Hundreds of thousands of Maryland residents who buy health insurance on the state’s exchange will see a significant increase in their rates despite state efforts to keep prices under control.

Rates for the policies, commonly known as Obamacare, are set to rise an average of 13.4% for individuals and nearly 5% for small businesses. That’s less than what the carriers requested — about 17% — but substantially higher than in recent years, according to figures released by the Maryland Insurance Administration on Friday.

There could be even more pain for consumers. On top of the rate increases, Congress has yet to renew expiring federal subsidies that the bulk of low- and middle-income consumers have been using to offset their premium costs.

“We’re coming off the tremendous work the state has done for 12 years to really get the enrollments where we are,” said Michele Eberle, executive director of Maryland Health Benefit Exchange, which oversees the state’s health insurance marketplace.

“Now we face this double whammy.”

Most people get their health insurance through their employers. But about 300,000 individuals and another 200,000 small-business employees buy coverage on the state’s health exchange or directly through insurers.

Since the Affordable Care Act went into effect in 2014, the rate of uninsured people in the state has dropped in half, to 6%. Exchange officials have estimated the number would rise again because of higher premiums and fewer subsidies, with an estimated 70,000 dropping more expensive coverage.

Despite rising costs, people don’t stop needing health care, potentially burdening the health system with those who can’t pay their medical bills and eventually driving up costs for everyone, according to Eberle.

Most immediately, the Maryland Insurance Administration said the loss of federal subsidies would lead younger, healthier people to drop coverage, potentially resulting in even higher costs for those who remain enrolled.

Rising medical and drug costs are also to blame for the new rates, which officials said are the highest since 2019. That’s when the Maryland General Assembly created a state reinsurance fund to help insurers pay for their costliest consumers. The state lawmakers expanded on that plan this year to help replace some of the expiring federal premium subsidies.

The insurance regulators said that creates a bright spot: Contributions from the fund, which mainly benefits lower-income enrollees, helped keep rates lower than what insurers had originally requested.

Those with middle incomes could still be hit hard. Under the new rates for next year, a 30-year-old earning $39,125 annually could still see their monthly premiums nearly double to $121 a month on a mid-cost Silver plan. But without assistance, the plan would have increased 348% to $275.

Officials from the exchange and the state called on Congress to restore the full enhanced premium subsides before open enrollment begins on the exchange Nov. 1.

“Under this new federal administration, Washington has shirked its duty to help middle-class Americans and families in poverty get affordable health care,” Gov. Wes Moore said in a statement. “Congress should act without delay to avoid these federal tax credits being ripped away from hardworking families.”

UnitedHealthcare, CareFirst BlueCross BlueShield and Kaiser Permanente are offering private plans in 2026, while Aetna will drop out of exchange coverage.

In a statement, Kaiser said higher demand for health care and higher pharmacy costs drove an increase in rate requests, which officials said were on par with other insurers. It also called on Congress to extend the premium subsidies or risk rate increases nationally. Officials also said they’d look at their own practices to control costs.

In addition to rate increases, the exchange faces other challenges, including cuts to an assistance program that helps people choose and enroll in private insurance and Medicaid plans.

The federal government hasn’t paid about $5 million it normally funds for so-called navigators.

“These cuts come at a time when Marylanders’ need for guidance and culturally competent support in navigating their health benefits is greater than ever,” said Traci Kodeck, CEO of HealthCare Access Maryland, one of the navigator groups.

For more information on specific rate increases, the Maryland Insurance Administration has some charts and answers to commonly asked questions.

For assistance in signing up for medical and dental insurance through the exchange, go to Maryland Health Connection.