What’s the Deadline for Open Enrollment for Marketplace in 2025?
November 12, 2024 | Johanna Karlsson
Open enrollment for the Marketplace is an annual window during which individuals can sign up for, modify, or cancel their health insurance plans. This period typically lasts just a few weeks, and if you miss it, you may have to wait until the next enrollment period to make any adjustments. So, how long is open enrollment for Marketplace?
For individual/family health coverage, open enrollment begins on November 1 in nearly every state and ends on January 15 in most states, but there are some exceptions. Here are some key dates to remember, according to HealthCare.gov:
November 1: Open enrollment starts, and coverage can start as soon as January 1.
December 15: Last day to enroll in or change a health insurance plan for coverage to start January 1. These plans play their first premium on January 1.
January 15: Open enrollment ends to enroll in or change Marketplace health plans for 2025. For those who enroll in or change plans between December 16 and January 15, coverage begins on February 1. These plans pay their first premium on February 1.
January 16 through October 31: Special Enrollment Period for those who qualify due to a life event or based on income. Individuals can apply for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP) anytime.
Individuals who qualify for Medicare do not need to join the Marketplace, and it does not affect Medicare choices or benefits. The Medicare Open Enrollment Period runs from October 15 to December 7, and you do not need to do anything with the Marketplace during this time. Additionally, it is against the law for someone to sell you a Marketplace plan if you have Medicare.
The Open Enrollment Period is a designated time frame each year when individuals can sign up for, renew, or modify their health insurance plans under the Affordable Care Act (ACA) via the Health Insurance Marketplace. This period is typically held during the fall every year and is limited to a few weeks. The Marketplace has designated this period to prevent people from signing up for insurance when they are sick, which would increase rates for everyone. Outside of this open enrollment, people can only apply for a plan if they experience a qualifying life event, such as childbirth, loss of income, marriage, or loss of insurance from a spouse.
What Are the Three Types of Plan Categories Within the Marketplace?
Investopedia outlines four tiers of health plans, categorized by the average percentage of medical expenses covered by the insurer, known as actuarial value. The remaining percentage is paid by the plan enrollee. Gold and platinum plans will pay towards your bill and lower your out-of-pocket costs for copayment, deductibles, and coinsurance.
It is important to note that the categories have nothing to do with the quality of care you receive but rather on your share of costs for the services covered. Some people may qualify for extra savings based on their income. If these individuals enroll in a Silver plan, the plan pays more while the enrollee pays less.
The Health Insurance Marketplace offers three main plan categories:
Bronze: This option features lower premiums but requires you to cover a higher percentage of your overall healthcare costs. Typically, the deductible is high, with the plan covering 60% of expenses.
Silver: This plan may provide opportunities for cost-sharing subsidies, with moderate deductibles and coverage of 70% of healthcare costs. For those eligible for extra savings, Silver plans can cover between 73% and 96% of costs, often with lower deductibles.
Gold: This plan comes with higher premiums but allows you to pay a smaller share of your total healthcare expenses. Gold plans cover 80% of costs and generally have lower deductibles.
Additionally, there is a platinum level with a low deductible, and the plan pays 90% of the costs. It is also important to note that the level of your Health Insurance Marketplace plan affects the premium amount you pay for coverage each month. As you move up in tiers, premiums tend to increase while deductibles decrease.
What Is the Lowest Income to Qualify for Marketplace Insurance?
There is no minimum income requirement to access health insurance through the Marketplace. However, to receive additional savings on the Silver plan, you need to meet certain conditions:
Your household income must fall between 100% and 250% of the federal poverty level (FPL). For example, this means individuals earning $15,060 or less annually before taxes. Keep in mind that the FPL can differ depending on the state.
Be eligible for the premium tax credit.
Enroll in a Silver plan through the Marketplace.
Marketplace has a subsidy calculator to help determine your eligibility for different income amounts and family sizes. Healthcare.Gov also provides a calculator to help determine if you qualify for savings. In some states, if your income is below 138% of the FPL, you may qualify for Medicaid.
What Are Two Main Things You Should Consider When Picking Your Health Insurance Plan?
There are many factors to consider when comparing and picking an insurance plan during ACA open enrollment, but two key components are coverage and cost. Start by assessing how frequently you anticipate using your health insurance. For instance, do you want insurance for a catastrophic event that might happen, or do you have a health issue now that you will need ongoing care for? This can influence whether you need a plan with lower premiums and higher deductibles if you are fairly healthy and only want health insurance in case of an emergency. For individuals with underlying health conditions who may need continued prescription medications and frequent doctor appointments, a plan with a lower deductible and higher premiums may be best to lower your out-of-pocket costs.
NPR has compiled a list of important factors to consider when choosing your health insurance plan. Some of these include:
Familiarize yourself with key insurance terminology, such as premium, cost-sharing, deductible, and copay.
Get trustworthy professional help, such as an insurance agent.
Being cautious of online plans that seem too good to be true.
Know how long open enrollment in the Marketplace is and specific deadlines.
HealthPlusLife Can Help You Navigate Open Enrollment for Marketplace
Now that you know how long is open enrollment for Marketplace, as the end of open enrollment for Marketplace quickly approaches in mid-December, finding the right type of health insurance coverage can feel increasingly daunting. The Marketplace offers a lot of options, which is beneficial; it can leave you spending hours comparing various plans. HealthPlusLife is your trusted insurance agency dedicated to helping individuals navigate the complexities of Marketplace health insurance, Medicare, and life insurance policies. Our insurance agents will guide you through the complexities of the Affordable Care Act Marketplace, including eligibility and plan options.
Whether enrolling in ACA Marketplace health insurance for the first time or looking to change your coverage, our experienced team is ready to support you at every turn, ensuring you make the best decision for yourself and your family. Remember, the open enrollment deadline is December 15th, so don’t wait to secure your insurance coverage starting January 1st. Reach out to HealthPlusLife today at 888-828-5064 to connect with one of our trusted insurance agents.
Johanna Karlsson Johanna Karlsson is a veteran health and life insurance professional licensed in 50 states. She relocated from the countryside in the south of Sweden and has not looked back. After coming to the United States to attend university, she gained her degree in Public Relations. She brought her public relations skills to a local international health insurance where she discovered a new passion in insurance. After years with that company, Johanna now joins HealthPlusLife to help build a team of licensed insurance agents ready to meet your insurance needs.
