Plans sold on the Maryland Health Connection carry an average 14.6% rate increase for the 2027 plan year, following a 13.4% hike the year before. State regulators approved the increase in response to the expiration of enhanced federal tax credits that had lowered monthly costs for many enrollees.

The enrollment window opened Nov. 1. Residents who select a plan by Dec. 31 will see coverage begin Jan. 1; those who wait until the Jan. 15 deadline will have coverage start in February.

"We know getting or renewing health insurance can be confusing," said Johanna Fabian-Marks, executive director of the Maryland Health Benefit Exchange, which runs the marketplace. "We've got folks standing by, trained experts who offer free help."

The exchange offers telephone, online and in-person assistance, including free access to insurance brokers, pop-up enrollment events across the state and virtual enrollment webinars, Fabian-Marks said.

The expiration of the enhanced federal credits in December 2025, after Congress declined to renew them, is the main driver of this year's increases. In response, state lawmakers in 2025 created Maryland Premium Assistance, a stopgap program funded to offset some of the lost federal help for both the 2026 and 2027 plan years.

The state aid is scaled to household income. Residents earning up to 400% of the federal poverty level may qualify for assistance that replaces some or all of the savings the federal credits would have provided. Households above that threshold receive no state subsidy and face the full brunt of the approved rate increases, leaving some to pay more and others to drop coverage altogether.

"We know rates have gone up for a lot of people, and it's unfortunate … and it's really sad," said Vincent DeMarco, president of the Maryland Healthcare for All coalition.

Even with the state subsidy in place, affordability remained a struggle during the 2026 plan year. Enrollment initially hit a record 255,600 people despite the 13.4% increase, but many later downgraded to less comprehensive plans with higher deductibles to keep monthly costs manageable. Thousands eventually dropped coverage entirely.

Fabian-Marks said enrollment in August ran 12% below the same month a year earlier, with roughly 211,890 Marylanders now covered through the exchange. She attributed much of the decline to new federal restrictions barring certain legally present non-citizens from receiving federal assistance for low-income households.

The state's premium assistance program was designed as a temporary measure, and Maryland's tight fiscal outlook means the subsidy will end after next year unless lawmakers identify new funding. DeMarco is pressing state leaders to find new revenue sources to sustain it.

He also hopes the incoming Democrat-controlled Congress will restore the federal tax credits next year, following midterm elections that gave Democrats control of the U.S. House and Senate.

"When you mess with people's healthcare, you lose," DeMarco said. "Many people saw their premiums skyrocket – people thrown off healthcare. They saw a lot of problems caused by H.R.1 and the failure to continue those tax credits … Hopefully that will convince the president and the Republicans in the Senate, who could block things, not to do so."

Fabian-Marks said the exchange would move quickly to implement restored credits if Congress acts. "They really made coverage more affordable and put it in reach for a lot of Marylanders," she said. "For multiple reasons, from a financial standpoint, for our enrollees and for the state, we would certainly welcome reinstatement of those enhanced tax credits."

Despite the increases, she noted that coverage in Maryland remains comparatively affordable relative to other states, crediting state investments in the marketplace.

"I know healthcare doesn't feel affordable, and it is still a financial challenge for a lot of people," she said. "We are fortunate in Maryland to have the investments the state has made … There are changes coming next year during open enrollment, but this open enrollment is operating as people are used to and it should look familiar."