The 2025 Open Enrollment period for health insurance introduces several notable updates, including changes in coverage options, cost structures, and policies that could affect individuals and families seeking coverage through the federal marketplace, state exchanges, or employer-sponsored plans. Here’s a breakdown of what’s new for the 2025 enrollment season.
Updates for the 2025 Open Enrollment Period
For the 2025 coverage year, the federal marketplace’s open enrollment period is set to run from November 1, 2024, to January 15, 2025. This mirrors recent years, providing individuals ample time to evaluate their options and enroll in a plan. Some states that run their own exchanges may offer extended or slightly modified enrollment periods. It is critical to check state-specific deadlines.
Introduction of New “Standardized Plans”
Starting in 2025, many state exchanges and the federal marketplace are offering standardized health plans. These plans will have the same benefits across insurers, making it easier to compare plans based on cost, networks, and additional features. Standardized plans help simplify decision-making by providing uniform benefit designs. This includes deductibles, copayments, and coinsurance. Consumers will now be able to focus more on network access and premium affordability without worrying about varying cost-sharing structures between insurers.
Enhanced Subsidy Extensions
The expanded premium tax credits, which make health insurance more affordable for middle-income earners, are extended through 2025. These tax credits reduce the monthly cost of premiums for people who purchase their health insurance through the marketplace. This means that many individuals and families will continue to benefit from lower premiums than they would have otherwise paid without these subsidies. Additionally, the income cap for receiving subsidies has been eliminated, which means more people can qualify for some level of financial assistance. Check the IRS website for eligibility HERE.
Expanded Family Glitch Fix
The family glitch—which previously prevented family members of employees with access to employer-sponsored coverage from qualifying for marketplace subsidies—has been addressed. It is also expected to expanded further in 2025. If the employer’s plan is considered unaffordable for family members, they can now qualify for subsidies to buy coverage through the marketplace.
This change is expected to provide relief to many families who were caught in a gap of affordability in previous years. “The threshold used to determine whether an employer offer is considered unaffordable also dropped for 2024, from 9.12 percent of household income to 8.39 percent, potentially allowing more households to qualify for PTCs.” –Center on Budget and Policy Priorities Jan 25, 2024
Increased Focus on Preventive Care
In 2025, there will be greater emphasis on preventive care services. New federal guidelines require insurers to cover more preventive services at no cost to the insured. This includes expanded screenings for mental health conditions, chronic disease management, and preventive screenings for conditions like cancer, diabetes, and hypertension. These changes are aimed at improving long-term health outcomes by encouraging early detection and ongoing management of chronic diseases.
More Affordable Prescription Drug Costs
Prescription drug costs continue to be a significant concern, and in 2025, steps have been taken to reduce out-of-pocket costs. The Inflation Reduction Act of 2022 introduced provisions that limit price hikes on medications and cap insulin costs, and these measures will continue to be implemented through 2025. Medicare beneficiaries, in particular, will see improvements, including a cap on out-of-pocket prescription drug expenses.
New Health Equity Measures
A focus on health equity has become a priority for many insurers in 2025. Some plans now include enhanced benefits for underserved populations, providing additional resources for racial and ethnic minorities, rural communities, and those with disabilities. This could mean better access to specialized providers, culturally competent care, and targeted health education resources.
Telehealth Coverage Expansion
Telehealth usage surged during the pandemic, and many insurers have continued to offer robust telehealth services. In 2025, expect to see increased access to telehealth services, with many plans offering no-cost or low-cost virtual visits for primary care and mental health services. Some plans may also include telehealth as part of their preventive care offerings, providing patients with easier access to ongoing care from the comfort of their homes.
Increased Plan Choices for Small Businesses
Small businesses will see expanded options in the health insurance marketplace for 2025. New plan designs and offerings geared specifically towards small employers are being introduced. Providing more affordable coverage options for both employers and employees. With healthcare costs expected to rise 8%-9% in 2025, small businesses continue to search for more affordable options for themselves and their employees. In some states they are also offering additional incentives for small businesses that provide health coverage to their employees. Learn more about small business health care tax credits HERE.
How Can AUI Help You with Open Enrollment for 2025
As the healthcare landscape continues to evolve, the knowledgeable healthcare brokers at AUI are here to help through all of these changes. The changes are designed to improve access to affordable care, provide more robust coverage options. IN addition, address long-standing issues in the system. However, If you’re navigating your health insurance options alone it can be tough to know what is what.
When you use a healthcare broker like the team of AUI you get a person to help you make the right decision for you, your family and your small business. Take advantage of these updates for 2025 to secure the best possible coverage for you and your family. Don’t wait for open enrollment to start. Contact us now and let us get to work for you, or your small business today to get started.
