland.
• Mobile app: Apply from your phone by downloading the mobile app, Enroll MHC.

You can find affordable individual and family health plans in Maryland through MarylandHealthConnection.gov, the state’s ACA exchange.

About 78% of Maryland’s exchange enrollees receive subsidies, saving about $390 monthly on their 2024 premiums.¹⁵ These subsidies are called Advance Premium Tax Credits (APTC). With subsidies, Maryland residents pay about $174 monthly on average in premiums (average includes those who pay full price).¹⁶

(The numbers above are based on effectuated enrollment in early 2024; the chart below shows some different metrics and is based on data from all enrollments submitted during the open enrollment period for 2024 coverage.)

If your income is no more than 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR) to lower your deductibles and out-of-pocket costs.¹⁷

Thanks to a state-funded subsidy program, young adults aged 18 to 37 may qualify for additional help paying their monthly premiums. This assistance is in addition to the federal APTC.¹⁸

The young adult subsidy program was initially slated to be available in 2022 and 2023, but legislation (HB814 and SB601) enacted in 2023 made it permanent. And although it initially only applied to adults up to age 34, the state has extended the eligible age range up to 37.¹

Source: CMS.gov¹⁹

Although Maryland does not have plan standardization, the exchange does offer “Value Plans,” which have lower out-of-pocket costs for certain frequently-used services.²⁰ And for 2024, changes were made to the Value Plans “to make the costs for common health care services clearer and more consistent across insurance companies.”²¹

For Maryland residents who aren’t eligible for premium subsidies or Medicaid, short-term health insurance can be a lower-cost coverage option, although Maryland limits short-term health plans to three-month durations and it’s important to understand that these plans are not ACA-compliant. For example, they don’t have to cover pre-existing conditions or essential health benefits.

For 2024, five insurance companies (including two CareFirst entities) are offering coverage through the Maryland exchange, including one new insurer:²²

For 2025, another new insurer — Wellpoint Maryland — is joining the market, bringing total insurer participation to six (including two CareFirst entities).²

For 2025, the insurers that offer individual/family coverage through Maryland Health Connection will implement the following average rate changes, amounting to an overall average increase of 6.2%.² 

Source: Maryland Insurance Administration²²³

Note that the average rate changes affect full-price premiums, and most enrollees are eligible for premium subsidies and thus don’t pay the full amount. These subsidy amounts are adjusted annually to match the cost of the second-lowest-cost Silver plan. 

Maryland established a reinsurance program in 2019, and federal approval was granted in 2023 to extend this program for another five years. The reinsurance program has kept Maryland’s individual market premiums much lower than they would otherwise have been.²

The entry of Aetna Health to Maryland’s Marketplace in 2024 gave consumers additional coverage options. And the same is true of Wellpoint Maryland’s entry into the Marketplace for 2025. But it’s also important to understand how the entry of a new insurer can affect premium subsidies, depending on how the new plans are priced relative to existing plans.

If your premiums are increasing from one year to the next, you might want to consider other Maryland Health Connection plans that better fit your budget and offer the benefits you need.

Here’s a look at how overall average premiums have changed each year in Maryland:

• 2015: 1% increase²⁴
• 2016: 20% increase²⁵
• 2017: 25.2% increase²⁶
• 2018: 43.8% increase²⁷ (after accounting for loss of federal CSR funding)
• 2019: 13% decrease²⁸ (reinsurance took effect)
• 2020: 10.3% decrease²⁹
• 2021: 11.9% decrease³⁰
• 2022: 2.1% increase³¹
• 2023: 6.6% increase³²
• 2024: 4.7% increase³³

213,895 people enrolled in private plans through Maryland Health Connection during the open enrollment period for 2024 coverage.³⁴ This was a significant record high (see below for a chart of prior year enrollment totals).

This surge in enrollment in recent years was due largely to the American Rescue Plan, which improved affordability starting in 2021. The Inflation Reduction Act extended these improvements until 2025, ensuring coverage remains more affordable than it was before the ARP became law.

Another factor in the 2024 enrollment spike was the end of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in 2023, after being paused for three years. By April 2024, almost 49,000 Maryland residents had transitioned from Medicaid to a private plan obtained via Maryland Health Connection, including more than 27,000 who were automatically enrolled³⁵ (most states do not have an automatic enrollment process for people transitioning away from Medicaid, but Maryland does).

(Maryland Health Connection reported that more than 14,000 of the people who enrolled during the open enrollment period for 2024 coverage had transitioned away from Medicaid,³⁴ but the disenrollments and coverage transitions had begun in mid-2023, well before the start of open enrollment.)

Source: 2014,³⁶ 2015,³⁷ 2016,³⁸ 2017,³⁹ 2018,⁴⁰ 2019,⁴¹ 2020,⁴² 2021,⁴³ 2022,⁴⁴ 2023,⁴⁵ 2024⁴⁶

Maryland Health Connection
This is the state’s official health insurance Marketplace, where residents can shop for and enroll in health coverage plans.

Maryland Department of Health
This department oversees various health-related programs in the state, including providing information and managing enrollment for Medicaid.

Maryland Health Education and Advocacy Unit
This unit offers education and support to help individuals understand and navigate their health insurance options, making informed decisions about their coverage.

Health Care Access Maryland
This organization ensures that Maryland residents can access quality healthcare services, assisting with enrollment, navigation, and resources.

Maryland Senior Health Insurance Program
Designed for older adults, this program offers valuable information and assistance related to Medicare.