Maryland families struggle as health insurance costs surge

Family health insurance for most American workers averaged $27,000 this year, according to a survey released Wednesday by the health research group KFF, and Maryland families are feeling the strain.

Rising premiums are hitting the state’s middle class especially hard, experts say, as wage growth remains stagnant and local healthcare costs climb. National surveys show that workers are paying more out of pocket for coverage, and recent disruptions in the Baltimore-area insurance market are adding to the pressure.

“It really is the middle class who is most squeezed by surging health insurance costs,” said Anirba Basu, chairman and CEO of Sage Policy Group, a Baltimore-based consultancy. “The upper class can better withstand inflation triggered by health insurance, groceries, and electricity rates. Those with lower incomes may receive support in the form of Medicaid, SNAP, and housing vouchers. But the middle class is on its own, faced with an increasingly stagnant labor market and continually rising prices.”

Gene M. Ransom III, CEO for MedChi, the Maryland State Medical Society, said patients in the state may soon face higher medical costs, not because of rising insurance rates, but because insurers are increasingly dropping doctors from their networks.

Ransom emphasized that Maryland’s physicians are among the lowest-paid in the nation, even as hospital costs are tightly controlled under the state’s rate-setting system. Doximity, an online network for healthcare professionals, lists the Baltimore metro area as the ninth lowest in the nation for 2025, when it comes to physician compensation. A 2025 WalletHub study ranks Maryland 44th in terms of “where doctors can find the most financial success and the best quality employment.”

“Our rates have been flat or going down, yet money isn’t reaching physicians or hospitals. Consumers should be asking: Where is it going?” Ransom said.

A growing issue with insurers

MedChi points to insurers’ growing focus on profits and investments outside traditional insurance, including acquiring medical practices and other healthcare businesses.

“Everything being done by insurance companies is aimed at improving their bottom line, not patient care,” Ransom said.

Maryland’s insurance market is highly concentrated, with CareFirst BlueCross BlueShield controlling roughly 60–70%, giving it enormous leverage over providers and patients. This concentration, combined with aggressive insurer practices like down-coding claims or refusing reasonable prior authorizations, is pushing more doctors into large hospital systems, further changing the patient-doctor relationship, according to MedChi.

For doctors, the financial pressures are significant. Many leave medical school with hundreds of thousands in debt, starting their careers in their 30s after years of training.

“You lose time to earn money, and it’s hard to justify borrowing $200,000 to $300,000 and not being fairly compensated,” Ransom said.

Despite the challenges, many physicians remain motivated by a commitment to patient care rather than financial gain.

Meanwhile, federal policy changes threaten to further strain the system. Cuts to subsidies and Medicaid could increase rates and push more people into the uninsured pool, amplifying financial pressure on providers and patients alike.

“We’re putting a lot of time, energy, and resources into figuring out how to improve it — for doctors and, most importantly, for patients,” Ransom said.

Breaking down annual premiums

Annual premiums for employer-sponsored family coverage reached $25,572, a 7% increase from last year, KFF reported. Workers contributed an average of $6,296 toward the cost, while the typical deductible for single coverage in plans with general annual deductibles was $1,787, according to the report.

“Employers are shelling out the equivalent of buying an economy car for every worker every year to pay for family coverage,” KFF President and CEO Drew Altman said in a statement. “In the tight labor market in recent years, they have not been able to continue offloading costs onto workers who are already struggling with health care bills.”

About 180 million Americans under 65 receive insurance through their employers, according to America’s Health Insurance Plans, a national trade association for health insurance providers. Others rely on government programs such as Medicare and Medicaid or purchase coverage through the Affordable Care Act.

The recent breakdown in talks between Johns Hopkins Medicine and UnitedHealthcare has also put a strain on the local market. Doctors at Johns Hopkins hospitals and facilities and the national health insurer, failed to reach a contract by an Aug. 25 deadline.

Just under 60,000 patients on UnitedHealthcare plans see Hopkins providers in Maryland, Virginia, and Washington, D.C. Hopkins said all of its providers or facilities, except for Johns Hopkins All Children’s Hospital in Florida, are considered out-of-network by UnitedHealthcare after negotiations broke down.

“Circumstances are particularly dire for Maryland’s middle class as the state legislature relentlessly increases fees and because of idiosyncratic events such as the stalled negotiations between Johns Hopkins Medicine and UnitedHealthcare, a massive national insurer,” Basu said. “One of the responses has been for the middle class to abandon Maryland. Recent data indicate that that is precisely what has been happening, and the motivation to leave is intensifying under current leadership.”

In a guide it posted about the split from UnitedHealthcare, Hopkins clarified that the end of talks does not mean they will never work with the insurance provider again.

“The problem isn’t rates — it’s access,” Ransom said about the stalled negotiations.

Patients seeking care from out-of-network doctors could face steep bills, putting more pressure on families already stretched by health insurance costs, he said.

Have a news tip? Contact Todd Karpovich at [email protected] or on X as @ToddKarpovich.

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