ACA Open Enrollment 2025 Guide

The Affordable Care Act’s (referred to as ACA or Obamacare) open enrollment period is the annual window during which individuals and families can compare the various health plans that are available and select the one that will best fit their needs for the coming year.

The open enrollment period typically runs from November 1 through January 15, but the dates vary in some states that run their own exchanges.

The open enrollment window applies to plans sold through the Marketplace/exchange as well as plans purchased off-exchange, directly from an insurance company.

Outside of open enrollment, you can only sign up for ACA-compliant individual and family health insurance (or switch to a different plan) if you experience a qualifying life event that triggers a special enrollment period.

How much could you save on 2025 coverage?

Compare health plans and check subsidy savings from a third-party insurance agency.

When is open enrollment for my state?

In the majority of the states, open enrollment for 2025 coverage runs from November 1, 2024 through January 15, 2025. But some state-run exchanges have different schedules. You can see the deadlines for each state in the table below.

How to enroll in the Marketplace

During open enrollment, you can enroll in an ACA-compliant individual and family health insurance plan – or make changes to your existing coverage – through the Marketplace in your state.

• If you have specific doctors or medical facilities you want to use, check to see if any plans have them in-network. If you take any medications, check to see if any plans have them in their formularies and what the out-of-pocket costs will be.
• If you want help with the process, assistance is available via local insurance brokers and Navigators, as well as enhanced direct enrollment entities.

Here’s what you’ll need for each enrollee:

• Name, Address, Social Security Number (Here’s why it’s required.) and Birth date
• Citizenship or legal residency status. (Proof may be required.)
• Payment information for the first month’s premium. (Setting up automatic payments for future months can help you avoid an inadvertent lapse in coverage.)
• If you’re 30 or older and want a catastrophic plan, you’ll need a hardship exemption. 1
• Many applicants are eligible for financial assistance. 2 If you’re applying for subsidies, you’ll also need the number of people on your tax return and your total household income. (The Marketplace may require proof of your income through a variety of documentation, 3 and coverage details about any employer-sponsored coverage available to you.)

• You can do this yourself or have a broker, Navigator, or enrollment assister help you with the process.
• You can apply online, over the phone, submit a paper application, or enroll in-person with a local broker, Navigator, or enrollment assister.
• You will not need to answer any medical history questions. But be sure that the plan you’re selecting has your medical providers in-network, covers your medications, and has out-of-pocket costs that you’ll be able to manage.

• Log into your Marketplace account after you’ve completed the process, to make sure everything is in order.
• Watch your email and mail for communications from the Marketplace and your new insurer. (For example, you may be asked to provide documentation to verify income or legal residency).
• Once your policy and ID cards arrive in the mail, read through all of it and reach out to your broker, Navigator, or the health plan if you have questions.

Frequently asked questions about Obamacare open enrollment

Who is eligible for Marketplace enrollment?

To be able to enroll on the ACA’s Marketplace: 4

• You must live in the United States.
• You must be a U.S. citizen or national or be lawfully present (Washington state allows undocumented immigrants to use its Marketplace, and Colorado has a separate platform that undocumented immigrants can use to enroll in coverage 5 ).
• You must not be incarcerated.
• You can not be enrolled in Medicare coverage.

DACA recipients will be allowed to use the Marketplace and obtain income-based subsidies for 2025, and can sign up for Marketplace coverage starting November 1, 2024. This is due to a rule change that the Biden administration finalized in 2024. 6 Historically, DACA recipients were not allowed to use the Marketplace, even though they were considered lawfully present in the U.S.

Who is eligible for financial assistance when buying coverage through the Marketplace?

Being eligible to enroll in the Marketplace is not the same as being eligible for financial assistance. In short, the income-based subsidies available through the Marketplace/exchange are reserved for people who aren’t eligible for Medicaid, zero-premium Medicare Part A, or coverage offered by an employer that’s deemed affordable and comprehensive. (Here’s how to determine whether employer-sponsored coverage is affordable to you.)

What is a premium subsidy and how do I get financial help during open enrollment?

Premium subsidy rules are designed to ensure that subsidy-eligible individuals won’t pay more than 8.5% of their household income in premiums for the benchmark (second-lowest-cost Silver) plan in the Marketplace. 7 (The percentage of household income that people are expected to pay can be much lower – as low as 0% – depending on their income.) 7

You can use our subsidy calculator to get an idea of whether you’re eligible for premium subsidies, and if so, how much those subsidies could be.

Premium subsidies are a refundable tax credit. 8 You may qualify for a subsidy based on your projected household income for the year you’ll have coverage. And then you’ll need to reconcile that with the IRS when you file your tax return for that year, based on your actual income. 9

Marketplace cost-sharing reductions (CSR) 10 are another type of Obamacare subsidy. CSR assistance is designed to ensure that people with low to moderate incomes can afford to receive health care services. Enrollees who qualify for CSR usually also qualify for premium subsidies.

CSR subsidies result in lower out-of-pocket costs, including lower deductibles and copays. For applicants with eligible incomes, these subsidies are automatically incorporated into all of the available Silver-level plans. But if you’re eligible for CSR subsidies and you buy a metal plan other than a Silver plan, you’ll forfeit this advantage

In addition to federal premium subsidies and CSR subsidies, some state-run Marketplaces offer their own subsidies.

I have Medicare. Can I buy supplemental insurance through the ACA Marketplace during open enrollment?

No. It is unlawful for someone to sell you a Marketplace plan (or an individual/family plan outside the exchange) if you already have Medicare, even if you only have either Medicare Part A or Part B. 11 So if you’re enrolled in Medicare, the Marketplace open enrollment period does not apply to you.

How is open enrollment for 2025 coverage different from the year before?

During the open enrollment period for 2024 coverage, enrollment reached a record high, with more than 21.4 million people signing up for coverage through the Marketplaces nationwide. 12

The record-high enrollment was driven largely by the subsidy enhancements created by the American Rescue Plan (ARP) — which are still in effect for 2025 — as well as the “unwinding” of the pandemic-era Medicaid continuous coverage rule.

For 2025 coverage, several changes will be applicable:

• DACA recipients will be eligible to use the Marketplace for the first time. 6
• Georgia will be running its own enrollment platform. Georgia residents will not use HealthCare.gov to sign up for 2025 coverage.
• Colorado’s state-funded cost-sharing reductions will only be available to those with household income up to 200% FPL, instead of the 250% FPL limit that applied in 2024. 13
• State-funded subsidies are expanding in California and New Mexico, and will provide benefits to more people.
• There will be some states where existing carriers exit the market (Washington is an example) and other states where new carriers enter the market (Michigan is an example). The current list of insurer entries and exits is as follows (more details are on each state’s page):
  • UnitedHealthcare entering Indiana.
  • HAP CareSource entering Michigan.
  • WellSense entering New Hampshire.
  • WellPoint entering Texas, Florida, and Maryland.
  • Simply Healthcare Plans, Inc. entering Florida.
  • Antidote Health Plan of Ohio, Inc. entering Ohio (already offers plans off-exchange, but is also expanding coverage area)
  • Celtic leaving Indiana Marketplace (will still offer plans outside the Marketplace).
  • Ascension (US Health & Life) exiting the market in Indiana, Kansas, Tennessee, and Texas.
  • Cigna exiting the market in Pennsylvania, South Carolina, and Utah.
  • Ambetter/Western Sky exiting New Mexico
  • PacificSource exiting Washington.

  For 2024 coverage, several changes were applicable:

  • Healthcare.gov’s automatic re-enrollment protocols changed somewhat, 14 to allow the exchange to move a CSR-eligible enrollee from a Bronze plan to a Silver plan, if the Silver plan would have an equal or lower premium and the same provider network and product type (HMO, PPO, EPO, etc.) as the Bronze plan. This protocol could be used regardless of whether the Bronze plan continues to be available for 2024. The idea behind this change is to maximize the benefits that enrollees can receive, but it’s still in each person’s best interest to log into their account and select their own coverage. Read why letting your individual health insurance plan automatically renew may not be in your best interests.
  • In some states, new insurers joined the exchange for 2024, including Indiana, Maryland, Colorado, California, Nevada, Oklahoma, New Mexico, Utah, Pennsylvania, New Jersey, South Carolina, Wisconsin, Kansas, Ohio, and Delaware.
  • In other cases, insurers left the exchange at the end of 2023. For example, Oscar Health left the exchange in California, 15 and Cigna left the Marketplace in Kansas and Missouri. 16 Piedmont Community Healthcare exited the individual market in Virginia, 17 and US Health & Life exited the Marketplace in Michigan. 18 One of Louisiana’s insurers was acquired by another, reducing the number of participating insurers by one. 19
  • Some states began offering new or enhanced state-funded subsidies for 2024, including California, 20 Colorado, 21 Maryland, 22 Massachusetts, 23 and New Mexico. 24 Read more about states that offer their own health insurance subsidies.
  • Virginia began using a new exchange platform (the Virginia Health Insurance Marketplace), instead of HealthCare.gov. 25 (Georgia had also sought approval to operate its own state-based exchange platform, but CMS delayed Georgia’s implementation until the fall of 2024.) 26
  • Medicaid expansion took effect in North Carolina on December 1, 2023. North Carolina Marketplace enrollees with income from 100%-138% of the poverty level were eligible for subsidies for private plans in 2023, but became eligible for Medicaid in 2024. 27
  • Agents and brokers assisting with enrollments in states that use HealthCare.gov are now required to document that the enrollee has consented to the agent/broker’s assistance, and maintain a record of the consent on file for ten years. 28 The consent can be obtained via an audio recording or a written document, 29 and must include, at a minimum, the date, the consumer’s name, the agent/broker’s name, and an explanation of the attestations in the eligibility application. 30

  Is there a penalty for not having insurance?

  There is no longer a penalty imposed by the federal government for being uninsured. But some states impose penalties when residents do not have health coverage or a qualifying exemption. They include:

  • Massachusetts 31
  • New Jersey 32
  • California 33
  • Rhode Island 34
  • District Of Columbia 35

  Should I let my existing ACA-compliant health plan auto-renew?

  In a nutshell, this author says no. Auto-renewal or automatic re-enrollment (when a plan is terminating) for the coming year’s coverage is available through the Marketplaces in every state. However, it may not be in your best interest to rely on automatic renewal. Selecting your own plan for the coming year is better than relying on auto-renewal or a Marketplace algorithm that will select a new plan on your behalf.

  You’ll want to pay close attention to any notices you receive from your health plan and Marketplace, as they will let you know how your benefit details, monthly premium, and premium subsidy (if applicable) are changing for the coming year. You’ll also want to carefully compare the other options available in your area, as they may not be the same as the options that were available for this year.

  Who can help me enroll in an ACA-compliant / Obamacare health insurance plan?

  You can certainly choose to select a plan and complete the enrollment process on your own, through the Marketplace/exchange website (or via an enhanced direct enrollment entity if you’re in a state that uses HealthCare.gov). 36

  But if you prefer to have help with the process, it’s available for free online, over the phone, and from people in your community:

  • Health insurance Navigators
    • Provide education and outreach about the Marketplace and available health plans, help applicants determine whether they qualify for subsidies or Medicaid, and assist in the enrollment process.
    • Can generally provide assistance after you enroll, helping with issues like eligibility appeals and how to utilize your health coverage.
    • Are funded by the federal government in states that utilize a federally run exchange, and by the states that run their own exchanges. 37
    • Similar to Navigators, but their focus tends to be strictly on helping people enroll, without the more extensive assistance that some Navigators can provide.
    • The exchange designates local “CAC organizations” (health centers, faith-based organizations, colleges, etc.) and people who are affiliated with or employed by those organizations are eligible to serve as CACs. 38
    • CAC funding can come from a variety of state and federal sources, and CACs are often volunteering their time to help people enroll in health coverage.
    • Licensed by the state and certified by the Marketplace/exchange.
    • Can help consumers determine subsidy or Medicaid eligibility, and they can also make plan recommendations based on a client’s particular situation. 39 (Navigators and CACs cannot do this).
    • Provide ongoing assistance for questions and problems regarding billing, utilization, claims, and appeals.
    • Generally carry errors and omissions insurance.