Marketplace Open Enrollment (OE) in states using HealthCare.gov is still open. The Centers for Medicare & Medicaid Services (CMS) recently reported that 496,000 consumers who do not currently have health care coverage through the individual-market Marketplace have signed up for coverage during plan year 2025. In addition, over 2.5 million existing consumers have returned to the Marketplace to select their plan for 2025.
With enrollment ending on January 15, active outreach is critical to help ensure that no one misses the deadline for Marketplace coverage. Clients who enroll by midnight on December 15 can get full-year coverage that starts January 1. Individuals who enroll after December 15 will have their coverage begin on February 1.
In the 20 states that do not use HealthCare.gov, the OE window for 2025 Marketplace coverage may vary. Visit our website for more information about 2025 OE windows, as well as Special Enrollment Periods (SEPs) and other opportunities for 2025 coverage, in states with state-based exchanges. 2025 Marketplace Open Enrollment will be updated as new information becomes available.
As you’re assisting clients in enrolling in healthcare plans, here are some reminders.
1) Financial help is available.
As you help your clients shop for a plan through HealthCare.gov or your state’s Marketplace, remember there are two types of financial assistance available to eligible individuals: Premium Tax Credits (PTCs) and Cost-Sharing Reductions (CSRs). PTCs and CSRs can help cover health insurance costs for plans purchased on the Marketplace.
PTC eligibility has expanded, and subsidies have increased. The Inflation Reduction Act (IRA) passed in August 2022 expands and increases PTCs for Marketplace coverage through 2025. This means:
- Many people who earn between 100% and 400% of the federal poverty level (FPL) can qualify for increased financial help through PTCs.
- People who earn below 150% FPL are eligible for a $0 premium plan.
- Many people who make over 400% FPL are eligible for Marketplace subsidies (people with higher incomes pay no more than 8.5% of their income for a silver plan premium).
Remember, the Ryan White HIV/AIDS Program (RWHAP), including the Part B AIDS Drug Assistance Program (ADAP), can help eligible clients in many jurisdictions cover some premium or out-of-pocket (OOP) costs (copayments, deductibles, coinsurance). Learn more about PTCs and CSRs with ACE’s FAQs: Premium Tax Credits (PTCs) and Cost-Sharing Reductions (CSRs) and Understanding Premium Tax Credits and Cost-Sharing Reductions eLearning Module.
2) Active plan renewals make a difference.
Encourage active renewal. If clients don’t take action during OE, they could end up being auto-enrolled into a Marketplace plan that may not be the best option for their health needs. Here are a few things to watch out for:
- If a client does not log into their Marketplace account to actively choose a plan by the last day of OE, they will be automatically re-enrolled in their current plan.
- If a client’s plan is not offered again this year, they will be auto-enrolled into a different plan with a similar premium amount. If they miss the deadline to re-enroll in a plan of their choice, they will not be able to make any plan changes until the next OE Period, unless they qualify for a SEP.
3) The Public Charge policy no longer affects eligibility requirements for any public benefit, regardless of a client’s immigration status.
There is no longer a relationship between health coverage and the public charge test. Learn more about the Public Charge final rule.
4) Deferred Action for Childhood Arrivals (DACA) recipients are now able to enroll in health coverage through the Health Insurance Marketplace.l
DACA recipients who need health care coverage in 2025 should enroll on HealthCare.gov by January 15. To help partners reach uninsured, qualified DACA recipients and inform them on how to enroll in Marketplace coverage, CMS has designed this toolkit with resources for social media, listservs, and other modes of communication.
5) The ACE TA Center is here to help.
Have questions about 2025 Marketplace OE? Send us an email.
We encourage RWHAP staff to customize the ACE TA Center's editable PDFs with your own organization’s logo and contact information so that clients know where to go for help:
In addition, check out these partner tools & toolkits and outreach & education materials which can help Navigators, Certified Application Counselors, and other partners promote, educate, and enroll consumers during the Marketplace OE Period. We also encourage you to access these CMS fact sheets for more information about how to assist clients in need of coverage: