Rising ACA marketplace premiums are pushing thousands of Marylanders into lower-tier health plans — or out of coverage entirely. If you've recently downgraded your plan, skipped renewal, or are struggling to afford your monthly premium, ACA premium tax credits (also called subsidies) may be available to help reduce your costs. Understanding how these subsidies work, what income levels may be eligible, and how to access free enrollment help are the most practical first steps you can take right now.

Data Snapshot

According to reporting by Maryland Matters, thousands of Maryland residents downgraded their marketplace health plans during the most recent Open Enrollment Period, largely in response to premium increases. Nationally, the Centers for Medicare & Medicaid Services (CMS) reported that 21.4 million people enrolled in ACA marketplace coverage for plan year 2024 — a record high — yet affordability pressures continue to push lower-income enrollees toward bronze-tier or catastrophic plans that carry higher out-of-pocket costs when care is actually needed.

The U.S. Department of Health and Human Services (HHS) reports that 4 in 5 marketplace enrollees nationally were able to find a plan for $10 or less per month after applying available premium tax credits (HHS.gov). That gap — between what people are currently paying and what they could be paying with subsidies properly applied — is precisely why reviewing your options matters, even if you've already enrolled for the current plan year.

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Why Premiums Are Rising and How It Affects Your Plan Choice

ACA marketplace premiums are set annually by insurers and approved by state regulators. When premiums rise faster than household income, many people respond by shifting from silver or gold plans — which offer stronger coverage and lower cost-sharing — to bronze plans with lower monthly premiums but significantly higher deductibles and copays. Some households drop coverage altogether, accepting the risk of being uninsured.

What often gets overlooked in this situation: premium tax credits are designed specifically to offset this kind of cost pressure. If you didn't apply for subsidies when you enrolled, or if your subsidy wasn't recalculated after your income changed, you may be paying considerably more than necessary. Updating your marketplace application — even mid-year under certain circumstances — can trigger a recalculation.

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How ACA Premium Tax Credits Work

Premium tax credits are federal subsidies that reduce your monthly health insurance premium on the ACA marketplace. They are calculated based on your household income as a percentage of the Federal Poverty Level (FPL) and the cost of plans available in your area.

Who May Be Eligible

  • 100% to 400% FPL: Households in this range have traditionally been eligible for premium tax credits. Exact dollar figures change each year — always verify current FPL tables at HHS.gov or through your state marketplace before estimating eligibility.
  • Above 400% FPL: Under enhanced subsidy provisions extended through the Inflation Reduction Act, households above 400% FPL may also be eligible if their benchmark plan premium exceeds a defined percentage of their income. This expansion has made assistance available to middle-income households that previously received nothing.
  • Medicaid gap consideration: Maryland has expanded Medicaid under the ACA. Households at or below 138% of FPL may qualify for Maryland Medicaid rather than marketplace subsidies. Checking Medicaid eligibility first is the right starting point for very low-income residents, since Medicaid typically provides more comprehensive coverage at lower or no cost.

How the Subsidy Amount Is Calculated

The subsidy is tied to the cost of the second-lowest-cost silver plan (the benchmark plan) in your geographic area. The federal government calculates how much of that plan's premium you're expected to contribute based on your income, and covers the remainder. If you choose a less expensive bronze plan, your out-of-pocket premium may drop to near zero. If you choose a gold plan, you pay the difference above the subsidy amount.

Benefit amounts vary by household size, income, and the specific plans available in your county. No specific dollar amount can be guaranteed — your actual subsidy depends on your individual circumstances.

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Steps to Take If You've Downgraded or Dropped Coverage

Step 1: Determine Whether You're in an Enrollment Window

ACA Open Enrollment typically runs from November 1 through January 15 in most states. Maryland's marketplace — Maryland Health Connection — may have slightly different dates; check their website for the current plan year's schedule.

Outside of Open Enrollment, you generally need a qualifying life event to change plans through a Special Enrollment Period (SEP). Qualifying events include:

  • Loss of other health coverage (including job-based insurance)
  • Change in household size (marriage, divorce, birth, adoption)
  • Change in income that affects subsidy eligibility
  • Moving to a new coverage area
  • Gaining citizenship or lawful immigration status

If you've experienced any of these, you may have up to 60 days from the qualifying event to enroll or switch plans.

Step 2: Gather Your Documents Before You Apply

Having the right documents ready before starting your application reduces delays. Collect the following:

  • Proof of identity: Driver's license, passport, or state-issued ID
  • Social Security numbers for all household members applying for coverage
  • Income documentation: Most recent federal tax return, recent pay stubs, or a self-employment income statement
  • Current health insurance information, if you have any active coverage
  • Immigration documents, if applicable to any household member
  • Employer-sponsored insurance details: If anyone in your household has access to job-based coverage, you'll need information about that plan's cost and coverage level

Step 3: Apply or Update Through Maryland Health Connection

Maryland residents apply through Maryland Health Connection — the state's official ACA marketplace — not the federal HealthCare.gov portal. If your income has changed since you last enrolled, even modestly, updating your application can trigger a subsidy recalculation that lowers your premium going forward.

If you enrolled through HealthCare.gov in a prior year before establishing Maryland residency, you'll need to transfer your enrollment to Maryland Health Connection.

Step 4: Use Free Help From a Certified Navigator or Assister

Maryland Health Connection provides free, certified enrollment assistance through navigators and certified application counselors. These are trained professionals — not insurance salespeople — who can help you compare plans side by side, apply for subsidies, and understand your coverage options without any cost or obligation.

Navigators are particularly useful if: - You're self-employed or have variable income - You're unsure whether Medicaid or a marketplace plan is the better fit for your household - You've had a subsidy reconciliation issue on a past federal tax return - English is not your primary language — many navigators offer multilingual assistance

You can locate free local help through the Maryland Health Connection website or by calling their enrollment helpline directly.

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If You Can't Afford Any Marketplace Plan: Additional Programs to Know

Maryland Medicaid

If your household income is at or below 138% of FPL and you live in Maryland, you may be eligible for Maryland Medicaid, which provides free or very low-cost health coverage with no monthly premium for most enrollees. You can apply through Maryland Health Connection — the same portal handles both marketplace and Medicaid applications simultaneously, so you don't need to apply separately.

CHIP — Maryland Children's Health Program (MCHP)

The Children's Health Insurance Program (CHIP), called the Maryland Children's Health Program (MCHP) in this state, may cover children in households that earn too much for Medicaid but cannot afford marketplace premiums. Income limits vary, but CHIP generally covers children in households up to 200% of FPL or higher, depending on state policy. Applications are also handled through Maryland Health Connection.

Federally Qualified Health Centers (FQHCs)

If you've dropped coverage and need medical care now, Federally Qualified Health Centers provide primary care on a sliding-fee scale based on income, regardless of insurance status. They are not a substitute for health insurance, but they can provide essential care while you work through your coverage options. Locate a center near you at findahealthcenter.hrsa.gov.

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A Note on Enhanced Subsidies and Their Future

The enhanced premium tax credits that have helped millions of Americans afford marketplace coverage were extended through the Inflation Reduction Act. These enhancements are currently authorized through 2025, and their continuation beyond that point depends on Congressional action. If you're currently benefiting from enhanced subsidies — or haven't checked your eligibility recently — reviewing your options now gives you the most time to plan for any changes.

Maryland Matters and other state-level outlets have documented that premium increases are already prompting plan downgrades among Maryland enrollees. Staying current on subsidy policy is one of the most practical ways to protect your household's coverage stability.

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What to Realistically Expect From the Process

  • Application processing: Maryland Health Connection typically processes most applications within a few business days. Cases involving immigration status verification or complex self-employment income may take longer.
  • Subsidy application: If a premium tax credit is applied to your account, it reduces your monthly premium directly — you do not wait for a tax refund to see the benefit.
  • Plan comparison: You'll be able to review plans side by side, including monthly premiums, deductibles, copays, and in-network providers before making any selection.
  • Tax reconciliation: If your actual annual income differs from the estimate you provided when applying, you'll reconcile the difference when filing your federal taxes. Overestimating income may result in a tax credit at filing; underestimating may require repaying a portion of the subsidy received.

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Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: July 2025