Thousands of Marylanders downgraded health plans on ACA marketplace amid rising premiums

Approximately 8,000 Marylanders downgraded their ACA plans from gold to bronze in order to save on monthly costs, taking on higher-risk plans as a tradeoff. (Photo by Danielle J. Brown/Maryland Matters)

As fewer Marylanders qualify for federal tax breaks that used to keep health care costs down, state officials report that higher monthly premiums have led thousands to opt for lower-coverage healthcare plans than in previous years.

Approximately 8,000 Marylanders who previously selected gold plan coverage opted to take on a bronze plan this year, according to healthcare officials. That's higher than the previous estimate initially reported to lawmakers in January of roughly 5,000 people downgrading their plans.

That said, overall enrollment since last year has not greatly changed, showing that people are willing to take on higher-risk plans if it means they can stay covered, said Johanna Fabian-Marks, deputy executive director for Maryland Health Benefit Exchange.

"What we've really seen out of this open enrollment is that we see our enrollees want to keep their coverage, and they're making tradeoffs to do that," she said. "We see that in the fact that people are moving into these lower cost plans, rather than just throwing their hands up and dropping coverage all together."

The expiration of the federal Enhanced Premium Tax Credit last year led to higher health care costs across the board, and some Marylanders just couldn't afford their previous plans, opting for cheaper, less-comprehensive health care coverage for the 2026 plan year.

Higher costs are only part of the changes coming to health insurance

Fabian-Marks says that the decrease in gold plans in favor of bronze is because some 190,000 Marylanders no longer receive the popular federal tax credits that previously brought down the costs of monthly premiums for those who purchased individual plans on the state's Affordable Care Act marketplace.

The end of the federal tax credit in December had ripple effects on the whole healthcare economy. Last year, state insurance officials approved an average 13.4% premium rate increase for 2026 health care plans, to compensate for the expected drop in enrollment.

That said, enrollment overall has not seen a large decrease, due in part to state officials providing a subsidy to help offset the impacts of the federal tax credit's absence – though the future of that subsidy is hanging in the balance.

According to March data from the exchange, bronze plan enrollment is up this year by 13%, while enrollment for gold plans is down 9%.

The March report says that approximately 63,400 Marylanders are enrolled in a bronze plan in 2026, up from 55,900 this time last year. Meanwhile, enrollment in gold plans dropped, with 100,800 people selecting it this year compared to the 110,800 plans last year.

The number of silver plans stayed relatively the same, with 70,500 people selecting the middle-rung option compared to last year's 68,300 plans.

While all plans on the exchange offer coverage for preventive care, such as vaccinations and regular check-ups, bronze plan deductibles can be as high as $10,000, meaning that a bronze-plan enrollee will have to pay that much before health insurance kicks in.

Compare that to the $1,000 deductible offered on most gold plans, which makes it easier for families to be more proactive in their healthcare needs rather than delaying until their medical needs are dire.

A graph comparing enrollment totals between March 2025 to March 2026. The data shows more people selecting bronze-level plans compared to gold. (Chart by the Maryland Health Benefit Exchange)

"When they're choosing to move into a plan that covers less, they might defer care, because they know they're going to have to pay more out of pocket," said Fabian-Marks.

There were concerns that rising premium costs would lead to a greater number of what the exchange refers to as "non-effectuations," meaning Marylanders who signed up for coverage during open enrollment, but did not pay their premiums and were disenrolled.

Fabian-Marks said that only about 6,000 people who renewed coverage this year did not pay the January premium, which is not a significant increase from previous years.

Maryland lawmakers created a state subsidy to offset those effects for some lower-income Marylanders. The Maryland Premium Assistance subsidy replaces the extended tax credit for those earning up to twice the federal poverty level. For those earning two to four times the federal poverty level, the state subsidy can replace 50% of the value of the federal tax credits. Those with income levels above 400% of poverty level do not qualify for the state subsidy.

Older Marylanders struggle with costs

The downside is that a significant portion of those who benefited from the enhanced tax credits but do not qualify for the state subsidy are people aged 55 and older who do not qualify for Medicare yet, which kicks in at 65 years old.

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"They could have seen premiums increase from say, $800 with financial assistance to pay a full cost of as much as $2,000, so those are individuals who are really looking to reduce their premium costs," Fabian-Marks said. "One way you can do that is by moving to a lower-tier metal level."

Nancy Carr, communications director for AARP Maryland, says it's a "concerning" trend.

"A decision to save money by going with a bronze plan with a $10,000 deductible per individual, it's a calculated risk-benefit analysis," Carr said. "They need more money to cover other rising household costs, so they're calculating that the regular … preventative care will be sufficient to meet their needs."

She said that older Marylanders have had to choose between paying hundreds more in premiums, selecting lower-coverage plans or foregoing healthcare coverage entirely.

"It's going to be a significant challenge, and there are going to be people who are going to feel compelled to drop their coverage," Carr said. "We're also concerned that these vulnerable families could wind up incurring significant medical debt in the case of a major illness or injury where they have to spend up to $10,000 out of pocket. That age group, it's going to be harder to recover from substantial debt."

Fabian-Marks said that the exchange will continue to monitor trends, but there are concerns that the new state subsidy to offset the impacts of federal tax credits expiring will not be as generous next year due to the state's tight financial situation.

Advocates push lawmakers to end tax break for drug commercials, advertising

A bill that would have helped fund state subsidies through a prohibition on tax breaks on pharmaceutical advertisements did not get enough momentum this year and died in committee.

"It does look like we will not be able to offer as generous a state subsidy as we have this year, so we're trying to figure out what we can afford and how to use that money to have the most impact," Fabian-Marks said, noting that more information will be available in the summer.

Meanwhile, Carr urges older Marylanders to take a hard look at their medical needs to ensure they are getting the best coverage possible for their situation.

"We're encouraging people to think very carefully as they make these important decisions," she said. "Not just AARP, I think a lot of Americans are concerned about this and how it will affect them … This is an issue that's not going to go away."

Courtesy of Maryland Matters