Congress will discuss the future of ACA Marketplace subsidies in the coming months, but 2025 subsidy eligibility guidelines are locked in, and there’s still time to select a Marketplace plan for 2025. Jan. 15 is the deadline in most states to enroll in ACA-compliant coverage — also known as Obamacare — for the 2025 plan year.
“Most enrollees will qualify for federal subsidies that help lower the cost of health insurance purchased through the ACA Marketplaces,” said Louise Norris, health policy analyst for healthinsurance.org. “The enrollment period is nearing its end so the time to enroll is now.”
The annual open enrollment period began on Nov. 1. In all but seven states open enrollment ends on Jan. 15. The exceptions are Idaho (Dec. 16); Massachusetts (Jan. 23); California, the District of Columbia, New Jersey, and New York (Jan. 31); and Rhode Island (Feb. 28).
Missing the open enrollment deadline can have serious consequences. Here’s what consumers need to know:
1) This may be your only chance to sign up for 2025 coverage
Once open enrollment closes, you can’t enroll in an ACA-compliant plan unless you qualify for a special enrollment period. Most special enrollment periods are triggered by qualifying life events, such as losing other coverage or having a baby. This is true regardless of whether you’re trying to obtain coverage through the Marketplace or directly from an insurance company.
“This is an important deadline because open enrollment may be your one chance each year to enroll in ACA-compliant coverage, as well as Marketplace tax credits that make that coverage more affordable,” explains Norris.
ACA-compliant plans include key characteristics such as coverage for pre-existing conditions, out-of-pocket spending caps, and essential health benefits like preventive care and prescription drugs.
2) You may get stuck with a plan you didn’t pick
If you have existing Marketplace coverage but don’t shop for a new plan, the Marketplace will automatically re-enroll you.
While auto-renewal prevents gaps in coverage, it can lead to surprises as plan benefits, premiums and subsidies often change from year to year. Also, some plans were discontinued for 2025.
Last year, nearly 6.6 million enrollees let their coverage auto-renew for 2024, missing the chance to explore options that may have been better for them.
“Putting your enrollment on auto pilot can be convenient but comes with the risk of surprises,” explains Norris. “Shopping during open enrollment ensures you choose a plan that best suits your needs, covers your medications, and fits your budget.”
3) You may lose out on savings
Enhanced subsidies, made possible by the American Rescue Plan and Inflation Reduction Act, are available for 2025 coverage and can help reduce Marketplace premiums for millions of enrollees. And as a result of the “family glitch” fix that took effect in 2023, the family members of some workers are eligible for Marketplace subsidies if their employer-sponsored family health insurance is considered unaffordable.
To continue receiving a Marketplace subsidy in 2025, you may need to participate in open enrollment, rather than rely on auto renewal. Auto renewal can sometimes result in losing your subsidy if you don’t provide updated financial information and haven’t authorized the Marketplace to access your updated tax return data.
In 2024, 20.1 million out of the 21.6 million Americans who purchased health insurance through ACA Marketplaces received enhanced subsidies, according to the Congressional Budget Office.
While subsidy guidelines are intact for 2025, extending enhanced premium subsidies beyond 2025 would require federal legislation.
“It’s hard to say if the current level of savings will continue to be available on Marketplace plans next year, but that’s all the more reason to make sure you’re not missing out for 2025,” Norris said. “But remember, there’s not much time left to enroll, so don’t let the deadline pass you by.”