Hundreds of thousands of Marylanders on Saturday will get their first chance to buy health insurance for the coming year through the state’s online health exchange. And they may be in for sticker shock.

In most cases, enrollees will pay substantially more next year — possibly 50% more — because Congress remains at an impasse over extending enhanced federal subsidies that for years have made premiums far more affordable for low- and middle-income consumers.

Other residents with employer-based insurance, many of whom also are entering their own open enrollment periods, will likely face higher premiums because the price of medical services, and drugs in particular, is rising.

“We all see and appreciate the stress this can cause for people,” Dr. Meena Seshamani, the state health secretary and chair of the Maryland Health Benefit Exchange, said during a Friday news conference.

“The health system even on a good day can be complex to navigate,” she said. “Now there is even more uncertainty.”

State regulators and advocates have been sounding alarms for months about the extra federal subsidies for exchange plans, which expire at the end of the year. The issue is at the center of the monthlong federal government shutdown.

Without a resolution, consumers will face a double whammy.

First, exchange premiums in Maryland will directly rise an average of 13.4%, which is less than insurers requested because the state has worked to offset costs through its own program. Nationally, the exchange premiums are expected to rise an average of 18%, according to the health policy group KFF.

But then many consumers will receive even higher monthly bills because of the end of pandemic-era federal subsidies to pay down premiums. The lowest-income earners on the exchange will get some subsidies, and Maryland has also used its own program to help many people buy coverage. But middle-income individuals, in particular, will be out of luck.

Consumers can get estimates on the state health exchange website, even if they roll over their current plan for themselves, family or small business, according to Michele Eberle, executive director of the Maryland Health Benefit Exchange, which operates the online marketplace.

Exchange officials have offered general examples. A family of four with a combined income of about $129,000 a year that no longer qualifies for federal subsidies and won’t qualify for state aid would see monthly health insurance bills rise 56% in 2026 to $1,427, up from $916.

For a family of four making just over $80,000 that qualifies for the planned state subsidy, the bill would likely rise about 55% to around $419 a month, up from $271. Without the state subsidy, the coverage would more than double to $568.

Eberle said consumers can get more personal assistance during open enrollment, which runs Nov. 1 to Jan. 15., through a licensed broker or navigator group. Those groups will offer in-person assistance at events during open enrollment. There is also assistance to sign up for Medicaid, the federal-state health program for poor and disabled people that covers a quarter of Maryland residents.

Republican leaders in Congress have indicated some willingness to negotiate new subsidies to offset the steep rise in costs, but they decry the current estimated cost: $355 billion over the next decade, according to the Congressional Budget Office.

Most Marylanders, along with Americans generally, get their insurance through their employers. But even they are expected to see their premiums rise an average of 6%, according to KFF. That translates into workers paying about $6,850 toward premiums out of their paychecks next year.

They could also see their rates jump more down the road to compensate for those who forgo costly insurance purchased through the exchange but can’t pay their health care bills out of pocket. That means everyone is affected, said Vinny DeMarco, president of the Maryland Citizens’ Health Initiative, a nonprofit advocacy group that hosted the Friday news conference.