Friday marks the start of the annual open enrollment period for the Affordable Care Act (also known as “Obamacare”) health insurance marketplace. Most people who get health insurance through the federal or state marketplaces have six weeks to decide on a plan if they want their health care to continue uninterrupted after January 1st.
A record 21.3 million people chose a health insurance plan through the ACA marketplaces last year, according to the U.S. Department of Health and Human Services. In total, about 45 million Americans receive health insurance through the ACA marketplace or through expanded Medicaid.
The size of the program has increased since expanded subsidies were introduced in 2021 to help people with both financial and medical costs associated with the pandemic. They were initially only in effect for two years, but the Inflation Reduction Act of 2022 eliminated the subsidies until the end of next year.
During open enrollment, people who already have ACA insurance can purchase a new plan or keep their current one. In most cases, if you take no action, you will automatically be re-enrolled into your existing plan the following year. If your plan is no longer available, you will be enrolled in a plan with comparable coverage.
But because even “comparable” plans may have different doctor networks and prescription drug coverage, it’s a good idea to do your research and make sure you get a plan that meets the specific medical needs of you or your family, says Louise Norris, a health policy analyst at healthinsurance.org.
Even if you intend to keep the same plan, this is also an opportunity to make sure that your doctors and medications you take regularly will still be covered by your plan in the new year.
When will enrollment open for 2025 health insurance?
The ACA open enrollment period runs from Friday (November 1) through January 15, 2025, although if you want to buy or keep insurance starting January 1, you’ll need to enroll no later than December 15 (technically that’s 5 a.m. EST) . December 16). If you enroll between December 16 and January 15, your health coverage should begin on February 1 after you pay your first premium.
Most state exchanges have the same terms as the federal market, but some have different terms.
In Idaho, for example, open enrollment began on October 15th and will end on December 15th. The deadline in Massachusetts is January 23, and California, New Jersey, New York and Rhode Island, as well as Washington, D.C., allow residents to register until January 31.
But Norris says it’s wise not to wait until the last minute, especially if you expect to need help choosing and signing up for a plan. Wait times at the call center can be long, and if you need the help of a broker or navigator, their time will be very valuable as December 15 approaches.
This deadline is your last chance to make changes to your health insurance for 2025, unless there is a major event in your life that affects how and where you get coverage. People may be eligible for a special enrollment period if they or their family members experience a life event such as marriage, divorce, birth or death, if they move, or if they lose health insurance through their employer. The government also makes exceptions for people who fail to register on time due to unforeseen events such as natural disasters.
Where can I find the health insurance marketplace?
The federal ACA marketplace is located at health.gov. (Experts say it’s important to make sure you’re on a genuine website, since some brokers use similar web addresses.) Additionally, 20 states and Washington, D.C. have their own marketplaces where people can buy health insurance for 2025. . State pages also link to the federal site, so you can start there no matter where you live.
What else you need to know about signing up for the 2025 marketplace insurance
ACA premiums (also known as monthly payments) are rising 4% nationally, according to health policy and research nonprofit KFF. However, this doesn’t necessarily mean you’ll pay more. The plans available in the market have four levels of coverage: bronze, silver, gold and platinum. If the cost of the second-most expensive silver plan—what the industry calls the “benchmark” plan—increases, the subsidies that the vast majority of participants receive will also increase. This is what will happen in 2025.
“This means that most Americans who purchase health insurance will be able to find a plan with a premium that fits their budget,” says Cynthia Cox, vice president and director of the ACA program at KFF.
“Most people can still find premium for less than $10 a month,” she says. “In terms of what people are paying, it will probably be very similar to last year.”
More insurers are entering state markets and expanding their presence in states they already serve, which is also good news for consumers, Cox said. The downside to having so many plans to choose from is that it can get overwhelming. MAll people sign up through brokers or seek help from trained market navigators because pricing plans are very complex.
Regulators have introduced some standardization rules to make the price comparison process easier. “The idea was that people should be able to shop in one place and be able to compare on an apples-to-apples basis,” Cox says.
Despite this, consumers may still have dozens of plans to choose from. If you need help purchasing coverage, you can search for local help by zip code. A trained expert called ASA-navigator can help you understand your plan options, or you can work with a broker or agent. Brokers are paid by insurance companies, but navigators are not paid by insurers. However, navigators can only help you understand your options; they may actually recommend one plan over another.
You’ll need to calculate the actual cost of your premiums after taking into account subsidies or tax credits, which can be a challenge for people whose income fluctuates from year to year, which could affect the amount of help they receive. But the bonus is only one part of the equation. You also need to compare the costs of different plans for expenses such as deductibles, copays and prescriptions.
If you have a chronic condition or need to see a specialist regularly, you should make sure the plans you’re evaluating have these providers in network. If you take medications regularly, you’ll need to find out what coverage each plan provides for those prescriptions.
Open Enrollment Changes for 2025
KFF reports that registration this year may take longer for some people who work with brokers as the federal government has had to respond to a flood of complaints – 200,000 in six months – from consumers who were unknowingly and reluctantly enrolled or transferred to unscrupulous plans brokers. To thwart these attackers, regulators have introduced new rules: Customers purchasing their plan through a new broker not already included in their plan will be required to have a conference call with the broker and a legal representative of the ACA marketplace.
Georgians now have a government marketplace called Georgia Access where they can compare and sign up for plans. Norris says customer information has been migrated from the federal platform to the new state platform, so Georgia residents already enrolled in the marketplace plan should find the transition to be relatively seamless.
“It’s the same insurance companies, the same subsidies, the same premiums,” she says. “Everyone who had insurance coverage had their accounts transferred. This doesn’t mean you have to start all over again.”
Another change for 2025 is that people eligible for the Deferred Action for Childhood Arrivals program (also known as Dreamers, or undocumented immigrants who were brought to the U.S. as children) now have a new right to enroll in the market insurance and receive subsidies if their income meets these requirements. .
People who have been relying on short-term plans for their insurance will need to find an alternative. From September, people can no longer buy short-term plans lasting more than four months. People with short-term policies set to expire at some point in 2025 will have to seek alternative coverage now.
For example, unlike losing health insurance through your employer, terminating a short-term plan does not entitle you to a special enrollment period.
More money:
Medicare drug negotiations are expected to save enrollees $1.5 billion a year.
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