4 Key Changes to Obamacare Open Enrollment for 2025

Some things, though, haven’t changed.

Open enrollment on HealthCare.gov runs from Nov. 1, 2024, through Jan. 15, 2025. In most states, you have to enroll by Dec. 15 for your coverage to start Jan. 1. If you enroll after Dec. 15, but before the January deadline, your coverage will start Feb. 1.

Katie Charleson, communications officer at Silver State Health Insurance Exchange, which operates Nevada’s online Marketplace, recommends not putting off signing up for a health plan.

“Get it out of the way — sooner rather than later is always advised — especially since the holidays are a really busy time of year,” she told Healthline.

Most states follow the same timeline, although in California, New Jersey, New York, Rhode Island and the District of Columbia, it runs through Jan. 31, and in Idaho, it runs from Oct. 15 through Dec. 15.

To see the deadlines for your state, check with your state’s health insurance Marketplace website or go to healthinsurance.org.

Charleson said another reason to apply early is that if you miss the final deadline, you can only apply for health insurance through HealthCare.gov or a state Marketplace if you have a qualifying life event, like getting married, having a baby, or losing other health coverage.

“At that point, you would have 60 days from that life event to enroll in coverage,” she said.

According to an analysis by KFF, insurers are proposing an average increase of 7% for premiums for 2025. This is average, so while some insurers are lowering premium rates, many others are increasing them.

KFF also reports that because most Marketplace enrollees receive subsidies, they will not be impacted by these increased premiums. However, the federal government will spend more on subsidies to offset the premium increases.

Two types of Obamacare subsidies may be available to you:

• A premium tax credit that lowers the amount you pay each month for your health insurance plan.
• Cost-sharing reductions reduce the amount you must pay for out-of-pocket costs such as deductibles, copayments, and coinsurance. You will also have a lower “out-of-pocket maximum,” the total you must pay in a year. If you qualify for this reduction, you must enroll in a plan in the silver category to receive this benefit.

A deductible is the amount you pay for medical expenses before your plan starts covering them. For example, if you have a $750 deductible, you pay the first $750 in medical costs (except for free preventive services), and then your plan kicks in.

Copayments and coinsurance are the payments you make each time you get medical care. For example, you may have to pay a $10 copayment for each doctor visit.

You will find out if you qualify for either subsidy after you apply at HealthCare.gov or through a state Marketplace. You can also use an online calculator at HealthCare.gov to estimate how much you might get in subsidies.

Subsidies are based on the expected income for all members of your household who are required to file a federal tax return. This includes your spouse if you are married, and any dependents you claim on your tax return.

If your income is low enough, you may qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

“If you apply through Nevada Health Link, and we find that you’re eligible for Medicaid, we will send your information over there so you can fill out [a Medicaid] application,” Charleson said. “So we’ll make sure you on the right program.”

For people who are self-employed or have irregular income, Charleson recommends making the best guess about your income for next year.

Report any changes in income as soon as possible, because this can affect the size of your subsidy. If you fail to report an increase in income, you could have to pay money back when you file your federal tax return.

“So if you update your income throughout the year, you can avoid issues at tax time when you’re reconciling,” said Charleson.

“Dreamers” are recipients of the Deferred Action for Childhood Arrivals (DACA), a federal program offering some protection to people brought to the United States as children without proper immigration documentation.

Starting this year, Dreamers can enroll in ACA coverage and are eligible for subsidies, the Biden-Harris administration announced earlier this year.

Short-term plans — which are not ACA plans and are not subject to the ACA benefit rules and protections — can be issued for only up to four months of coverage, due to a Biden-Harris administration rule that took effect Sept. 1.

The four-month limit includes renewals. Existing plans and those issued before Sept. 1 don’t fall under the new rule.

The rule is intended to make it clearer that these short-term plans are not compliant with ACA benefit rules and protections, and to “reduce the number of people who inadvertently purchase short-term coverage when trying to buy comprehensive coverage,” the administration said.

People who relied on longer short-term plans should check the details for their plan, and consider enrolling in an ACA plan to avoid losing coverage midyear.

In the first six months of 2024, more than 200,000 people reported to the Centers for Medicare & Medicaid Services that they were enrolled in an Obamacare plan or switched to another plan without their permission, reports KFF Health News.

To keep this from happening again next year, the Biden-Harris administration has put new rules in place. Specifically, insurance agents will be unable to make changes to Obamacare enrollments made through HealthCare.gov, unless the agent is “associated” with a consumer’s policy, says KFF.

If you are working with a new agent, you will need to do a three-way call with the unassociated agent and the HealthCare.gov call center to make the change. You can also make the changes yourself through HealthCare.gov.

The advice for which ACA plan to choose largely remains the same this year.

There are four categories of plans in the Marketplace — bronze, silver, gold and platinum. Each has different costs and different benefits.

However, they all offer the same essential benefits, including:

• free preventive services
• outpatient care
• inpatient/hospital care
• mental health services
• pregnancy and maternity care
• prescription drug benefits

Your choice of level will affect your costs for healthcare services. For example, Bronze plans have the lowest premiums but usually higher out-of-pocket costs, such as deductibles, copayments and co-insurance. If you select a plan with a higher premium, those out-of-pocket costs may be lower.

Some plans also offer other benefits, such as:

• dental
• vision
• weight loss programs
• diabetes management
• birth control coverage

When choosing a plan, think about what level of care your household will need. If you have a current primary care doctor or are seeing medical specialists, check to see if they are included in the plan’s network. Also, make sure your current medications are included in the plan’s prescription drug coverage.

Even if you like your current plan, it’s a good idea to review what it offers next year — premiums, out-of-pocket costs, in-network doctors and hospitals, and other benefits may have changed.

Perry Braun, president & CEO of the Benefit Advisors Network, recommends that you prepare a financial plan for next year, including expected medical expenses before choosing a plan.

“Compare that to the out-of-pocket costs and contributions to the plan to determine how best to maximize the benefits and minimize your expenses,” he told Healthline.

You can find the answers to many of your questions at HealthCare.gov, or by calling the call center at 1-800-318-2596.

You can also find an agent, broker or assister by clicking on the “find local help” button on the Healthcare.gov website. State healthcare Marketplaces have similar tools.

Assisters can help you apply and enroll for a health plan through HealthCare.gov or a state Marketplace. However, they are not licensed as insurance agents or brokers, so they can’t make specific recommendations about plans.

Charleson said Nevada, which runs its own Marketplace, has a network of almost 900 assisters who can help people in the state find and sign up for a plan. Their assistance is free.

“They are the experts,” she said. “They can make sure that whichever plan you choose, you’re getting one that’s going to work best for you.”

Agents and brokers, who are licensed by the state, can also show you Marketplace plans. But they might also offer you plans outside of the Marketplace or plans that don’t meet the ACA requirements, such as short-term insurance.

If you qualify for a premium tax credit or cost-share reductions, you will need to enroll through the Marketplace to get those savings. Again, the cost-reduction subsidy is only available if you sign up for a plan in the silver category.

The Affordable Care Act’s 2025 open enrollment period allows people to sign up for health insurance coverage or switch to a new plan. To ensure that you have coverage on the first day of the year, sign up early, typically by Dec. 15.

People can sign up through the federal government’s HealthCare.gov website. Some states run their own health insurance Marketplace. People can also call the federal or state helpline, or contact a local assister, broker or agent to find help signing up for a plan.

Subsidies are available, based on household income, that can lower your monthly premium and out-of-pocket costs for medical visits, prescription drugs and other care. People with low income may also qualify for Medicaid or the Children’s Health Insurance Program (CHIP).