Just 5 days ago I posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026. Since Maryland Health Connection is one of the few states which publishes effectuated enrollment data on a monthly basis, I was able to look at hard enrollment data (along with demographic breakouts) through March.
As I noted last week, Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
I also noted that as of March, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time, with effectuated enrollment being 12.6% higher than it was a year earlier in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025.
Maryland Health Connection is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly basis, so let's take a look...
Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
Unlike the other five states I've written updates about so far, however, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time...at least as of March, anyway. Effectuated enrollment was 12.6% higher in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025:
About a month ago, I once again reiterated that the official year over year ACA Open Enrollment Period plan selection drop from OEP 2025 to OEP 2026, which currently stands at around 1.26 million people (23.06M in 2026 vs. 24.32M in 2025) was incredibly misleading for a number of reasons:
Not only are there always some people who never have their enrollment effectuated in the first place due to either the policyholder actively cancelling their policy before it even begins or having it terminated by the carrier due to them not paying their first monthly premium, but that effectuated enrollment can vary widely from month to month due to the "churn" of people either starting or ending exchange coverage.
The Maryland Health Benefit Exchange has their own Open Enrollment dashboard which, while not providing nearly as much data as New Mexico's, at least breaks out the top-line data. With the 2026 Open Enrollment Period (OEP) now over in the Old Line State, here's what their final numbers look like (barring any last-minute clerical corrections):
Total Renewals: 236,338
New Enrollees: 47,815
Total Enrollments: 255,612
Disenrollments (already subtracted from renewals)
67.4% are subsidized; 32.6% are unsubsidized
They also break out total enrollment by county, which isn't terribly relevant to me.
Final 2025 OEP enrollment in Maryland was 247,243, so this represents a 3.4% QHP selection increase vs. last year, in spite of the enhanced federal tax credits expiring...
IMPORTANT:Premium Alignment is NOT a substitute for making the enhanced ACA tax credits permanent. It does little to help the lowest-income folks who are still better off with Silver plans thanks to robust CSR assistance, and the benefits of it will be mediocre for those over 400% FPL if the enhanced tax credits expire.
Even for those it benefits the most (primarily those who earn between 200 - 400% FPL), it's a complement to the upgraded subsidies, not a replacement for them.
HOWEVER, it's still hugely helpful to those who know how to take advantage of it, and particularly in the states newly implementing it, it should relieve a huge portion of the pain being caused by the enhanced APTC expiring next month.
Every year, even when the ACA is running smoothly, there are always changes in market participation, as different insurance carriers enter or exit the individual market in certain states or either expand or shrink what parts of the state they offer healthcare policies in.
2026 is no exception, and given the massive turmoil the ACA exchanges are undergoing right now (due primarily to the expiring federal tax credits as well as regulatory changes made by the Trump Regime's so-called "Integrity & Affordability Rule"), there's either 13 or 32 insurance carriers throwing in the towel in one or more states, depending on how you count a carrier operating in multiple states or under multiple subsidiary brandings.
It's important to keep in mind that the following list probably isn't comprehensive--it includes the carriers which I've confirmed are pulling out statewide (with one exception: Meridian Health Plan of Michigan is only pulling out of parts of the state). There's likely one or two that I've missed, especially given that several of these have only made their final decisions within the past week or so.
As anyone not under a rock for the past few months knows by now, the improved federal Affordable Care Act tax credits which were put into place by President Biden and Congressional Democrats starting in 2021 are currently scheduled to expire at the end of December, just 2 1/2 months from now.
On top of this, the Trump Regime has also made administrative regulatory changes to how the ACA is structured resulting in the remaining tax credit formula becoming even less generous yet, while also eliminating eligibility for either financial assistance or even ACA enrollment whatsoever to many other Americans.
With the 2026 ACA Open Enrollment Period officially starting on November 1st, and with millions of ACA enrollees being bombarded with scary letters from their insurance carriers and headlines warning of massive premium hikes, residents of six states* (as of this writing) can already enter their own household information to find out how much their net health insurance premiums are going to increase starting January 1st, 2026:
Health Carriers Propose Affordable Care Act Premium Rates for 2026
Anticipated loss of federal enhanced premium tax credits leads to highest individual market rate increases proposed since the start of Maryland’s reinsurance program
BALTIMORE – The Maryland Insurance Administration has received the 2026 proposed premium rates for Affordable Care Act products offered by health and dental carriers in the individual, non-Medigap and small group markets, which impact approximately 502,000 Marylanders.
Maryland Insurance Administration Approves 2026 Affordable Care Act Premium Rates
Despite increases, Maryland remains a national leader in affordable rates; new state subsidy to offset loss of enhanced federal tax credits
BALTIMORE – Maryland Insurance Commissioner Marie Grant today announced the premium rates approved by the Maryland Insurance Administration for individual and small group health insurance plans offered in the state for coverage beginning January 1, 2026.
