Private Health Insurance in Maryland
Private health insurance in Maryland is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Maryland Marketplace premiums rising 14.6% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Maryland and when the Marketplace is the better call.
Who buys their own coverage in Maryland
Maryland Health Connection reported 255,612 plan selections to CMS for 2026, up about 3 percent from 247,243 in 2025, making Maryland one of only 10 states, counting the District of Columbia, where sign-ups grew after the enhanced credits ended. The share getting an advance premium tax credit fell from about 76 percent to about 67 percent, so close to one in three Maryland buyers, about 33 percent, now pays full price. Census data for 2024 show about 51.7 percent of Maryland households with incomes of $100,000 or more, a group that mostly sits above the credit line.
How Maryland regulates private plans
Maryland excludes hospital and fixed indemnity insurance from its individual health plan rules only when it pays fixed amounts regardless of the bill, stands apart from other coverage and, under Insurance § 15-1301, shows a capitalized notice in 14-point type in the application saying it is not a substitute for major medical coverage. Sharing ministries are exempt under § 1-202(a)(4) only if they meet 12 conditions, including no paid sellers and registration with the Secretary of State. That section has no exemption for agricultural organization plans. A 2018 law, § 15-1202(c), applies small-group rules to association plans covering small employers.
Protecting yourself when you buy in Maryland
Individual health policies in Maryland must carry a notice, required by Insurance § 15-201(h), letting you cancel in writing within 10 days after delivery; the insurer then refunds the pro rata premium for the unused term. The Maryland Insurance Administration's Company and Producer Search shows whether an agent or insurer holds a license. Complaints can be filed online or by calling 1-800-492-6116. On its fixed indemnity page, the Administration says it is concerned about misleading marketing by unlicensed sellers and tells consumers who get an unsolicited call to hang up and check the caller's license at that number.
The Maryland Marketplace you would be comparing against
Maryland Health Connection, the state's own exchange, sets its own open enrollment dates; check its site for 2027 deadlines. Maryland offers more state help than most states: its State Reinsurance Program, approved through 2028, helps hold down premiums, and the Maryland Premium Assistance Program adds state help on top of federal tax credits for eligible enrollees based on household income. Maryland's continuation law reaches the small employers that federal COBRA skips, so leaving a small shop usually means you can keep the group plan for up to 18 months if you elect within 45 days. Short-term plans are tightly limited to less than three months with no renewals, which makes them a narrow bridge rather than a long-term option. Because the state subsidy runs through Maryland Health Connection, buying through the exchange matters if you want the full amount of help.
Other Maryland rules to know
- Leaving a small employer: Maryland requires insured group plans, including those of employers with fewer than 20 workers, to offer up to 18 months of continuation to Maryland residents who leave a job voluntarily or are let go for reasons other than cause after three months of coverage. You have 45 days to elect it and pay the full premium plus up to a 2 percent fee.
- Short-term plans: Maryland law limits short-term plans to less than three months with no renewals, which is stricter than the federal rule, so the federal enforcement pause does not change anything in Maryland.
- Where to enroll: Maryland runs its own exchange, Maryland Health Connection. Maryland Health Connection sets its own open enrollment dates; check its site for 2027 deadlines. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 14.6% on average, small-group plans about 10.2%. See the Maryland 2027 rate page.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
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Maryland questions
Where do Maryland residents enroll in 2027 coverage?
Maryland runs its own exchange, Maryland Health Connection. Maryland Health Connection sets its own open enrollment dates; check its site for 2027 deadlines.
What continuation rights does Maryland give after leaving a small employer?
Maryland requires insured group plans, including those of employers with fewer than 20 workers, to offer up to 18 months of continuation to Maryland residents who leave a job voluntarily or are let go for reasons other than cause after three months of coverage. You have 45 days to elect it and pay the full premium plus up to a 2 percent fee.
How much are Maryland premiums rising for 2027?
Individual-market premiums are set to rise 14.6% on average, and small-group plans about 10.2%.
What is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, mgaleg.maryland.gov, mgaleg.maryland.gov, insurance.maryland.gov, insurance.maryland.gov. Facts checked October 2026. See all Maryland health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Maryland and 30 other states, NPN 21032307.