Maryland Approved 10.2 Percent for 2027 Small Group Plans. Your Carrier Number Is the One That Matters

By Joshua Lavine, CEO and Company Culture Expert, Capitol Benefits  ·  Last updated October 22, 2026

Maryland approved an average 10.2 percent increase for 2027 small group health plans on September 25, 2026, down from the 13.1 percent carriers asked for. That 10.2 percent is a market wide average, not a forecast of your renewal: approved carrier averages run from 3.1 percent to 11.7 percent, and the quarter your plan year begins changes the number again.

The headline number landed on September 25 and it is already being quoted in renewal conversations across Maryland. An average 10.2 percent increase for 2027 small group plans.

It is a real number and it is worth knowing. It is also close to meaningless for any individual employer, and if your renewal conversation stops there you are going to be surprised twice: once by your own number, and again by what the company down the road got.

What the MIA actually approved

Carriers had asked for an average 13.1 percent across the Maryland small group market. The MIA approved 10.2 percent, nearly three percentage points lower. Filed carrier averages ranged from 4.1 percent all the way up to 20.7 percent.

Here is the approved average by carrier, with market share, because this is the table almost nobody publishes:

• CareFirst BlueChoice HMO, 73 percent of the market, approved 11.7 percent, having asked for 13.8.
• CareFirst GHMSI and CFMI PPO, about 11 percent of the market combined, approved 3.1 percent, having asked for 4.1.
• UnitedHealthcare of the Mid-Atlantic HMO, approved 10.0 percent, having asked for 20.7.
• UnitedHealthcare MAMSI EPO, approved 9.1 percent, having asked for 20.5.
• UnitedHealthcare Insurance Company PPO, approved 8.5 percent, having asked for 19.7.
• UnitedHealthcare Optimum Choice HMO, approved 8.2 percent, having asked for 19.6.
• Kaiser HMO, approved 7.0 percent, which is exactly what it asked for.

By network type, HMO plans were approved at 11.3 percent, EPO at 9.1 percent and PPO at 4.9 percent. That is the opposite of the pattern most employers expect, and it is one of the fastest things to check on your own renewal.

The story in that table is UnitedHealthcare. Four entities filed for roughly 20 percent and every one came back between 8.2 and 10.0 percent. That is the regulator doing its job, and it is also a reminder that a filed rate and an approved rate are different animals.

Your renewal month is worth several points

This is the part that gets lost. Maryland lets small group carriers change rates quarterly, and the MIA approved four separate quarterly changes for each carrier. The 10.2 percent is a blend of them.

Across the market, the approved quarterly changes are 11.7 percent in the first quarter, 12.2 percent in the second, 8.7 percent in the third and 8.6 percent in the fourth.

For CareFirst BlueChoice, which covers nearly three quarters of the Maryland small group market, the spread is wider: 13.8 percent in January, 14.5 percent in April, 9.5 percent in July and 9.6 percent in October.

Same carrier, same plan, same employer. Roughly five points of difference driven entirely by which month the plan year starts. If you are a January or April renewal, budget accordingly and start early. If you are a July or October renewal, you have more runway than the headline suggests.

A note on the other numbers circulating this week

You may see a different set of figures quoted: CareFirst BlueChoice at 14.7 percent, CareFirst PPO at 6.4 percent, Kaiser at 4.9 percent. Those are accurate, but they are not carrier averages. They are the approved change on one specific benchmark, the lowest cost off exchange silver plan for a 40 year old in the Baltimore metro region, out of more than 265 plans in the market.

On that benchmark a 40 year old goes from 464 to 532 dollars a month on CareFirst BlueChoice, from 409 to 429 on Kaiser, and from 582 to 619 on the CareFirst PPO. Useful for comparing plans against each other. Not a prediction of your group renewal.

The gap matters. Kaiser looks like the smallest increase on the benchmark at 4.9 percent, but its actual approved carrier average is 7.0 percent. If you take the benchmark to your CFO and the renewal arrives at the carrier average, that is an uncomfortable meeting.

What is driving it

The MIA named three cost trends by service category: hospital costs trending up 7.8 percent, professional services 8.6 percent and prescription drugs 14.8 percent. These are trend rates for underlying cost, not slices of the 10.2 percent, and they do not add up to it. The Administration also pointed to higher utilization, not just higher prices, for inpatient hospital care and prescription drugs.

Prescription drug trend at 14.8 percent is the one to sit with. It is nearly double hospital trend, and it is the piece most directly affected by plan design choices you actually control.

What a double digit renewal can become

If level funding or a different funding model is new territory, our plain English guide to small business health insurance options lays out what each one actually changes about your cost. And if you are weighing whether your current broker is bringing you real options at renewal, what to look for in an employee benefits broker covers the questions worth asking.

A double digit renewal letter is not a final answer. It is an opening position, and there is usually more room than employers realize. The moves worth pricing:

• Plan design. Deductible, out of pocket maximum, copay structure and the pharmacy tier design. Given a 14.8 percent drug trend, the formulary and specialty tier deserve real attention rather than a glance.
• Network type. PPO plans were approved at 4.9 percent this year against 11.3 percent for HMO. That is unusual and it will not repeat every year, but it is true for 2027 and worth modeling.
• An HSA qualified option. Often the cleanest way to hold premium while giving employees a tax advantaged way to fund the deductible, and it changes the conversation from what was taken away to what was added.
• Remarketing. With 265 plans in the market and approved carrier averages ranging from 3.1 to 11.7 percent, the spread between carriers is larger this year than the headline implies.
• A level funded quote, priced honestly. Worth seeing the number. Also worth understanding the tradeoffs, which we cover below.

Level funding, and what the MIA said about it

More Maryland small employers are looking at level funded plans, and the Administration addressed them directly this year. Its points were specific and they are fair to pass along.

Level funded arrangements rate on the health status of your group, which is prohibited in the fully insured small group market. That cuts both ways. A young, healthy group can genuinely save money. A group with a few significant claims can be quoted far above the fully insured rate, or declined, and the fully insured market you left will still be there but at standard rates rather than favorable ones.

These arrangements are also, in part, self insured. That brings duties and obligations the employer takes on directly, and the MIA noted they lack a number of protections that Maryland law gives fully insured plans.

None of that makes level funding wrong. We place it, and for the right group it is a good answer. It makes it a decision that deserves a real conversation about your claims history and your tolerance for year to year volatility, rather than a decision made off a first year quote.

The market itself is shrinking

About 199,000 Marylanders are covered through the small group market, down from roughly 203,000 a year ago. The MIA said plainly that it is concerned about the effect of rising costs and declining enrollment on the future of this market.

That is why the October 1 meeting exists, and why it is worth an hour of an employer time.

The October 1 meeting, and how to be heard

The MIA and the Maryland Health Benefit Exchange are holding a joint public meeting on options for supporting small business on Thursday, October 1, 2026, from 1:00 to 4:00 pm. It is virtual, on Zoom, and open to the public. Registration is on the MIA website.

The agenda includes policy levers that would change this market meaningfully: possible changes to stop loss regulation for small groups, a potential merger of the individual and small group markets, and possible support for ICHRA and CHOICE arrangements. These are discussion items, not decisions, which is exactly when employer input is worth the most.

Written feedback is accepted before, during and after the meeting. If you want to speak, the MIA asked that people sign up in advance.

One contrast worth noticing

The MIA cut small group rates by nearly three points from what carriers requested. In the individual market it did the opposite, approving an average 14.6 percent against the 13.7 percent filed, largely because of the expiration of enhanced federal premium tax credits and changes to Exchange eligibility.

If you have employees who buy their own coverage, or if you have been weighing an ICHRA, that divergence is the number to watch. Individual market rates are moving up faster than small group right now, which changes the arithmetic on sending people to the Exchange.

What we are doing about it

We are working through every Maryland small group client with a first quarter renewal now, because those are the ones carrying the 11.7 to 13.8 percent quarterly increases and they have the least time. If your renewal is later in the year, we will get to you well before it lands, and the runway is genuinely longer.

If you want your own number rather than the market average, send us your renewal letter and your current plan design and we will tell you what it looks like against the approved rates and what the alternatives cost.

Frequently Asked Questions

What did Maryland approve for 2027 small group health insurance?
On September 25, 2026 the Maryland Insurance Administration approved an average increase of 10.2 percent across the small group market, below the 13.1 percent carriers had requested. Approved averages by carrier range from 3.1 percent to 11.7 percent.

Why is my renewal higher than 10.2 percent?
The 10.2 percent is a market wide average across every carrier and plan. Your own increase depends on your carrier, your network type, your plan design, your group demographics and the quarter your plan year begins. Very few employers land on the market average.

Does the month my plan renews really change the rate?
Yes. Maryland approves small group rates quarterly. For 2027 the market wide approved changes are 11.7 percent in the first quarter, 12.2 percent in the second, 8.7 percent in the third and 8.6 percent in the fourth. For the largest carrier the spread is roughly five points between a January and a July renewal.

Which employers count as small group in Maryland?
Maryland defines a small employer as one that employed an average of not more than 50 employees during the preceding calendar year, counting full-time employees plus full-time equivalents. Part-time hours are converted, so a business with many part-timers should run the calculation rather than assume.

What is the Maryland meeting on October 1 about?
The Maryland Insurance Administration and the Maryland Health Benefit Exchange are holding a joint virtual public meeting from 1:00 to 4:00 pm on options for supporting small business. The agenda includes stop loss regulation, a possible merger of the individual and small group markets, and support for ICHRA and CHOICE arrangements.

Is a level funded plan a good way to avoid the increase?
Sometimes, and it depends on your claims history. Level funded plans rate on the health status of your group, which fully insured small group plans may not do, so a healthy group can save and a group with significant claims can be quoted higher or declined. They are also partly self insured, which brings employer obligations and fewer of the protections Maryland law gives fully insured plans.

If you are anywhere near 50 full time equivalents

The small group market stops at 50 employees in Maryland, and crossing that line brings the employer mandate with it. For plan years beginning in 2027 the IRS set the affordability threshold at 10.22 percent of household income, up from 9.96 percent for 2026, so the lowest cost self only plan you offer has to cost a full time employee no more than 10.22 percent of income under whichever safe harbor you use. If you expect to pass 50 full time equivalents during 2027, price that test into the renewal conversation now rather than in December. Source: IRS Revenue Procedure 2026-26.

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