Health insurance Open Enrollment 2025 is an important time for anyone who doesn’t get their health insurance from Medicare or via their employer.
Health Insurance Open Enrollment 2025 Season
It’s the one time during the year when everyone enjoys the guaranteed right to enroll in a new health insurance plan, or make changes to their existing coverage.
If you miss Open Enrollment, you may not be able to get coverage at all, or be stuck with your old plan until next year, unless you have a qualifying life event that triggers a 60-day Special Enrollment Period.
Otherwise, you’ll likely need to wait until next November to choose a new plan, and a year from January for it to become effective.
Here are the top 10 things you need to know about this year’s health insurance Open Enrollment season.
1. What is Open Enrollment?
Open Enrollment is a designated period, usually once a year, when you can sign up for a new health insurance plan or make changes to your existing one.
This is the only time you can make these changes, except for specific life events that may qualify you for a Special Enrollment Period.
2. When is the Health Insurance Open Enrollment 2025 season?
In most states, Open Enrollment runs from November 1 to January 15th.
However, if you want your coverage in a new plan to be effective as of January 1st, then most states will require you to complete your enrollment by December 15th.
Some states have opted for extended enrollment dates:
For Massachusetts residents, your open enrollment will run from November 1, 2024 through January 23, 2025.
New Jersey, New York, California, Rhode Island and Washington D.C. residents will have their open enrollment run through January 31, 2025.
For Idaho residents, your open enrollment period will only run from November 1, 2024 to December 15, 2024. So the cut off is a full month earlier than in most of the country.
3. Premiums are Going Way Up – But That May Not Affect You.
Early reports suggest that health insurance premiums are increasing sharply.
As usual.
According to a Mercer survey, indications are that unsubsidized health insurance premiums are surging by about 5.4%, on average, for 2024.
But that doesn’t mean you won’t be able to afford a great health plan!
If you are eligible for a health insurance subsidy under the Affordable Care Act, your out of pocket premiums are effectively capped. The government will subsidize all your premiums above that cap, in most cases. That means Uncle Sam will be picking up the additional 5.4% increase, and probably more than that for most people who get a subsidy.
So if you read about rising health insurance premiums this year, but you are qualified for a subsidy, you don’t need to be concerned.
However, these premium increases could affect you if you’re among the millions of American families who don’t qualify for a subsidy. That means there’s no safety valve for you. You’ll have to face the full brunt of any health insurance premium increases in your market.
If this is your situation, you may benefit from switching to a lower-cost health sharing plan, rather than a traditional Marketplace health insurance policy.
Before switching, though, take stock of the new plan’s pre-existing condition waiting periods, surgery limitations, and other limitations and exclusions.
4. Premiums aren’t everything.
Of course, monthly premiums are an important consideration.
But zeroing in on the cheapest possible monthly premiums to the exclusion of other factors is a mistake.
When comparing plans, look beyond the monthly premiums. You should consider other costs like deductibles, co-pays, and out-of-pocket maximums.
You also need to look at what doctors, clinics, and hospitals are included in your plan’s network of authorized providers, and whether you need to get a referral from your primary care physician before you can see a specialist on your plan.
A plan with a low premium might seem attractive, but the high costs associated with medical services could offset the initial savings.
5. You Can Choose Health Sharing
Don’t feel limited to the insurance policies offered over the Obamacare marketplace sites.
You can also choose health sharing plans as an alternative.
These are affordable non-insurance plans that also help individuals and families pay unexpected medical expenses.
They are different from insurance, and should not be confused with insurance. Instead, health sharing plans are non-profit associations of like-minded people who agree to form a community and help share the medical bills incurred by other plan members.
They don’t qualify for a subsidy under Obamacare. But they are typically available for about half the cost of a comparable traditional insurance policy without a subsidy.
So if you don’t get an Obamacare subsidy, or you only get a small one, considering a health sharing plan could make a good deal of sense!
However, health sharing plans typically impose a waiting period before they will share costs to treat pre-existing conditions.
Click here to learn more about health sharing plans, and to get a free quote. So you can compare costs against your after-subsidy cost of health sharing plans.
Compare Pricing on the Best Insurance Plans Available
6. Coverage Varies From Plan to Plan
Pay close attention to the services covered under each plan.
Coverage can differ significantly between plans. Look closely at your plan’s guidelines for details affecting services like mental health benefits, maternity and childbirth, preventive services, drug and alcohol addictions treatment, and prescription medications.
While all ACA-qualified plans must offer ten minimum essential coverages, and offer parity between mental health and physical health benefits, the details can still vary.
Also, health sharing plans are not subject to the minimum essential coverage requirement. If you are considering a health sharing plan, you should carefully consider these provisions.
Health sharing plans can save money compared to unsubsidized health insurance premiums. But they typically don’t provide as much coverage for mental health or drug addiction treatment.
They may also restrict sharing of maternity and childbirth costs to married women, or to pregnancies beginning after the plan’s effective date.
7. Not All Plans Qualify For Cost Sharing Reductions
ACA-qualified health plans come in four “tiers:: Bronze, Silver, Gold, and Platinum.
You can qualify for premium tax credits with any of these tiers. But if you qualify for extra savings too, you’ll get those savings only if you pick a Silver plan.
Bronze is the cheapest of the four “metal” tiers. But it also provides the least coverage and presents the most risk for policy holders. The Bronze plan pays 60% of eligible medical expenses. You will be responsible for 40% of your costs, up to the maximum out-of-pocket costs for the year.
Silver plans are the next cheapest. They pay 70% of eligible medical costs. You pay approximately 30%, up to the OOP maximum.
Gold and Platinum plans have the highest premiums. They pay 80% and 90% of eligible costs, respectively. You are responsible for the remainder, up to the out-of-pocket limit for the year.
Because of their higher premiums, they are usually a good fit for people who have significant health care needs and who go to the doctor frequently.
Catastrophic Plans
There’s an additional “catastrophic” tier, which only covers major medical events. This plan is only available to policyholders age 30 and under, and certain low-income individuals and households, or those undergoing specific hardships.
Catastrophic plans have low premiums, but neither they nor Bronze-tier plans qualify for cost sharing reductions.
If your income is limited, it probably doesn’t make much sense to opt for a Catastrophic or Bronze plan, since you would retain a lot of risk for medical bills, but you wouldn’t get a premium tax credit subsidy.
Consider going for at least a Silver tier plan instead.
8. Don’t Miss the Deadline!
Failing to enroll or make changes during Open Enrollment can lock you into your existing plan for another year or leave you without coverage.
Either scenario could put your health and finances at risk. Mark the dates on your calendar and set reminders so you don’t miss the deadline.
9. Did You Fall Behind on Premiums or Taxes Last Year? You Can Still Enroll!
In the past, insurers could deny coverage to people who fell behind on their premium payments in the previous year.
That’s changed.
Thanks to certain provisions in the American Rescue Plan Act, if you fell behind on insurance premiums in 2024, insurance companies must still allow you to enroll in 2025.
10. Consider Professional Help
The complexities of health insurance can be overwhelming.
If you’re unsure about what plan is best for you, consider seeking advice from a professional, your own Personal Benefits Manager. They are available at no cost to you, and can provide invaluable insights tailored to your unique needs.
Don’t let this important period pass you by; take control of your health insurance and, by extension, your health. After all, investing in good health insurance is an investment in your future.
Here are some additional blogs: Should I Switch from a Traditional Health Insurance Plan to Health Sharing? | The Battle of Our Time: Fighting for Healthcare Freedom | How Much Does Health Sharing Save Compared to Health Insurance? | When Can I Sign Up for a Health Plan for 2024?
Here are some additional pages related to this blog: Healthshare Plans | Complete Guide to Direct Primary Care (DPC)
Compare Pricing on the Best HealthShare Plans Available
Frequently Asked Questions
What is a Health Insurance Marketplace, and how does it work during Open Enrollment?
A Health Insurance Marketplace, also known as the Exchange, is a platform where individuals and families can compare and purchase health insurance plans.
During Open Enrollment, the Marketplace allows you to explore various plans, assess their costs and benefits, and enroll in the coverage that best meets your needs and budget.
Financial assistance options available during Open Enrollment include Premium Tax Credits and Cost-Sharing Reductions (CSRs). Premium Tax Credits help lower your monthly premium costs, while CSRs reduce your out-of-pocket costs like copayments and deductibles. To determine your eligibility for these subsidies, you’ll need to provide information about your income and household size when applying through the Marketplace.
Do I need to reapply for health insurance through the Marketplace every year during Open Enrollment?
Yes, it’s advisable to review and update your health insurance coverage during each Open Enrollment period.
In most cases, you don’t need to take any action. You normally only need to take action if you receive notice of a material change to your plan, you have a major change to your income or household size, or your medical situation changes.
Can I apply for health insurance through the Marketplace if I’m a legal immigrant or have non-citizen status?
Yes, legal immigrants and individuals with eligible non-citizen status can apply for health insurance through the Marketplace during Open Enrollment.
You can also explore your eligibility for Medicaid or CHIP based on your immigration status and income.
How can I estimate my potential premium tax credit and cost-sharing reductions (CSRs) during Open Enrollment?
To estimate your potential premium tax credit and CSRs, you can use online calculators available on the Health Insurance Marketplace websites.
These calculators consider factors like your income, household size, and location to provide an estimate of the financial assistance you may qualify for when purchasing health insurance through the Marketplace.
Your Personal Benefits Manager can also walk you through different scenarios and help you estimate your available subsidies.
Are there any penalties for not having health insurance if I miss the Open Enrollment period?
Currently, as of 2024, there is no federal penalty for not having health insurance, regardless of whether you miss the Open Enrollment period or not.
However, some states have implemented their own individual mandate penalties. These states include California, Massachusetts, Rhode Island and the District of Columbia.
What should I do if I experience a qualifying life event outside of Open Enrollment?
If you experience a qualifying life event, such as marriage, the birth of a child, or the loss of other coverage, you may be eligible for a Special Enrollment Period (SEP).
SEPs allow you up to 60 days to enroll in or make changes to your health insurance plan outside of the regular Open Enrollment period.
How do I compare health insurance plans effectively during Open Enrollment?
To compare health insurance plans effectively, consider factors such as premiums, deductibles, copayments, coinsurance, provider networks, prescription drug coverage, and total out-of-pocket costs.
Additionally, think about your healthcare needs, including any medications or treatments you expect to require in the coming year.
What is the difference between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO) plan available during Open Enrollment?
HMO and PPO plans are two common types of health insurance plans you may encounter during Open Enrollment.
HMOs typically require you to choose a primary care physician and obtain referrals for specialist visits, while PPOs offer more flexibility in selecting providers and do not mandate referrals. However, PPOs often come with higher premiums and out-of-pocket costs.
When does my new health insurance coverage start if I enroll during Open Enrollment?
If you enroll in a health insurance plan during Open Enrollment, your coverage typically starts on January 1st of the following year.
However, if you enroll after December 15th, your coverage may have a delayed start date, often the first day of the month following your enrollment.
Can I apply for Medicaid during Open Enrollment?
Yes, you can apply for Medicaid during Open Enrollment.
If your income falls within your state’s Medicaid eligibility criteria, you can enroll in Medicaid at any time of the year, not just during Open Enrollment. Medicaid enrollment is year-round.
What if I already have health insurance through my employer?
If you have health insurance through your employer, you are generally not eligible for subsidies through the Marketplace unless your employer’s plan does not meet certain affordability and coverage standards set by the ACA.
However, you can still use Open Enrollment to compare your employer’s coverage to other Marketplace options.
