Private Health Insurance Maryland: PPO and EPO Plans Outside Maryland Health Connection
FreedInsure doesn't sell Maryland Health Connection plans, and for many Marylanders those plans are the better buy. What we do offer in Maryland are group-style PPO and EPO plans sold outside the exchange that use the Cigna PPO network. Here's who they can fit, who should stay with Maryland Health Connection, what the plans cost as of fall 2026 and how applying works.
Compare Your Options ↓Can You Buy Private Health Insurance in Maryland Outside Maryland Health Connection?
Yes. Private health insurance in Maryland isn't limited to Maryland Health Connection, the state's official health insurance marketplace. FreedInsure offers group-style PPO and EPO plans in Maryland that are sold outside it and use the Cigna PPO network. They are not insured by Cigna. The trade-off is easy to state: you give up the tax credits and state help that only Maryland Health Connection plans get, and you take on each plan's own eligibility rules, limits and exclusions.
A note on words: Maryland Health Connection plans are private insurance too, because private insurers sell them. On this page, “private plans” means plans sold outside the ACA Marketplace, which in Maryland is Maryland Health Connection.
Quick answer: Yes, as of October 2026. FreedInsure offers PPO and EPO plans in Maryland, sold outside Maryland Health Connection, that use the Cigna PPO network. Approval depends on each plan's eligibility and underwriting rules. Tax credits and Maryland Premium Assistance don't apply, so check Maryland Health Connection first if your income is 400% FPL or less.
The Cigna PPO network is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
FreedInsure LLC is an independent broker; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states, and our help is free to you: (844) 788-3733. Two of our licensed staff speak Spanish.
Last updated: October 7, 2026
Who Private Plans Fit in Maryland, and Who Should Use Maryland Health Connection
Income decides most of this. For 2027 coverage, federal premium tax credits apply at 100%–400% of the federal poverty level (FPL): about $15,960–$63,840 for one person or $33,000–$132,000 for a family of four, as of fall 2026 under current law. Maryland adds its own help for eligible Maryland Health Connection enrollees: Maryland Premium Assistance, which the Maryland Insurance Administration describes as for households with incomes below 400% FPL, and a Young Adult Subsidy for young adults up to age 37. None of that help works on a plan sold outside Maryland Health Connection.
Straight talk: A plan sold outside the Marketplace can cost less than a full-price ACA plan if you're healthy, earn too much for a tax credit, or want a specific network. But if you qualify for a tax credit, Maryland Premium Assistance or Medicaid, have a pre-existing condition, are pregnant or planning to be, or take expensive medications, an ACA plan is usually the safer buy, and the only way to get the premium tax credit is through the Marketplace. FreedInsure doesn't sell Marketplace plans in Maryland: for those, go to Maryland Health Connection or call 1-855-642-8572. We'll gladly price a private plan to set beside your Maryland Health Connection estimate. Call (844) 788-3733.
When a private plan can make sense
- No tax credit. Your household income is above 400% FPL (about $63,840 for one person or $132,000 for a family of four for 2027 coverage), so you'd pay full price on Maryland Health Connection. The Maryland Insurance Administration says rates for unsubsidized individual ACA plans will rise an average of 14.6% in 2027.
- Self-employed, above the tax-credit range. If you have no job-based plan and earn more than 400% FPL, a private plan is worth pricing next to a full-price Maryland Health Connection plan. Whether you qualify for a group-style plan depends on that plan's eligibility rules; we check before you apply. More in our self-employed insurance guide.
- Early retirees not yet on Medicare whose household income is above the tax-credit range. See our early retirement health insurance guide.
- Between jobs, after checking Maryland Health Connection. Losing job-based coverage can open a Special Enrollment Period, and a lower income this year may mean a tax credit or Medicaid. If neither applies, a private plan is one option to compare.
- Healthy, with predictable, low use: no ongoing specialist care, generic drugs only, no planned surgery or pregnancy.
- You want the Cigna PPO network. Some standard-design PPO plans we offer also pay for out-of-network care, at a higher cost. Check that your doctors are in the network first.
- You accept the trade-offs: higher deductibles, yearly service limits and exclusions.
The Cigna PPO network is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
When Maryland Health Connection is the better call
- Your income is 400% FPL or less. Tax credits and Maryland Premium Assistance work only on Maryland Health Connection plans. Below about 250% FPL, cost-sharing reduction silver plans also lower deductibles. Estimate yours with our 2027 ACA subsidy calculator; Maryland's state help comes on top of the federal credit.
- Your income is up to about $1,835 a month for one adult (138% FPL). Maryland Medicaid may cover you. If it's your best option, we'll tell you and point you to the state application.
- You have a pre-existing condition or ongoing treatment. All Marketplace plans must cover treatment for pre-existing medical conditions. For the private plans we offer, ask us to confirm in writing how a plan handles them before you enroll.
- You're pregnant or planning a pregnancy. On a Marketplace plan, “once you're enrolled, your pregnancy and childbirth are covered from the day your plan starts” (HealthCare.gov). The private plans' own coverage examples show a member paying about $6,050–$6,960 of a normal delivery, before any gap benefit.
- You take expensive brand-name or specialty drugs. Some private designs put all prescriptions under the deductible.
- You need guaranteed acceptance. Open enrollment and Special Enrollment Periods are the guaranteed routes. Private plans have their own eligibility rules.
Don't drop coverage first. Voluntarily dropping coverage doesn't create a Special Enrollment Period (45 CFR 155.420(e)), so if you cancel a Maryland Health Connection plan you may have to wait for the next open enrollment to get back in. Keep what you have until a private plan approves you and confirms a start date in writing.
PPO Health Insurance in Maryland: What the Private Plans Look Like
Some private PPO plans we offer are group health plans offered through a sponsoring employer or organization, not individual ACA plans. We describe them by category rather than by product name, because the details vary by plan design. Both categories below use the Cigna PPO network. Some private plans rent access to the Cigna PPO network: your plan administrator, not Cigna, may process your claims. Check your ID card and search Cigna's directory for the network named on it.
Standard-Design Group PPO Plans
In the plan documents we reviewed, in-network deductibles ran about $5,000–$6,000 for one person, with out-of-pocket limits of about $7,000–$8,700. Some designs let you see a primary care doctor or specialist for a flat copay before the deductible (for example $40 and $80), with generic drugs at $0.
Group Plans With a Gap Benefit
Group EPO/PPO plans with a high stated deductible, $6,000–$9,000 for one person in the documents we reviewed, that equals the out-of-pocket limit. An “integrated gap benefit” may pay down eligible in-network costs, subject to the plan's terms and limits.
In Network vs. Out of Network
A “PPO” label doesn't guarantee out-of-network coverage. In the standard PPO plans we reviewed, out-of-network care meant 50% coinsurance after a separate, higher deductible. The EPO plans we reviewed cover in-network care only, except emergencies.
Limits and Exclusions
Services have yearly limits, for example 60 home-health visits, 35 rehab visits and 25 skilled-nursing days. Common exclusions include adult dental and vision, hearing aids, infertility treatment, bariatric surgery and acupuncture.
Standard-design group PPO plans
ER visits, imaging, surgery, hospital stays and childbirth are typically 30% after the deductible. Other designs put almost everything, including prescriptions, under the deductible; in-network preventive care is the exception. Out-of-network care is covered at a higher cost: in the plans we reviewed, 50% coinsurance after a separate deductible of about $9,000–$10,000 for one person. The plans' own coverage examples show a member paying roughly $6,400–$7,000 of a $12,700 normal delivery.
Out-of-network costs: Out-of-network providers may bill you for the difference between their charge and what the plan pays. That amount doesn't count toward your out-of-pocket limit. Out-of-network preventive care and prescriptions are not covered.
Group plans with an integrated gap benefit
In the documents we reviewed, the stated in-network deductible and out-of-pocket limit were $6,000–$9,000 for one person ($12,000–$18,000 for a family). The gap benefit “may reduce eligible in-network member exposure” to a lower amount, subject to the plan's terms and limits. Copays, penalties, balance billing and non-covered services may not be eligible for the gap benefit. Before the deductible, office visits run $25–$40 for primary care and $50–$60 for a specialist, and generic drugs are $0. The plans' own coverage examples, before the gap benefit, show a member paying about $6,050 for a normal delivery. In the EPO designs, out-of-network care isn't covered except for emergencies.
How the “integrated gap benefit” works: The plan's stated in-network deductible and out-of-pocket limit are higher than the reduced amount you may see advertised. The plan's integrated gap benefit may offset eligible in-network deductible and coinsurance amounts, subject to the terms and limits of the plan. Copayments, non-covered services, penalties, balance billing and other excluded charges may not be eligible. Ask us for the plan's Summary of Benefits and Coverage and the gap benefit's terms before you enroll.
Group plan notice: This is a group health plan offered through a sponsoring employer or organization, not an individual ACA plan. Its Summary of Benefits and Coverage states that it provides minimum essential coverage and meets the minimum value standard. If you are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. Eligibility is set by the plan document.
Pre-certification: Some services, such as imaging, surgery and hospital stays, need pre-certification before you get them. If you skip it, the plan may charge a penalty ($500 in the plans we reviewed), and in most of those plans the penalty doesn't count toward your out-of-pocket limit.
About the network: The Cigna PPO network is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
Want the mechanics? Read EPO vs PPO for the out-of-network difference, or our PPO health insurance guide.
How Much Does Private Health Insurance Cost in Maryland?
For the group-style PPO and EPO plans above, these are the monthly premium ranges we commonly see as of fall 2026. They come from FreedInsure's broker plan catalog and cover both plan categories together. Plans in these categories we see often run roughly $500–$950/month for a healthy single adult, roughly $1,000–$1,800/month for a couple, roughly $950–$1,700/month for one adult plus children and roughly $1,600–$2,300/month for a family, depending on age, state, network and underwriting.
| Group-Style PPO/EPO Plans (Per Month) | Fall 2026 Range |
|---|---|
| Single adult | $500–$950 |
| Couple | $1,000–$1,800 |
| One adult + child(ren) | $950–$1,700 |
| Family | $1,600–$2,300 |
Pricing note: Price ranges are examples of monthly quotes we commonly see as of fall 2026, not offers or guarantees. Your rate depends on age, state, household size, network, plan design and each plan's eligibility and underwriting rules. Premiums are separate from what you pay when you get care (deductibles, copays and coinsurance). Some quotes in this range include a separate hospital and accident gap policy.
Monthly rates for some plans include a separate hospital and accident gap plan. Gap benefits are subject to that policy's own terms, limits and exclusions. The medical plan's deductible and cost sharing are shown before any gap benefit.
These plans are not sold through the ACA Health Insurance Marketplace (HealthCare.gov or your state's exchange) and are not individual-market ACA plans. You can't use a premium tax credit or cost-sharing reduction to pay for them. As HealthCare.gov puts it, “the only way to get the premium tax credit is through the Marketplace.” In Maryland, the state's exchange is Maryland Health Connection, and Maryland Premium Assistance is applied to plans bought there, so it doesn't apply to these plans either.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan's own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
Premium is not total cost
A premium of $500–$950 a month is about $6,000–$11,400 a year before any care (our arithmetic). Then comes the deductible: about $5,000–$6,000 for one person in the standard designs we reviewed, or a stated $6,000–$9,000 in the gap-benefit designs. The out-of-pocket limit doesn't cap everything, either: premiums, balance billing, pre-certification penalties and non-covered care fall outside it.
To compare fairly, use Maryland Health Connection's “Get an Estimate” tool, which shows 2027 plans and prices, then set our private quote beside it. If you may qualify for a tax credit or Maryland Premium Assistance, don't compare against the full sticker price: that help may lower it. For every plan category in our catalog, see the private health plan price report.
Maryland Health Connection vs. Private PPO Plans vs. Maryland Medicaid
Three routes, three sets of rules. This table puts the ACA plans sold on Maryland Health Connection, the private plans we offer that use the Cigna PPO network, and Maryland Medicaid side by side, using official Maryland and federal sources and the plans' own documents.
| Feature | Maryland Health Connection ACA Plans | Plans That Use the Cigna PPO Network | Maryland Medicaid |
|---|---|---|---|
| What it is | Plans from private insurers, sold on Maryland's state-based marketplace, run by the Maryland Health Benefit Exchange | Group health plans offered through a sponsoring employer or organization and sold outside Maryland Health Connection; they use the Cigna PPO network and are not insured by Cigna | Maryland's public coverage program, delivered through HealthChoice managed care organizations; children under 19 through MCHP |
| Who it usually fits | Households that qualify for tax credits or state help (up to 400% FPL, about $63,840 for one person for 2027 coverage), and anyone with a pre-existing condition | Healthy people above 400% FPL, or otherwise ineligible for a tax credit, who would pay full price on Maryland Health Connection | Adults with income up to about $1,835 a month for one person (138% FPL) |
| When you can sign up | Open enrollment November 1, 2026 – January 15, 2027; otherwise you need a Special Enrollment Period | You can apply outside open enrollment; approval depends on eligibility and underwriting, and the plan sets the start date | Year-round |
| Financial help | Federal tax credits; cost-sharing reductions on silver plans at or below 250% FPL; Maryland Premium Assistance and the Young Adult Subsidy (young adults up to age 37) for eligible enrollees | None: you can't use a tax credit, cost-sharing reduction or Maryland Premium Assistance | Public coverage for people who qualify; no tax credit needed |
| Pre-existing conditions | Must cover treatment for pre-existing medical conditions (HealthCare.gov) | Ask us to confirm in writing how a plan handles them before you enroll | Can't refuse to cover you or charge you more because of a pre-existing condition (HealthCare.gov) |
| Pregnancy | Covered from the day the plan starts (HealthCare.gov) | The plans' own coverage examples show a member paying about $6,050–$6,960 of a normal delivery, before any gap benefit | Healthy Babies Program for pregnant people of any immigration status |
| Network | Each insurer's own network | Cigna PPO network; standard PPO designs pay out of network at a higher cost, and EPO designs cover in-network care only, except emergencies | Care through a HealthChoice managed care organization |
| What changes for 2027 | Unsubsidized individual plan rates rise an average of 14.6% (Maryland Insurance Administration); state premium assistance continues below 400% FPL | Prices on this page are fall 2026 quotes; rates aren't guaranteed and can change | Work requirements start January 1, 2027 for many adults 19–64, with 6-month renewals |
| How to get it | marylandhealthconnection.gov or 1-855-642-8572 | Through a licensed broker; FreedInsure: (844) 788-3733 | Maryland Health Connection website, the Enroll MHC app or 1-855-642-8572 |
The Cigna PPO network is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card. Private-plan figures come from the plan documents we reviewed; the official plan document controls. Medicaid income figure: about $1,835 a month for one adult, $2,490 for two and $3,795 for four, effective February 1, 2026, per Maryland Health Connection.
How Applying and Underwriting Work for Private Plans in Maryland
You can apply for a private plan outside open enrollment, but applying isn't the same as being covered. Plans sold outside the ACA Marketplace may be subject to underwriting, age limits and each plan's own eligibility rules, and for group plans, eligibility is set by the plan document. Here's how we work through it with you.
- Income first. We ask about household income before anything else. If you may qualify for a tax credit, Maryland Premium Assistance or Medicaid, we'll tell you and point you to Maryland Health Connection.
- Check your doctors. Search the network named in the plan materials for your doctors and hospitals before you apply.
- Read the plan documents. Ask for the Summary of Benefits and Coverage, the plan document and, for gap-benefit designs, the gap benefit's terms. Ask us to confirm in writing how the plan handles pre-existing conditions.
- Apply. Your application is reviewed under the plan's own eligibility and underwriting rules. Approval isn't guaranteed.
- Confirm the start date in writing. The start date depends on the plan and comes from its enrollment materials. We never promise one.
- Only then change your current coverage. If you cancel a Maryland Health Connection plan, you may not be able to re-enroll until the next open enrollment unless you qualify for a Special Enrollment Period.
Missed open enrollment? A Special Enrollment Period after a qualifying event, such as losing job-based coverage, is the usual way into Maryland Health Connection outside open enrollment. If you don't have one, call us at (844) 788-3733 and we'll go over the options until the next open enrollment, including short-term health insurance in Maryland, with the limits each one carries.
2027 Open Enrollment, Medicaid and Consumer Protections in Maryland
Maryland Health Connection open enrollment for 2027
Open enrollment for 2027 coverage runs November 1, 2026 – January 15, 2027, according to the Maryland Health Benefit Exchange's October 7, 2026 release. Maryland's regulation (COMAR 14.35.07.11B(3)) fixes open enrollment at November 1 to January 15, and the Get an Estimate tool shows 2027 plans and prices starting October 7, 2026. Outside that window you need a Special Enrollment Period. Maryland Health Connection: marylandhealthconnection.gov, Consumer Support Center 1-855-642-8572, with a Spanish-language site.
Maryland Premium Assistance is authorized for plan years 2026 and 2027; continuing it into 2028 needs new legislation in the 2027 session, according to the exchange. Maryland also runs the voluntary Easy Enrollment program: a checkbox on state tax Forms 502/502B lets the Comptroller share your household size and income with Maryland Health Connection, which then helps you enroll.
Maryland Medicaid and MCHP
Maryland has expanded Medicaid. Adults qualify with income up to approximately $1,835 a month for one person ($2,490 for two, $3,795 for four), effective February 1, 2026, which equals 138% FPL. Care is delivered through HealthChoice managed care organizations, children under 19 are covered through the Maryland Children's Health Program (MCHP), and enrollment is year-round. Apply at Maryland Health Connection, in the Enroll MHC app or by phone at 1-855-642-8572. The Healthy Babies Program is open to pregnant people of any immigration status.
Starting January 1, 2027, many Medicaid adults ages 19–64 must earn at least $580 a month (the 2026 figure), attend school at least half time, or complete 80 hours a month of approved activities, and those adults renew every 6 months. The requirement may not apply to people who are pregnant, disabled, caring for a young child or living with a long-term health condition. More in our Medicaid work requirements guide and Medicaid income limits guide.
Short-term health insurance in Maryland
In Maryland, a short-term plan must last less than 3 months and cannot be renewed or extended (Md. Code, Ins. § 15-1301(s)). Plan terms vary by insurer, and your advisor confirms the maximum term available for your start date. Details are on our short-term health insurance Maryland page.
The Maryland Insurance Administration and your review period
The Maryland Insurance Administration (MIA) regulates insurance companies and producers in the state. Consumer line: 800-492-6116 (toll-free) or 410-468-2000; Life and Health complaints: 410-468-2244; Health Coverage Assistance Team: 410-468-2442. You can file a complaint online. The Summaries of Benefits and Coverage for the group plans we reviewed point continuation-coverage questions to the U.S. Department of Labor's Employee Benefits Security Administration.
Free look: Maryland's 10-day review period in Insurance Article § 16-105 covers life insurance and annuity policies. For a private health plan, ask us before you sign to show you where the plan document explains cancellation and refunds.
Check our agent's license: Constantino Lardi holds Maryland non-resident producer license No. 3001923629, with Accident & Health or Sickness and Life authority, per his NIPR Producer Database report dated September 9, 2026. The MIA producer lookup is the live record, and all of our agent's state licenses are listed on our licenses page.
Sources
- FreedInsure broker plan catalog, fall 2026 — monthly premiums by household rate tier, plus the plans' Summaries of Benefits and Coverage and brochures (internal data; product names withheld).
- Maryland Health Benefit Exchange release, October 7, 2026 — 2027 open enrollment runs November 1, 2026 through January 15, 2027; Get an Estimate tool for 2027 plans and prices.
- MHBE: 2027 Open Enrollment Period (July 20, 2026) — Maryland's open enrollment dates are set in COMAR 14.35.07.11B(3).
- Maryland Insurance Administration, September 25, 2026 — average 14.6% increase for unsubsidized individual ACA plans in 2027; state premium assistance for households below 400% FPL.
- Maryland Health Connection: Maryland Premium Assistance — state help on top of federal tax credits, including extra help for young adults.
- MHBE: 2027 State Subsidy Parameters (August 4, 2026) — the state subsidy is authorized for plan years 2026 and 2027.
- Maryland Health Connection: How to Enroll in Medicaid — adult income limits effective February 1, 2026; year-round enrollment; how to apply.
- Maryland Health Connection: Medicaid Check-In — work requirements starting January 1, 2027.
- Maryland Health Connection: Easy Enrollment — the state tax-form checkbox that shares income information with Maryland Health Connection.
- Md. Code, Insurance § 15-1301 — short-term limited duration insurance: less than 3 months, no extension or renewal.
- Md. Code, Insurance § 16-105 — 10-day review period for life insurance and annuity policies.
- HealthCare.gov: pre-existing conditions — Marketplace plans must cover treatment for pre-existing medical conditions; Medicaid and CHIP can't refuse to cover you or charge you more because of one.
- HealthCare.gov: premium tax credit — the only way to get the premium tax credit is through the Marketplace.
- HHS ASPE poverty guidelines — 2026 guidelines of $15,960 for one person and $33,000 for a family of four, used for 2027 Marketplace credits.
- KFF: Status of State Medicaid Expansion Decisions — Maryland has adopted Medicaid expansion (data as of October 2026).
- 45 CFR 155.420 — Special Enrollment Periods; voluntarily ending coverage is not a loss of coverage.
How FreedInsure Helps Marylanders
FreedInsure LLC is an independent insurance broker; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states. Our help is free to you. We don't sell Maryland Health Connection plans, so if a tax credit, Maryland Premium Assistance or Medicaid looks likely for your household, we'll tell you and point you to Maryland Health Connection before we quote any private plan.
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In Maryland we also help with short-term health insurance, supplemental coverage such as hospital indemnity and critical illness insurance, and life insurance: term life, whole life, indexed universal life and mortgage protection.
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A licensed advisor prices private PPO and EPO plans for your Maryland household and tells you plainly when Maryland Health Connection or Medicaid looks like the better route. Free, no obligation.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan's own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
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