Maryland's ACA Enrollment Decline and State Subsidy Impact

Maryland has witnessed a rise in individuals dropping their Affordable Care Act (ACA) health plans following the termination of federal subsidies. In the first quarter, the state noted an 8% decline in enrollment, impacting about 18,000 residents who found it challenging to keep up with premium payments. This data serves as the first glimpse into the affordability of public health plans post the termination of federal tax credits last year. Importantly, Maryland offers a 90-day grace period for those with unpaid premiums.

Johanna Fabian Marks, deputy director of the Maryland Health Benefit Exchange, explained the disenrollment timeline: "If you missed a payment in January, your grace period is January, February, March, and if you haven't caught up by the end of March, then we'll get a termination from your insurer in the first couple weeks of April." Marks highlighted that the lack of tax credits led many to opt for less comprehensive plans, with some consumers shifting from gold to bronze plans, raising deductibles from around $1,000 to $10,000 per individual.

Despite the challenges, Maryland sustained stable enrollment during the 2025 open season for the 2026 enrollment year, contrasting with the national trend of a 5% decline in ACA sign-ups reported by Healthinsurance.org. This stability is attributed to additional state subsidies aimed at fostering continuous enrollment, helping Maryland avoid the widespread downgrading of coverage plans observed in other states. Notably, out of the 250,000 enrollees, approximately 177,000 qualified for state subsidies, designed for those up to 400% of the federal poverty level and extended to individuals aged 18-37.

Health policy analyst Louise Norris stressed, "The extra subsidies that Maryland kicked in is the reason why Maryland didn't see the declining enrollment that we saw nationwide and also didn't see as much downgrading of coverage, as we saw nationwide." However, Marks expressed concern over a potential enrollment decline as the repercussions of losing federal tax credit premiums become increasingly evident.