Maryland insurance regulators approved an average 13.4% increase in individual‑market health insurance premiums for 2026, the Maryland Insurance Administration said, citing a sicker enrollee pool and rising medical and prescription drug costs. The final rates, published Sept. 19, will vary by carrier and plan, with approved increases ranging from about 9.8% to 15.2%.

The approval matters because the state moved to replace some of the enhanced federal premium tax credits that are scheduled to expire. Michelle Everly, executive director of the Maryland Health Benefit Exchange, told the committee the Exchange designed a state subsidy that replaces 100% of the enhanced federal credits for people under 200% of the federal poverty level (FPL), phases down replacement between roughly 200–250% FPL, and provides roughly 50% replacement for households between 250% and 400% FPL. Households above 400% of FPL are not eligible for the state subsidy.

Maryland Insurance Commissioner Marie Grant said rate reviewers found medical trend averaging about 6.4% for 2026 — driven by hospital (roughly 4.8%) and professional services (about 6.1%) — and a larger prescription‑drug trend (about 10.4%). Grant said those trends, combined with expected enrollment declines and changes in morbidity, produced the approved increase. “Marylanders continue to enjoy some of the most affordable rates in the country,” Grant said, noting that the state’s Section 1332 reinsurance waiver still lowers premiums compared with a no‑waiver scenario.

State subsidy and reinsurance design
The Exchange and the Maryland Health Benefit Exchange Board adjusted the reinsurance attachment point and other parameters this year to free funds for a state subsidy while preserving reinsurance support for high‑cost claims. Everly said the board modeled multiple iterations to “get the best bang for the buck,” and that the chosen design was intended to preserve solvency through 2028 while mitigating premium increases.

Practical examples provided by regulators show the subsidy’s effect. Everly gave three examples presented to the committee:
- A 40‑year‑old single person earning about $31,300 (200% FPL) would pay an estimated $53 per month in 2026 with the state subsidy in place, compared with $173 per month without it.
- A family of four (two adults ages 45 and 43) earning roughly $80,000 could expect to pay about $419 per month in 2026 versus $271 in 2025; without a state subsidy that family would pay about $568 per month.
- A family of four at about 401% of FPL (roughly $129,000) would see premiums rise to about $1,400 per month in 2026 from $916 in 2025; that household is not eligible for the state subsidy.

Enrollment and market effects
Grant and Everly said two related enrollment dynamics are increasing costs. First, the Exchange expects enrollment to fall from a 2025 high — regulators cited an anticipated decline of about 16% — and that those who leave the individual market are likely to be healthier, leaving a less healthy (and more expensive) remaining pool. Second, Everly and Grant both pointed to rising prescription‑drug costs as a prominent driver of claims growth.

The carriers’ filings and regulators’ review also reflected other market changes: Aetna will exit the individual market nationwide in 2026; in Maryland that affects just under 5,000 members, the administration said.

Funding risks and projected coverage loss
Everly told the committee the combined choices (reinsurance, young‑adult subsidy and individual subsidy) were designed to limit coverage loss. Exchange modeling showed that without a state subsidy about 110,000 enrollees (roughly one‑third of the individual market) could become unable to afford coverage; the subsidy reduced that projected loss by about two‑thirds. With the chosen subsidy, regulators estimated roughly 30,000 people could still lose coverage because of affordability by 2026.

Separately, Everly said roughly 20,000 lawfully present immigrants could lose eligibility for premium tax credits because of federal policy changes; she warned that loss of federal pass‑through funding tied to those credits could reduce the state’s reinsurance fund by a projected $430,000,000 annually.

Smaller plan markets and dental
Regulators also approved small‑group average rate increases of about 4.9% (range 2.9%–11.8%) and noted continued small‑group enrollment loss. Individual ACA dental plans saw an average decrease of about 1.4%, with more than half of dental policyholders receiving rate decreases.

What’s next
Open enrollment is scheduled to begin Nov. 1. Regulators said they provided final rates to the Exchange and carriers on Sept. 19 to allow operational changes ahead of open enrollment. The Exchange and the Maryland Insurance Administration told the committee they will monitor market behavior and could examine carrier refilings if federal action extends enhanced tax credits after the rate deadline.

Ending
Regulators emphasized that the state subsidy and the reinsurance fund will blunt but not eliminate higher costs for many households. They urged residents to shop plans on Maryland Health Connection and to contact the Exchange or the Maryland Insurance Administration with questions about continuity of care or network concerns.