How Much Is Health Insurance in Maryland?

Health insurance costs can represent a significant portion of a household’s budget, and understanding the factors that influence these expenses is important for individuals and families. The price of health coverage is not uniform across the United States, and within states like Maryland, costs can vary considerably based on a range of personal and plan-specific details. This exploration aims to demystify health insurance costs in Maryland, providing clarity on average premiums, the elements that determine individual pricing, how to access coverage, and available financial assistance.

Understanding Average Premiums in Maryland

The cost of health insurance premiums in Maryland can vary, but generally, the state’s average marketplace benchmark plans are often more affordable than the national average. For instance, a benchmark plan in Maryland might average around $346 per month, which is lower than the broader national average. Individuals seeking the lowest initial monthly payments might find bronze-tier plans averaging about $256, while silver plans could average around $342, and gold plans approximately $336 monthly. These figures represent averages for the lowest-cost plans within each metal tier.

Actual premium amounts fluctuate based on age, with costs typically increasing as individuals get older. For example, a 21-year-old in Maryland might pay an average of $246 for a bronze plan, while a 40-year-old could see that rise to $314, and a 60-year-old might face premiums around $666 for the same tier. Silver and gold plans follow a similar pattern, consistently costing more than bronze plans across all age groups, often around 32% more.

Key Factors Affecting Your Premium

Several specific variables influence the precise amount an individual pays for health insurance premiums in Maryland. Age is a primary determinant, as premiums generally increase with advancing age, reflecting the higher anticipated healthcare utilization and risk. While a 21-year-old’s premium may rise modestly each year in their twenties and thirties, the increase tends to accelerate significantly for those in their forties and fifties. Location within the state also plays a role, with some counties experiencing slightly higher average premiums due to factors like local competition and cost of living. For example, average bronze premiums for a 30-year-old can range from approximately $276 in areas like Baltimore to about $283 in counties such as Montgomery or Prince George’s.

Tobacco use is another factor that can impact premiums, as Maryland allows insurers to charge a surcharge of up to 50% more for tobacco users. The type of health plan selected, often categorized by “metal tiers” (Bronze, Silver, Gold, Platinum), also directly affects the premium and the balance between monthly costs and out-of-pocket expenses. Bronze plans typically feature lower monthly premiums but higher deductibles, copayments, and coinsurance. Conversely, gold and platinum plans have higher monthly premiums but offer lower out-of-pocket costs when medical services are accessed. Silver plans represent a middle ground, balancing premiums with moderate out-of-pocket expenses, and are the only tier eligible for cost-sharing reductions.

A higher deductible, which is the amount paid out-of-pocket before insurance coverage begins, generally correlates with a lower monthly premium. Copays are fixed amounts paid for specific services, while coinsurance is a percentage of the cost paid after the deductible is met. The out-of-pocket maximum is the most an individual will pay for covered services in a plan year. Additionally, the type of provider network—such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), or Point of Service (POS) plans—can influence premiums and access to care. HMOs often have lower premiums but require referrals for specialists and limit coverage to in-network providers, while PPOs typically offer more flexibility, including out-of-network options, but usually come with higher premiums. EPOs are similar to HMOs with exclusive networks but may not require referrals, and POS plans combine aspects of both HMOs and PPOs.

Navigating Health Insurance Marketplaces

To find and compare health insurance plans in Maryland, individuals can utilize the state’s official marketplace, Maryland Health Connection. This platform presents a range of plans from different insurance companies, including Aetna, CareFirst, Kaiser Permanente, UnitedHealthcare, and Wellpoint Maryland.

Enrollment in plans through Maryland Health Connection primarily occurs during the annual Open Enrollment Period. For 2025 coverage, this period typically runs from November 1, 2024, through January 15, 2025. Plans selected by December 31 generally begin coverage on January 1 of the following year, while those chosen in the first two weeks of January start coverage on February 1.

Outside of this standard period, individuals may qualify for a Special Enrollment Period if they experience certain life events. These qualifying events include changes in family status like getting married or divorced, having a child, or losing other health coverage. Moving to Maryland or within the state, certain income changes, and turning 26 years old are also common triggers for a Special Enrollment Period, typically allowing a 60-day window to enroll. Maryland also offers unique Special Enrollment opportunities, such as for individuals with Deferred Action for Childhood Arrivals (DACA) status or by checking a box on their state tax form during tax season.

While Maryland Health Connection is the primary avenue for many, particularly those seeking financial assistance, plans can also be purchased directly from insurance companies or through licensed brokers outside the marketplace. However, individuals who purchase plans directly from an insurer or broker will not be eligible for Advance Premium Tax Credits or Cost-Sharing Reductions.

Financial Assistance Programs

Maryland offers various financial assistance programs to make health insurance more affordable. The primary forms of assistance available through Maryland Health Connection are Advance Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR). Advance Premium Tax Credits work to lower monthly health insurance premiums. Eligibility for these tax credits is based on household income relative to the Federal Poverty Level (FPL). For instance, in the past year, many Marylanders received an average of $388 per month in premium savings through these tax credits.

Cost-Sharing Reductions are another form of assistance that reduces the out-of-pocket costs associated with healthcare, such as deductibles, copayments, and coinsurance. These reductions are only available to eligible individuals who enroll in silver-tier health plans through Maryland Health Connection.

Beyond premium and cost-sharing assistance, Maryland also provides health coverage programs for low-income residents: Medicaid and the Maryland Children’s Health Program (MCHP). Medicaid, also known as Medical Assistance, offers comprehensive health benefits for very low-income adults, children, pregnant women, and individuals who are aged, blind, or disabled. Eligibility for Medicaid is determined by specific income limits, often tied to a percentage of the Federal Poverty Level, such as 138% for adults aged 19 to 64. The Maryland Children’s Health Program (MCHP) provides free or low-cost coverage for children under 19 and pregnant women whose family incomes are above the Medicaid threshold but still meet specific guidelines, such as up to 322% of the FPL for children in MCHP Premium. Individuals can apply for Medicaid or MCHP at any time of the year through Maryland Health Connection, as enrollment is not limited to the Open Enrollment Period.