Access to affordable health coverage is a priority for every Maryland resident, and the state offers some of the strongest insurance protections and financial assistance programs in the country. Through the Affordable Care Act and additional state-funded initiatives, Maryland residents can find quality health plans with significant help paying for monthly premiums and out-of-pocket medical costs. Whether you are uninsured, losing employer coverage, or simply looking for a better deal, understanding your options through Maryland Health Connection is the first step toward getting covered.
If you are unsure which programs you may qualify for, our free eligibility screener can check your eligibility for ACA marketplace plans, Medicaid, and other assistance programs in just a few minutes.
What Is Maryland Health Connection?
Maryland Health Connection is the state's official health insurance marketplace. Unlike the majority of states that rely on the federal HealthCare.gov platform, Maryland built and operates its own state-based exchange. This independence gives the state greater control over plan selection, enrollment timelines, consumer outreach, and the ability to create state-specific subsidy programs that go beyond what the federal government offers.
The marketplace uses an active purchaser model, meaning the Maryland Health Benefit Exchange negotiates directly with insurance carriers to determine which plans can be sold on the exchange. This approach helps keep premiums competitive and ensures that every plan meets strict quality standards.
For plan year 2026, Maryland Health Connection offers qualified health plans from five insurance companies:
- CareFirst BlueChoice (available statewide)
- CareFirst GHMSI/CFMI (available in select regions)
- Kaiser Permanente (available in the Baltimore-Washington corridor)
- Optimum Choice (available in select counties)
- Wellpoint Maryland (available in select regions)
Plan availability varies by county and ZIP code. When you create an account on Maryland Health Connection, the system automatically shows you the plans available in your area along with estimated costs after financial assistance.
Essential Health Benefits: What Every Plan Covers
All plans sold through Maryland Health Connection must cover ten categories of essential health benefits as required by the ACA. No matter which metal tier or insurer you choose, your plan will include:
- Ambulatory patient services (outpatient care you receive without being admitted to a hospital)
- Emergency services (emergency room visits, including out-of-network emergencies)
- Hospitalization (inpatient care including surgery and overnight stays)
- Maternity and newborn care (prenatal visits, labor and delivery, postnatal care)
- Mental health and substance use disorder services (therapy, counseling, inpatient treatment)
- Prescription drugs (generic and brand-name medications on the plan formulary)
- Rehabilitative and habilitative services and devices (physical therapy, occupational therapy, speech therapy)
- Laboratory services (blood work, diagnostic testing, imaging)
- Preventive and wellness services and chronic disease management (annual checkups, immunizations, screenings)
- Pediatric services (including dental and vision coverage for children under 19)
Preventive care is covered at no cost to you when provided by an in-network provider. This includes annual wellness visits, blood pressure screening, cholesterol screening, depression screening, diabetes screening for at-risk adults, immunizations, and many cancer screenings such as mammograms and colonoscopies.
Understanding Metal Tiers: Bronze, Silver, Gold, and Platinum
Maryland Health Connection organizes plans into four metal tiers. Each tier represents the average percentage of medical costs the plan is expected to cover. The tiers do not reflect the quality of care you receive. Instead, they describe how costs are shared between you and the insurance company.
Bronze plans cover approximately 60% of medical costs on average. These plans have the lowest monthly premiums but the highest out-of-pocket costs when you need care. Bronze plans work well for healthy individuals who want protection against unexpected medical emergencies but do not expect frequent doctor visits or prescriptions.
Silver plans cover approximately 70% of medical costs on average. Silver plans offer a balance between monthly premiums and out-of-pocket costs. They are especially valuable for people who qualify for Cost-Sharing Reductions, which are only available with Silver plans and can dramatically lower deductibles, copays, and coinsurance.
Gold plans cover approximately 80% of medical costs on average. These plans have higher monthly premiums but lower costs when you receive care. Gold plans are a good fit for individuals and families who visit the doctor frequently, take multiple prescription medications, or anticipate medical procedures during the plan year.
Platinum plans cover approximately 90% of medical costs on average. These plans have the highest monthly premiums but the lowest out-of-pocket costs. Platinum plans may make sense for individuals with chronic conditions or those who need frequent specialist visits and ongoing treatment.
In addition to the four standard tiers, Maryland offers catastrophic plans for individuals under 30 or those who qualify for a hardship or affordability exemption. Catastrophic plans have very low premiums but very high deductibles and are designed primarily to protect against worst-case medical scenarios.
Who Qualifies for Maryland Health Connection Coverage
To enroll in a plan through Maryland Health Connection, you must meet the following basic requirements:
- You must live in Maryland
- You must be a U.S. citizen or be lawfully present in the United States
- You must not be currently incarcerated
- You must not be enrolled in Medicare
Some lawfully present immigrants with income below 100% of the federal poverty level who are ineligible for Medicaid may also qualify for marketplace coverage with financial assistance.
To receive premium tax credits or other financial help, you must also meet these additional criteria:
- You must not have access to affordable employer-sponsored coverage that meets minimum value standards
- You must not be eligible for Medicaid or the Maryland Children's Health Program (MCHP)
- You must not be eligible for premium-free Medicare Part A
- You must file a federal income tax return for the year
- If married, you must file jointly (with limited exceptions)
- You must not be claimed as a dependent on someone else's tax return
Income Limits and Financial Assistance for 2026
Maryland residents can access financial help from multiple sources: federal Advance Premium Tax Credits (APTC), the new Maryland Premium Assistance program, and Cost-Sharing Reductions (CSR). The combination of these programs can make coverage surprisingly affordable, even for middle-income households.
The 2026 marketplace eligibility is based on the 2025 Federal Poverty Level (FPL) guidelines. Here are the income thresholds for common household sizes:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 200% FPL | 250% FPL (CSR Limit) | 400% FPL |
|---|---|---|---|---|---|
| 1 | $15,650 | $21,597 | $31,300 | $39,125 | $62,600 |
| 2 | $21,150 | $29,187 | $42,300 | $52,875 | $84,600 |
| 3 | $26,650 | $36,777 | $53,300 | $66,625 | $106,600 |
| 4 | $32,150 | $44,367 | $64,300 | $80,375 | $128,600 |
| 5 | $37,650 | $51,957 | $75,300 | $94,125 | $150,600 |
| 6 | $43,150 | $59,547 | $86,300 | $107,875 | $172,600 |
For households larger than 6 people, add $5,500 per additional person to calculate 100% FPL, then multiply accordingly for the other thresholds.
Federal Advance Premium Tax Credits (APTC)
Advance Premium Tax Credits are the primary form of financial assistance for marketplace enrollees. These credits are available to individuals and families with household income between 100% and 400% of the federal poverty level.
The credit amount is calculated based on the difference between your expected contribution (a percentage of your income) and the cost of the benchmark Silver plan in your area (the second-lowest-cost Silver plan). You can apply the credit directly to your monthly premium, reducing what you pay each month, or claim it when you file your annual tax return.
Key details about APTC for 2026:
- The enhanced premium tax credits from the Inflation Reduction Act expired at the end of 2025, so some enrollees may see higher costs compared to the previous year
- Maryland's new state-funded program (described below) helps offset the loss of enhanced federal credits
- Approximately 76% of Maryland marketplace enrollees received premium subsidies in 2025, saving an average of $404 per month
- You must reconcile your credits when filing taxes; if your actual income differs from your estimate, you may owe money back or receive an additional credit
Maryland Premium Assistance (New for 2026)
Maryland launched a new state-funded subsidy program called Maryland Premium Assistance beginning with plan year 2026. This program provides additional financial help on top of federal tax credits, specifically designed to keep coverage affordable for Maryland residents after the expiration of enhanced federal subsidies.
Maryland Premium Assistance is available to residents of any age with household income up to 400% of the federal poverty level. The amount of assistance depends on your income, household size, age, and ZIP code. The program works automatically through Maryland Health Connection, meaning you do not need to apply separately. When you complete your marketplace application, the system calculates your total financial assistance including both federal and state subsidies.
Young adults between the ages of 18 and 40 receive additional help through this program, recognizing that younger residents historically had lower enrollment rates due to cost concerns.
As an example, a 30-year-old individual earning approximately $39,000 per year could see their monthly Silver plan premium reduced from around $275 to approximately $121 when combining federal tax credits and Maryland Premium Assistance.
Cost-Sharing Reductions (CSR)
Cost-Sharing Reductions provide a separate layer of financial help that reduces your out-of-pocket costs when you receive medical care. CSRs are available exclusively on Silver plans and only for individuals and families with income between 100% and 250% of the federal poverty level.
When you qualify for CSRs and enroll in a Silver plan, the insurer adjusts your plan to provide richer coverage. Depending on your income level, you may receive an Enhanced Silver 94, Enhanced Silver 87, or Enhanced Silver 73 plan:
- Enhanced Silver 94 (income up to 150% FPL): The plan covers 94% of costs on average. Deductibles may be $0. Copays for primary care visits can be as low as $5.
- Enhanced Silver 87 (income 150% to 200% FPL): The plan covers 87% of costs on average, with significantly lower deductibles and copays compared to a standard Silver plan.
- Enhanced Silver 73 (income 200% to 250% FPL): The plan covers 73% of costs on average, with moderately reduced deductibles and copays.
CSRs make Silver plans the best value for lower-income enrollees. If you qualify, choosing a Silver plan almost always makes more financial sense than selecting a Bronze or Gold plan, even if the monthly premium is slightly higher.
Not sure if you qualify for CSRs or other assistance? Try our free eligibility screener to get a personalized estimate.
Maryland Medicaid and the Maryland Children's Health Program
Maryland expanded Medicaid under the ACA, extending coverage to nearly all adults with household income up to 138% of the federal poverty level. This expansion closed the coverage gap that exists in states that did not expand Medicaid, ensuring that low-income adults without children can also access coverage.
Who Qualifies for Maryland Medicaid
You may qualify for Medicaid in Maryland if you meet income requirements based on your coverage group:
- Adults ages 19 to 64: Income up to 138% FPL (approximately $21,597 for an individual or $44,367 for a family of four)
- Pregnant individuals: Income up to 264% FPL, covering prenatal care, delivery, and postpartum care for 12 months after pregnancy
- Children under 19: Income up to 317% FPL through the Maryland Children's Health Program (MCHP)
- Parents and caretaker relatives: Income limits vary by household composition
- Seniors and individuals with disabilities: Additional eligibility pathways with different income and asset limits
What Medicaid Covers
Maryland Medicaid provides comprehensive coverage at no cost or very low cost to eligible individuals. Benefits include:
- Doctor visits (primary care and specialists)
- Hospital stays and emergency services
- Prescription medications
- Mental health and substance use treatment
- Preventive care and wellness screenings
- Laboratory and diagnostic services
- Dental care (free for all Medicaid and MCHP enrollees)
- Vision services and eyeglasses
- Transportation to medical appointments
- Home health services and long-term care for qualifying individuals
Unlike marketplace plans, Medicaid enrollment is available year-round. You do not need to wait for an open enrollment period. If you think you may qualify, you can apply at any time through Maryland Health Connection, your local Department of Social Services, or your local health department.
Open Enrollment and Special Enrollment Periods
Open Enrollment for 2026
Open enrollment for plan year 2026 coverage runs from November 1, 2025 through January 15, 2026. Key enrollment deadlines:
- Enroll by December 31, 2025 for coverage starting January 1, 2026
- Enroll between January 1 and January 15, 2026 for coverage starting February 1, 2026
Maryland extends the deadline for January 1 coverage to December 31, which is more generous than the December 15 cutoff used by most other states and the federal marketplace.
Special Enrollment Periods
Outside of open enrollment, you can enroll in or change your marketplace plan if you experience a qualifying life event. You generally have 60 days from the event to enroll. Qualifying events include:
- Loss of other health coverage (losing employer insurance, aging off a parent's plan, losing Medicaid)
- Marriage or divorce
- Birth, adoption, or placement of a child
- Permanent move to a new ZIP code or county with different plan options
- Pregnancy (Maryland uniquely recognizes pregnancy as a qualifying event, giving you 90 days to enroll)
- Change in income that affects eligibility for financial assistance
- Becoming a U.S. citizen or gaining lawful presence
- Release from incarceration
- Domestic violence or spousal abandonment
Maryland Easy Enrollment
Maryland offers a unique pathway to coverage through the Easy Enrollment Health Insurance Program. When you file your state tax return, you can check a box authorizing Maryland Health Connection to determine if you qualify for free or low-cost coverage. If you are eligible, the marketplace contacts you with enrollment information. This program creates a special enrollment period tied to tax filing season, making it simple for uninsured residents to get connected with coverage.
Step-by-Step Application Guide
Here is how to apply for health coverage through Maryland Health Connection:
Step 1: Gather Your Information
Before starting your application, collect the following for yourself and every household member who needs coverage:
- Social Security numbers (or document numbers for lawfully present immigrants)
- Dates of birth for all household members
- Current employer information and income documentation (pay stubs, W-2 forms, tax returns, or self-employment records)
- Information about any current health coverage
- Immigration documents if applicable
Step 2: Create an Account
Visit MarylandHealthConnection.gov and click "Apply Now." Create a username and password. You will need a valid email address to set up your account.
Step 3: Complete the Application
The application asks about your household composition, income, residency, citizenship or immigration status, and whether you have access to other coverage. Answer all questions as accurately as possible, since your financial assistance amount depends on the information you provide.
Step 4: Review Your Eligibility Results
After submitting your application, Maryland Health Connection determines your eligibility. You will see one of several outcomes:
- Eligible for Medicaid or MCHP: You can enroll immediately at no cost
- Eligible for marketplace plans with financial assistance: You will see your estimated premium tax credit and any CSR eligibility, along with Maryland Premium Assistance amounts
- Eligible for marketplace plans without financial assistance: You can still shop for ACA-compliant plans at full price
- Not eligible: The system will explain why and may suggest other options
Step 5: Compare and Select a Plan
If eligible for marketplace coverage, browse available plans. Compare them by monthly premium (after subsidies), deductible, copays, coinsurance, maximum out-of-pocket cost, provider network, and prescription drug formulary. Use the plan comparison tools built into the website to view plans side by side.
Step 6: Enroll and Pay
Once you select a plan, confirm your enrollment and make your first premium payment by the due date. Coverage begins on the first day of the following month (or January 1 if enrolled during open enrollment before the deadline). Set up autopay to avoid missing payments and losing coverage.
Other Ways to Apply
If you prefer not to apply online, you have several alternatives:
- By phone: Call the Consumer Support Center at 1-855-642-8572 (TTY: 1-855-642-8573)
- In person: Visit a local connector entity, health department, or Department of Social Services office
- With a navigator or broker: Free enrollment assistance is available from certified navigators and licensed insurance brokers throughout Maryland
Frequently Asked Questions
Can I enroll in Maryland Health Connection if I already have employer coverage? Yes, you can shop on the marketplace. However, you generally will not qualify for premium tax credits if your employer offers coverage that is considered affordable (your share of the premium for self-only coverage is less than 9.02% of household income in 2026) and meets minimum value standards (covers at least 60% of costs).
What happens if my income changes during the year? Report income changes to Maryland Health Connection as soon as possible. If your income increases, your subsidy may decrease and you may owe money at tax time. If your income decreases, you may qualify for more help. If your income drops below 138% FPL, you may become eligible for Medicaid.
Can I keep my doctor with a marketplace plan? It depends on the plan you choose. Each plan has its own provider network. Before enrolling, check the insurer's online provider directory to confirm that your preferred doctors, specialists, and hospitals are in-network.
Do I have to pay a penalty for not having health insurance? There is no federal individual mandate penalty as of 2019. Maryland does not impose a state-level individual mandate penalty either. However, going without insurance means you risk large medical bills if you need care.
What is the difference between Medicaid and marketplace coverage? Medicaid is a government-funded program that provides free or very low-cost coverage to people with lower incomes. Marketplace plans are private insurance plans that you pay a monthly premium for, though subsidies can significantly reduce your costs. Your income determines which program you qualify for. Maryland Health Connection automatically routes you to the right program based on your application.
Can I apply for Medicaid at any time? Yes. Unlike marketplace plans, which require open enrollment or a qualifying life event, you can apply for Medicaid and MCHP at any time throughout the year.
What if I am pregnant and uninsured? Maryland recognizes pregnancy as a qualifying life event for special enrollment. You have 90 days from your pregnancy confirmation to enroll in a marketplace plan. Additionally, if your income qualifies, you may be eligible for Medicaid, which covers all pregnancy-related care and extends coverage for 12 months after delivery.
How do I get help applying? Maryland has a network of trained navigators, certified application counselors, and licensed brokers who can help you apply at no cost. Visit MarylandHealthConnection.gov or call 1-855-642-8572 to find free help near you.
Check Your Eligibility Today
Navigating health insurance options can feel overwhelming, but you do not have to figure it out alone. Maryland offers more financial assistance than most states, and between Medicaid, the ACA marketplace, Maryland Premium Assistance, and Cost-Sharing Reductions, there is a strong chance you qualify for help paying for coverage.
Use our free eligibility screener to find out which programs you may qualify for based on your income, household size, and location. It takes just a few minutes and could save you hundreds of dollars each month on health insurance.
For official enrollment assistance, visit MarylandHealthConnection.gov or call 1-855-642-8572 (TTY: 1-855-642-8573). Enrollment counselors are available Monday through Friday to answer your questions and guide you through the application process.
