Affordable Care Act Open Enrollment for 2025 Plans

For many, premium increases will be offset by expanded federal subsidies

Rachel Nania,

AARP

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En español

Published October 30, 2024

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Federico Gastaldi

People interested in signing up for health coverage through the Affordable Care Act’s (ACA) health insurance marketplace can start shopping on Nov. 1 when open enrollment begins. It’s also the time for current enrollees to compare and change plans.

The enrollment period for the federal HealthCare.gov marketplace ends on Dec. 15 for coverage that begins on Jan.1 and on Jan. 15 for coverage that starts on Feb.1.

Nineteen states and the District of Columbia operate their own marketplaces, and in some of these states, the open enrollment period differs from the federal window. For example, open enrollment for ACA plans in Massachusetts runs through Jan. 23; in New Jersey and New York it ends Jan. 31.

Premiums are increasing, but subsidies are sticking around

The average monthly premiums for marketplace plans are expected to increase by about 4 percent in 2025, but rate changes vary widely by state, according to data from the health policy nonprofit KFF.

Inflation, including rising hospital rates, and growing demand for pricey diabetes and weight loss medications such as Ozempic and Wegovy are among several factors driving the changes, a KFF analysis found.

For many people, premium hikes will be offset by enhanced federal subsidies that have been extended through 2025. Cynthia Cox, the director of KFF’s ACA program, says about 92 percent of people who sign up for marketplace plans qualify for a subsidy. Four in five customers will be able to find ACA coverage for $10 or less a month, according to the Centers for Medicare & Medicaid Services (CMS), which administers the ACA.

The subsidy you get depends on your income and choice of health plan. People with incomes above 400 percent of the federal poverty level ($60,240 for an individual) may be eligible for subsidies with a silver-level ACA plan if their premiums exceed 8.5 percent of their income. The eligibility threshold is lower for people with lower incomes.

“Let's say you have an older couple and maybe they even have adult children on their plan, you could easily have a very high income and still get a subsidy on the marketplace,” since premiums can be higher for older adults, Cox explains. KFF has a calculator that can help you estimate insurance premiums and subsidies for 2025 coverage.

ACA plans: What are the options?

There are four main categories of ACA plans:

Bronze
Silver
Gold
Platinum

Bronze plans tend to have the lowest monthly premiums and the highest deductibles and copays. Silver plans are the most popular, with generally moderate premiums and copays. If you qualify for a subsidy, you’ll need to enroll in a silver plan to get the savings. With gold and platinum plans, you pay less out of pocket but more for your monthly premium.

More insurer participation

Choice for ACA enrollees continues to grow. CMS says 97 percent of HealthCare.gov consumers will have access to at least three health insurance issuers for 2025. That’s “a pretty significant change from just a few years ago,” when insurer participation was low in some areas, Cox says.

“Now there's very widespread insurer participation,” she adds — a likely result of the subsidies that were expanded in 2021 and extended through 2025. What happens to the subsidies in 2026 depends on congressional action.

“With them in place, we've seen enrollment double in the last few years, and that has also made the marketplace more attractive for insurance companies,” Cox says.

ACA enrollment jumped from 11.4 million in 2020 to 21.4 million in 2024, a KFF analysis found.

What to look for in an ACA plan

If you already have an ACA plan, open enrollment is the time to make sure your coverage still works for your wallet and your health needs. You can only switch your ACA insurance outside of open enrollment if you move, lose your job or have another major life event.

What should you look for in a plan? Cox cautions buyers to be sure they can afford their chosen plan’s premiums all year long. And look closely at the deductibles and coinsurance for various types of care.

“Some people may be better off in a plan with a very low premium, like a bronze plan, where you might have little or no premium and have a lot of out-of-pocket costs,” Cox says. “Other people who have less risk tolerance might prefer to be in a plan where they know they're going to pay a higher premium each month but it might minimize their exposure to out-of-pocket costs.”

You’ll also want to make sure your doctor is in the plan’s network — or that your plan offers a large selection of providers — and that any medications you take are covered by your plan.

“It's important for people to actively shop every year,” Cox says, “especially now that there are more insurance companies participating.”

If you need help with enrollment, free assistance is available. Call the federal government’s Marketplace Call Center at 800-318-2596 (TTY: 855-889-4325) or search for help in your area from a trained health care navigator. Insurance agents and brokers may also be able to assist you, but bear in mind that they can be paid a commission by health insurance providers.

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