Maryland residents looking for affordable health coverage in 2026 have several options through the Affordable Care Act. Whether you qualify for free Medicaid coverage, subsidized private insurance, or the state's own Maryland Premium Assistance program depends on your household income, family size, and a few other factors. This guide breaks down exactly who qualifies, what the income limits are, and how to sign up through Maryland Health Connection, the state's official health insurance marketplace.
Not sure where you stand? Check your eligibility for all available benefits with our free screening tool, or visit our Maryland Benefits Overview for a full look at programs available in the state.
How ACA Eligibility Works in Maryland
Maryland runs its own state-based health insurance marketplace called Maryland Health Connection (marylandhealthconnection.gov). Unlike states that use the federal HealthCare.gov platform, Maryland manages enrollment, plan options, and financial assistance directly.
Here is how it works at a high level:
- Income below 138% of the Federal Poverty Level (FPL): You likely qualify for Medicaid (Maryland Medical Assistance), which provides free health coverage.
- Income between 138% and 400% FPL: You may qualify for premium tax credits (also called Advance Premium Tax Credits or APTC) that reduce your monthly insurance bill on a private marketplace plan.
- Income above 400% FPL: Under current 2026 rules, you generally do not qualify for federal premium subsidies. However, you can still purchase unsubsidized coverage through Maryland Health Connection or directly from an insurer.
Maryland also expanded Medicaid in 2014, so there is no "coverage gap" in the state. Adults without children can qualify for Medicaid if their income falls below the threshold.
2026 Federal Poverty Level Guidelines
The FPL is updated every year and serves as the baseline for all ACA eligibility calculations. Here are the 2026 figures published by the U.S. Department of Health and Human Services:
| Household Size | 2026 FPL (Annual) |
|---|---|
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
| 5 | $38,680 |
| 6 | $44,360 |
| 7 | $50,040 |
| 8 | $55,720 |
| Each additional person | +$5,680 |
These numbers are the foundation. Medicaid, premium tax credits, and cost-sharing reductions are all calculated as percentages of the FPL for your household size.
Maryland Medicaid Income Limits for 2026
If your income falls below the Medicaid threshold, you qualify for free health coverage and do not need to purchase a marketplace plan. Maryland uses the following monthly income limits, effective February 1, 2026, as published by Maryland Health Connection:
| Household Size | Adults (138% FPL) | Children (322% FPL) | Pregnant Individuals (322% FPL) |
|---|---|---|---|
| 1 | $1,835/mo | $4,283/mo | N/A |
| 2 | $2,490/mo | $5,809/mo | $4,763/mo |
| 3 | $3,142/mo | $7,332/mo | $6,011/mo |
| 4 | $3,795/mo | $8,855/mo | $7,260/mo |
| 5 | $4,449/mo | $10,381/mo | $8,511/mo |
| 6 | $5,102/mo | $11,904/mo | $9,760/mo |
Key details about Maryland Medicaid:
- Children qualify at much higher income levels through the Maryland Children's Health Program (MCHP), covering kids up to age 19 at up to 322% FPL.
- Pregnant individuals also qualify at the higher 322% FPL threshold. Coverage runs from the start of pregnancy through four months postpartum.
- Non-citizen pregnant individuals may qualify for pregnancy-related Medicaid coverage regardless of immigration status.
- Year-round enrollment: Unlike marketplace plans, you can apply for Medicaid at any time. There is no open enrollment window.
ACA Marketplace Income Limits for Premium Tax Credits
If your income is too high for Medicaid but falls within the subsidy range, you can get financial help paying for a private health plan through Maryland Health Connection. For 2026, the standard premium tax credit eligibility window is 100% to 400% FPL.
Here is what that looks like in dollar amounts for 2026:
| Household Size | Minimum Income (100% FPL) | Maximum Income (400% FPL) |
|---|---|---|
| 1 | $15,960/yr | $63,840/yr |
| 2 | $21,640/yr | $86,560/yr |
| 3 | $27,320/yr | $109,280/yr |
| 4 | $33,000/yr | $132,000/yr |
| 5 | $38,680/yr | $154,720/yr |
| 6 | $44,360/yr | $177,440/yr |
Important note about 2026 subsidies: The enhanced premium tax credits from the American Rescue Plan and Inflation Reduction Act expired on December 31, 2025. This means:
- The income cap for subsidies reverted to 400% FPL (previously there was no upper income cap).
- Premium contributions as a percentage of income increased across the board.
- Households above 400% FPL no longer receive any federal premium assistance.
If your income falls between 138% and 400% FPL, the amount of your premium tax credit is calculated on a sliding scale. Lower-income households pay a smaller percentage of their income toward premiums, while those closer to the 400% cap pay more.
Maryland Premium Assistance: Extra State-Level Subsidies
One of the biggest advantages of living in Maryland is the Maryland Premium Assistance program, a state-funded subsidy that goes beyond federal tax credits. For 2026, this program provides additional help paying monthly premiums for Maryland residents with incomes up to 400% FPL.
Key facts about Maryland Premium Assistance in 2026:
- Available to Maryland residents of any age with incomes up to 400% FPL
- Provides financial help on top of the federal Advance Premium Tax Credit
- Applies to Bronze, Silver, Gold, and Platinum plans purchased through Maryland Health Connection
- Young adults ages 18 to 37 receive extra help beyond the standard state assistance
- Enrollment deadline: You must enroll before April 1, 2026 to receive Maryland Premium Assistance for the 2026 plan year
Here is an example of potential savings from the Maryland Health Connection website:
| Household | Income | Monthly Silver Plan Without State Help | Monthly Silver Plan With State Help | Monthly Savings |
|---|---|---|---|---|
| Individual, age 30 | $39,125 | $275.18 | $121.29 | $153.89 |
| Couple, ages 61 and 60 | $52,875 | $371.89 | $274.07 | $97.82 |
| Family of 4 (ages 51, 50, 15, 13) | $104,487 | $867.24 | $723.57 | $143.67 |
This state subsidy is a significant benefit that many Maryland residents do not know about. It applies automatically when you enroll through Maryland Health Connection.
Cost-Sharing Reductions for Lower-Income Marylanders
If your income falls between 100% and 250% FPL and you choose a Silver plan, you may also qualify for cost-sharing reductions (CSRs). These are separate from premium tax credits and reduce your out-of-pocket costs when you actually use healthcare services.
Cost-sharing reductions can lower your:
- Deductible, so your insurance starts covering costs sooner
- Copayments, reducing what you pay per doctor visit (for example, $15 instead of $30)
- Out-of-pocket maximum, capping your total annual spending at a lower amount
You can only access cost-sharing reductions by enrolling in a Silver plan through Maryland Health Connection. They are not available on Bronze, Gold, or Platinum plans.
Who Is Eligible for ACA Coverage in Maryland?
Beyond income requirements, you must meet these basic criteria to enroll in a marketplace plan through Maryland Health Connection:
- Live in Maryland
- Be a U.S. citizen or lawfully present non-citizen
- Not currently incarcerated
- Not eligible for Medicare (in most cases)
You do not need to have a Social Security number for all household members. Mixed-immigration-status families can still apply, and information provided is protected and not shared with immigration authorities.
If you have access to employer-sponsored insurance, you may still qualify for marketplace subsidies if your employer's plan is considered "unaffordable." For 2026, employer coverage is considered unaffordable if the lowest-cost plan available to you costs more than 9.66% of your household income.
Open Enrollment and Special Enrollment Periods
Open Enrollment for 2026 plans ran from November 1, 2025 through January 15, 2026. If you missed open enrollment, you cannot enroll in a marketplace plan unless you qualify for a Special Enrollment Period (SEP).
Qualifying life events that trigger a Special Enrollment Period include:
- Losing existing health coverage (job loss, aging off a parent's plan, Medicaid loss)
- Moving to a new area
- Getting married or divorced
- Having or adopting a child
- Changes in household income that affect eligibility
- Becoming a U.S. citizen
A Special Enrollment Period typically lasts 60 days from the qualifying event. You need to report the change and enroll within that window.
Medicaid and MCHP are different. You can apply for Medicaid or the Maryland Children's Health Program at any time throughout the year. There is no enrollment deadline for these programs.
How to Apply for ACA Coverage in Maryland: Step by Step
Step 1: Gather Your Information
Before starting your application, collect the following for every household member:
- Social Security numbers (if available)
- Dates of birth
- Estimated annual income for 2026 (including wages, self-employment income, Social Security, unemployment, and other sources)
- Information about any employer-sponsored insurance available to you
- Immigration documents (if applicable)
Step 2: Create an Account on Maryland Health Connection
Visit marylandhealthconnection.gov and create an account. You will need an email address and a password. The system will walk you through the application.
Step 3: Complete the Application
Answer questions about your household, income, and current coverage. The system will determine whether you qualify for:
- Medicaid or MCHP (free coverage)
- Premium tax credits (federal subsidies)
- Maryland Premium Assistance (state subsidies)
- Cost-sharing reductions
Step 4: Compare and Select a Plan
If you qualify for a marketplace plan, you will see available options organized by metal level (Bronze, Silver, Gold, Platinum). Your estimated monthly cost after subsidies will be displayed for each plan. Pay attention to:
- Monthly premium after tax credits
- Deductible amount
- Copays for doctor visits and prescriptions
- Whether your preferred doctors are in network
Step 5: Enroll and Pay Your First Premium
Select your plan and confirm enrollment. Your coverage does not start until you pay your first monthly premium. Set up automatic payments to avoid accidental coverage gaps.
Step 6: Submit Verification Documents
Maryland Health Connection may ask you to submit documents verifying your income, citizenship, or other information. You will receive a notice if documents are needed. Submit them promptly to avoid delays in your coverage.
Alternative Ways to Apply
Not comfortable applying online? You have other options:
- By phone: Call Maryland Health Connection at 1-855-642-8572
- In person: Visit a Local Department of Social Services or find a free enrollment navigator at marylandhealthconnection.gov/find-help
- With a broker: Licensed insurance brokers can help you enroll at no cost to you
Frequently Asked Questions
Can I get ACA coverage if I already have Medicaid?
No. If you qualify for Medicaid, you are not eligible for premium tax credits on a marketplace plan. Medicaid provides more comprehensive coverage at no cost, so it is typically the better option. When you apply through Maryland Health Connection, the system automatically determines which program you qualify for.
What if my income changes during the year?
Report income changes to Maryland Health Connection as soon as possible. If your income goes up, your subsidies may decrease. If your income goes down, you may qualify for more help or even Medicaid. Failing to report changes can result in owing money back when you file taxes.
Do I have to file taxes to get premium tax credits?
Yes. You must file a federal income tax return to claim or reconcile the Advance Premium Tax Credit, even if your income is low enough that you would not normally need to file. If you received more tax credit than you were entitled to based on your actual income, you will need to repay the difference.
Is the Maryland Premium Assistance program the same as the federal tax credit?
No. The Maryland Premium Assistance is a separate state-funded program that provides additional premium reductions on top of the federal APTC. You may qualify for both. The state assistance is applied automatically when you enroll through Maryland Health Connection.
Can undocumented immigrants get ACA coverage in Maryland?
Undocumented immigrants are not eligible for marketplace plans or Medicaid in most cases. However, pregnant individuals regardless of immigration status may qualify for pregnancy-related Medicaid coverage in Maryland. Emergency Medicaid is also available regardless of status.
What happens if I miss the April 1 deadline for Maryland Premium Assistance?
If you enroll in a marketplace plan after April 1, 2026, you will not receive Maryland Premium Assistance for that plan year. You may still qualify for federal premium tax credits, but the additional state subsidy will not apply. This deadline is separate from the marketplace open enrollment deadline.
How do I know if my employer's insurance is "affordable"?
For 2026, employer-sponsored coverage is considered affordable if the employee-only premium for the lowest-cost plan is no more than 9.66% of your household income. If it costs more than that percentage, you may qualify for marketplace subsidies instead.
Next Steps
Figuring out your eligibility can feel complicated, but you do not have to do it alone. Start with our free benefits screening tool to see what programs you may qualify for based on your income and household size. The screener checks ACA subsidies along with Medicaid, SNAP, and other assistance programs all at once.
For Maryland-specific resources and program details, visit our Maryland Benefits Overview.
If you need help enrolling, contact Maryland Health Connection at 1-855-642-8572 or visit marylandhealthconnection.gov to find a free local navigator who can walk you through the process in person.
