Maryland bucked national ACA enrollment trends for 2025, despite rising premiums and the expiration of the federal premium tax credits.

The state’s ACA enrollment remained flat from the 2024 open enrollment period to the 2025 open enrollment period, with about a quarter of a million Marylanders signing up for plans.

Though Maryland’s flat enrollment is a reversal from years of increasing membership in ACA insurance plans, it’s still a feat considering the uphill battle states faced.

In total, the United States saw a 5% decline in ACA enrollment, according to Healthinsurance.org, an insurance plan analyzer.

Declines were due to Congress’s inability to renew the premium tax credit and subsequent increases in premiums because companies expected to lose customers.

Maryland’s ACA premiums rose an average of 13.4%.

However, the state continued to provide its own subsidies to customers in hopes of keeping up enrollment.

“The extra subsidies that Maryland kicked in is the reason why Maryland didn't see the declining enrollment that we saw nationwide, and also didn't see as much downgrading of coverage, as we saw nationwide, is because Maryland did enhance their state subsidies to try to offset at least some of the impact,” said Louise Norris, a health policy analyst for Healthinsurance.org.

The average premium in the United States after losing federal subsidies increased from $184 a month to $284 a month, Norris said.

A large majority of Marylanders using ACA plans were able to take advantage of the state subsidies.

About 177,000 of the approximately 250,000 people who enrolled were eligible for state funding.

Anyone in the state who is up to 400% of the federal poverty level is able to get assistance.

Additionally, Marylanders aged 18-37 receive assistance as well.

Maryland did see some changes in ACA enrollment behavior, however.

About 2.7% of people downgraded their plans, choosing higher deductibles and lower premiums.

That’s still better than the national average, which had 10% of people downgrading their plans.

The numbers come as Maryland says it will lose $71 million adjusting to new ACA, Medicaid and SNAP rules created by the Trump administration’s 2025 spending and tax legislation.

New work requirements and more frequent eligibility checks for Medicaid, ACA benefits and SNAP will add significant costs to Maryland’s Department of Health, Department of Human Services and the state’s health benefit exchange between 2026 and 2027.

The state will also lose about $2.7 billion in Medicaid funding from the legislation and new analysis of the rules shows as many of 270,000 may lose their Medicaid.