The 2025 ACA Open Enrollment Period (OEP) officially begins on November 1st.
This is the best OEP ever for the ACA for several reasons:
The expanded/enhanced premium subsidies first introduced in 2021 via the American Rescue Plan, which make premiums more affordable for those who already qualified while expanding eligibility to millions who weren't previously eligible, are continuing through the end of 2025 via the Inflation Reduction Act;
A dozen states are either launching, continuing or expanding their own state-based subsidy programs to make ACA plans even more affordable for their enrollees;
And remember, millions of people will be eligible for zero premium comprehensive major medical policies.
If you've never enrolled in an ACA healthcare policy before, or if you looked into it a few years back but weren't impressed, please give it another shot now. Thanks to these major improvements it's a whole different ballgame.
Here's some important things to know when you #GetCovered for 2025:
I've spent the past couple of weeks up to my ears in 2025 annual healthcare policy rate filing analysis, so I haven't gotten around to addressing JD Vance's recent appearance on NBC in which he finally explained exactly what Donald Trump's "concept of a plan" for healthcare is:
When Donald Trump stammered at the recent presidential debate that he had “concepts of a plan” for Americans’ health care, he came across like a child who had forgotten his homework. But thanks to his campaign and his running mate JD Vance, we know now the Republican ticket really does have some “concepts.” Those concepts are bringing health care into the election — and presenting a tremendous opportunity to Vice President Kamala Harris.
Last Sunday, Vance raised the eyebrows of anyone familiar with health care policy when he told NBC’s Kristen Welker about Trump’s “deregulatory agenda.”
Ah, at last, another state which includes both the average requested rate changes for 2024 as well as the number of enrollees each carrier has for both the individual and small group markets in clear, transparent language!
Generally, according to NC Insurance laws, health insurance rates must not be excessive, inadequate, or unfairly discriminatory, and must exhibit a reasonable relationship to the benefits provided in the policy.
Overall, individual market carriers in North Carolina are requesting 7% rate increases in 2025 for unsubsidized policies, while small group market carriers are asking for a 6.5% bump. It's worth noting that one of the three (!) UnitedHealthcare divisions is pulling out of the NC small group market next year for whatever reason.
In response, a couple of weeks later the Centers for Medicare & Medicaid Services (CMS) issued a statement about the actions they're taking to resolve the issue,
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (UIO). Today’s action is expected to improve access to culturally appropriate health care and improve the quality of care and health outcomes for tribal communities in Arizona, California, New Mexico, and Oregon, and will support IHS, Tribal, and UIO facilities in serving their patients.
Plans in the Health Insurance Marketplace® must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.
Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible
Covered contraceptive methods
FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:
Unfortunately, South Carolina is another state where they don't make unredacted rate filings available, either on the state insurance dept website, the federal Rate Review websiteor the SERFF database.
As a result, I'm limited to unweighted averages for both the individual and small group markets:
It's worth noting that Cigna Healthcare is dropping out of the South Carolina individual market next year, while Aetna is pulling out of the small group market (see below).
Back in June, I ran a state-by-state analysis which provided estimates of just how much various households would see their net individual market premiums jump starting in 2026 if the upgraded financial subsidies originally included in the American Rescue Plan Act (and later extended by the Inflation Reduction Act) are allowed to expire at the end of 2025, as is currently scheduled to happen without legislative action.
Washington Health Benefit Exchange (Exchange) and Health Care Authority (HCA) are pleased to announce Cascade Select will be available in all 39 Washington counties in 2025, with the addition of the two final counties: Lincoln and Grays Harbor.
“Cascade Select has grown significantly since it launched in 2021, with more than 75,000 Washington Healthplanfinder™ customers enrolled today,” reported Ingrid Ulrey, Chief Executive Officer for the Exchange. “In 2025, Cascade Select will be the lowest premium in 26 counties for silver health plans. Cascade Select has lower premiums compared to other health plans on the market because of the unique health care cost controls that save more money on premiums for consumers.”
Polis-Primavera Administration’s Landmark Reinsurance Effort Will Save Coloradans $493 Million on Healthcare Premiums in 2025, Putting Money Back in the Pockets of Hardworking Coloradans
Even more savings can be found by shopping and switching to a Colorado Option plan during open enrollment
DENVER - Today Governor Polis, Lt. Governor Primavera, and the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), announced that Reinsurance will save Coloradans almost $493 million on approved plans and premiums for 2025, building on the millions in savings available to Coloradans through Colorado Option plans. The figures below on the final, approved health insurance plans and premiums for 2025, highlight the impact of these efforts to save people money on health insurance.
