Open enrollment for individual plans on the ACA exchange begins Nov. 1.
Enrollment in ACA plans hit a record high of 21.4 million in 2024, spurred by enhanced premium subsidies.
2025 could be the last year for enhanced subsidies, which provide premium assistance to individuals with incomes up to 400% of the federal poverty limit. These subsidies are set to expire at the end of 2025 unless Congress passes legislation to extend them.
Open enrollment runs until Jan. 15 in most states. A few states extend the open enrollment period until Jan. 31, according to KFF.
Here are three changes to note for this open enrollment:
- For 2025, individuals who are part of the Deferred Action for Childhood Arrivals program will be able to enroll in ACA marketplace, pending a court challenge. In May, the Biden Administration said it would extend marketplace eligibility to DACA recipients. The agency said it expects 100,000 uninsured DACA recipients could receive coverage through the marketplace.
In August, 15 state attorneys general sued to block CMS from allowing DACA recipients to enroll in ACA plans. A judge has yet to issue a decision in the case. - In July, CMS implemented regulations designed to crack down on broker fraud on ACA exchanges. The agency is blocking unassociated or new agents from making changes to an individual's enrollment status. New agents and brokers will need to conduct a three-way call with the consumer and an agency call center to make any changes, or direct the enrollee to make the changes themselves. In the first six months of 2024, CMS said it received nearly 74,000 complaints about a plan being changed without the enrollee's consent.
- New regulations requiring plans to meet maximum appointment wait time standards will take effect in 2025. Behavioral health appointments must be available within 10 days, and primary care appointments within 15 days.