ACA open enrollment for 2025: What you need to know

Premium tax credits extend to DACA recipients

Any health insurance entity, especially a marketplace designed to reduce the uninsured population, should aim to reduce healthcare costs for enrollees.

A key way that CMS tries to achieve that goal in the ACA marketplace is through premium tax credits and cost-sharing reductions. In 2025, a new group of enrollees will benefit from these premium reductions: Deferred Action for Childhood Arrivals (DACA) recipients. As of Nov. 1, 2024, DACA recipients will be eligible for premium tax credits as lawfully present individuals. Previously, DACA recipients' uncertain residency status precluded them from enrolling in ACA marketplace plans.

Some long-standing policies continue to provide cost reductions in 2025 as well. Namely, the American Rescue Plan Act of 2021 and Inflation Reduction Act of 2022 will ensure better subsidies for consumers.

Marketplace plans continue to increase

Since every enrollee faces different healthcare conditions and every health plan has a different strength, increasing the number of health plans on the ACA marketplace is a concrete goal each enrollment season.

CMS shared that, during the 2025 ACA open enrollment season, nearly all (97%) HealthCare.gov consumers will have three or more payer options. From 2021 to 2025, the share of enrollees who have access to three or more issuers increased by 18%, although most of that growth happened prior to 2024. From 2024 to 2025, this stat saw only a 1% improvement.

Nearly a third of all counties (32%) will have five or more insurers on their exchange. In states like Oregon and Nebraska, most counties had five or more plans available. Alaska was the only state in which most counties had only one insurer per county.

CMS returns to tried-and-true outreach methods

Ensuring that consumers know their options and are aware of the ways that they can lower their healthcare costs is a top priority heading into any ACA open enrollment season. Studies have shown that outreach efforts, such as personalized phone calls have a positive impact on enrollment, can ensure that uninsured and underserved individuals can make an informed choice about their healthcare coverage. As a result, CMS is constantly refining its ACA open enrollment outreach and consumer support tools and strategies.

For the 2025 enrollment season, CMS extended the special enrollment period in a policy finalized in April 2024. This policy also standardized certain federal- and state-level functions to create a more unified and accessible member experience.

CMS also relied on proven methods to reach potential and current enrollees. The agency launched another nationwide, multi-platform outreach campaign. These efforts targeted underserved populations and uninsured individuals specifically. Reigniting an old partnership, CMS and the IRS teamed up to contact potentially uninsured individuals and inform them of their options in the marketplace. The agency worked with culturally competent partners to ensure successful communication with minority and non-English-speaking groups.

The agency provides two other key resources to connect consumers with trained individuals who can help them discern the best insurance plans for them. The Champion for Coverage program includes over 2,200 organizations that are actively providing consumer education and support during open enrollment. And HealthCare.gov/find-assistance helps consumers find agents, brokers, or assistants that can support them in the application and enrollment processes.

CMS also invested in training for the marketplace call center both pre-open enrollment and throughout the enrollment season. Call center employees will support enrollees alongside local support systems such as over 5,000 Navigators and assisters and 64,000 registered agents, CMS indicated. These federally funded Navigators are crucial since, in the past when funding diminished, private insurers did not step up to increase marketing in the most affected areas.

Finally, the agency sends out notices every year to inform consumers about open enrollment dates and update personal information. They also might receive notices if they are about to lose their premium tax credits.

With the ACA open enrollment season for 2025 underway, CMS will continue to invest in well-tested approaches to improve access to plans, lower costs, and reach as many eligible Americans as possible.

Kelsey Waddill is a managing editor of Healthcare Payers and multimedia manager at Xtelligent Healthcare. She has covered health insurance news since 2019.