Maryland health insurance Marketplace guide

To qualify for Marketplace coverage in Maryland, you must:⁵

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

Maryland has been working on the process of allowing undocumented immigrants to enroll via Maryland Health Connection, albeit without any subsidies unless state-funded subsidies were to eventually be allocated by the legislature.⁶ In early 2025, Maryland obtained federal permission to allow undocumented immigrants to begin enrolling in full-price Maryland Health Connection plans starting in November 2025.⁷

However, Maryland Health Connection is working to postpone this until the fall of 2027 (for coverage effective in 2028).⁸ This is due to the increased workload on the exchange due to the federal One Big Beautiful Bill and the federal Marketplace Integrity rule.

(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]
• File a tax return (including Form 8962) and if married, you must file a joint tax return⁹ (with very limited exceptions)¹⁰
• Not be able to be claimed by someone else as a tax dependent.¹¹

For 2026 coverage, Maryland’s open enrollment period for individual and family health plans runs from November 1, 2025 to January 15, 2026.¹²

• 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 15.¹³ 

But starting in the fall of 2026, for coverage effective in 2027 and future years, open enrollment will be shorter. Due to a federal rule that was finalized in 2025, state-run Marketplaces like Maryland’s will have to end open enrollment no later than December 31. And all plans selected during open enrollment will take effect on January 1.

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.¹⁴

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.¹⁵

People who qualify for Medicaid, the Maryland Children’s Health Program (MCHP), or MCHP Premium can enroll anytime.¹²

There are several ways to enroll in an ACA Marketplace plan in Maryland:¹²

• 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.¹⁶
• 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 76% of Maryland’s exchange enrollees received premium subsidies in 2025, saving about $404 per month on their premiums. These subsidies are called Advance Premium Tax Credits (APTC). With subsidies, Maryland residents pay about $184 monthly on average in premiums (average includes those who pay full price).¹⁷

Source: CMS.gov¹⁸

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.¹⁹

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.²⁰ Almost 65,000 young adults in Maryland qualified for these additional subsidies during the open enrollment period for 2025 coverage.²¹

The young adult subsidy program was initially slated to be available in 2022 and 2023, but legislation (HB814 and SB601) enacted in 2023 extended it through 2025. And although it initially only applied to adults up to age 34, the state has extended the eligible age range up to 37.²²

Maryland enacted legislation in 2025 to make the young adult subsidy program permanent and extend the upper age limit to 40.²³ But additional legislation enacted in Maryland in 2025 directs the state to use the same funding source to provide broader premium subsidies (not just to young people) to partially mitigate the effect of the expected sunset of federal premium subsidy enhancements at the end of 2025.²⁴ So if Congress doesn’t extend the federal subsidy enhancements, Maryland’s young adult subsidy program will be replaced with a broader subsidy program designed to offset some of the higher premiums that people will have to pay when the federal subsidy enhancements expire.²⁵

Maryland Health Connection has clarified that the state-funded subsidy program will be able to fully cover the loss of the federal subsidy enhancements for enrollees with income up to 200% of the federal poverty level, and partially cover it for enrollees with income up to 400% of the federal poverty level.³

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.²⁶ 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.”²⁷

Five insurers (including two CareFirst entities) will offer coverage through Maryland Health Connection in 2026:³

• CareFirst BlueChoice, Inc.
• CareFirst GHMSI/CFMI
• Kaiser
• Optimum Choice, Inc.
• Wellpoint Maryland

There were six participating insurers in 2025,²⁸ But Aetna is exiting the health insurance Marketplaces in all states where they currently offer coverage.

Aetna was new to Maryland’s Marketplace in 2024,²⁹ and their plans were available for 2024 and 2025. But Aetna enrollees will need to select replacement coverage for 2026, during the open enrollment period that begins November 1, 2025. According to the Maryland Insurance Administration, almost 5,000 enrollees have Aetna coverage in 2025 and will need to pick a new plan for 2026.²

The following average rate increases (calculated before subsidies are applied) have been approved for 2026, amounting to an overall average increase of 13.4%.³ 

Source: Maryland Insurance Administration³

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. But if the federal subsidy enhancements that have been in effect since 2021 are allowed to expire at the end of 2025, federal premium subsidies will be smaller and available to fewer people in 2026. This will cause net premiums to increase significantly. However, Maryland’s state-funded subsidy program will be able to fully cover the loss of the federal subsidy enhancements for enrollees with income up to 200% of the federal poverty level, and partially cover it for enrollees with income up to 400% of the federal poverty level.³

For the last few years, Maryland’s state-funded subsidy program has been available to young adults ages 18-37, helping to make coverage even more affordable for this population (this program was previously available to adults up to age 34, but has been extended to age 37).²² This program had been scheduled to sunset at the end of 2025, but Maryland enacted legislation in 2025 to make it permanent and extend the upper age limit to 40.[efn_note]”Maryland HB297” BillTrack50. Passed Apr. 2, 2025[/efn_note] And the program will pivot to being used to backfill the loss of federal subsidy enhancements in 2026 if necessary.

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.²⁸ The state is considering various changed to the reinsurance program parameters in 2025, in order to fund the additional subsidies that the state plans to provide if the federal subsidy enhancements expire at the end of 2025.²⁵

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% increase³⁰
• 2016: 20% increase³¹
• 2017: 25.2% increase³²
• 2018: 43.8% increase³³ (after accounting for loss of federal CSR funding)
• 2019: 13% decrease³⁴ (reinsurance took effect)
• 2020: 10.3% decrease³⁵
• 2021: 11.9% decrease³⁶
• 2022: 2.1% increase³⁷
• 2023: 6.6% increase³⁸
• 2024: 4.7% increase³⁹
• 2025: 6.2% increase²⁸

247,243 people enrolled in private plans through Maryland Health Connection during the open enrollment period for 2025 coverage.²¹ 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.

As noted above, these subsidy enhancements are scheduled to expire at the end of 2025, which will drive full price premiums higher than they would otherwise have been.²

Maryland Health Connection has noted that 70,000 fewer people are expected to enroll in Marketplace coverage in 2026 if the “Big Beautiful” federal budget reconciliation bill is enacted.⁴⁰

Source: 2014,⁴¹ 2015,⁴² 2016,⁴³ 2017,⁴⁴ 2018,⁴⁵ 2019,⁴⁶ 2020,⁴⁷ 2021,⁴⁸ 2022,⁴⁹ 2023,⁵⁰ 2024,⁵¹ 2025⁵²

Another factor in the enrollment growth in 2024 and 2025 was the end of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in 2023, after being paused for three years. By September 2024, more than 52,000 Maryland residents had transitioned from Medicaid to a private plan obtained via Maryland Health Connection, including more than 28,000 who were automatically enrolled⁵³ (most states did not have an automatic enrollment process for people transitioning away from Medicaid, but Maryland implemented this to mitigate loss of coverage post-pandemic).

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,⁵⁴ but the disenrollments and coverage transitions had begun in mid-2023, well before the start of open enrollment.

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.