What to know about marketplace open enrollment for 2025

Modern Healthcare – Wednesday, November 6, 2024
By Nona Tepper

In 2014, the very first open enrollment period for the health insurance exchanges had a disastrous start. HealthCare.gov was broken, frustrating eager shoppers and lending credence to critics who said the Affordable Care Act of 2010 was destined to fail.

The early years of the marketplaces brought other challenges that threatened to unravel the new system for subsidized health insurance. President Barack Obama’s administration struggled to ensure there were enough insurers participating as some major companies saw the initiative as a money-loser.

A lot has changed in a decade. The exchanges have evolved into a stable platform for coverage and a profitable business for health insurers. Last year, aided by beefed up premium tax credits, enrollment reached a record high surpassing 21 million.

When health insurance customers visit HealthCare.gov, Covered California, Your Health Idaho and other marketplaces this year, they will find an average of 9.6 plans from which to choose, up from 7.6 in 2014, according to federal data compiled by the health policy research institution KFF.

That reflects investment and commitment to this market from companies ranging from UnitedHealth Group to Centene to Oscar Health. Exchange plans now generate higher average profit margins than any insurance product other than Medicare Advantage, KFF reported.

The open enrollment period for 2025 began Nov. 1 and ends Jan. 15 in most states. The exceptions are Idaho (Oct. 15-Dec. 16), Massachusetts (Nov. 1-Jan. 23), and California, New Jersey, New York, Rhode Island and the District of Columbia (Nov. 1-Jan. 31). In addition, a state-based exchange, Georgia Access, debuted in the Peach State.

Here’s what to know about the 2025 open enrollment period on the health insurance exchange marketplaces:

Premiums

The average premium for benchmark silver plans is 3% higher this year, although the vast majority of exchange customers won’t feel that because subsidies rise by a corresponding amount. During open enrollment for 2024, 93% of consumers were eligible for tax credits. This does not account for people who buy unsubsidized individual market policies outside of the exchanges.

Although it will not affect 2025 sign-ups, the enhanced tax credits are due to expire at the end of next year unless Congress extends them. California, Colorado, New Mexico and New York provide additional financial assistance to some exchange enrollees.

CVS Health subsidiary Aetna instituted the largest average premium increases among large, for-profit insurers by hiking rates 16.6% to $511.60 a month, not counting subsidies, according to an analysis by the investment bank Stephens.

By contrast, Centene, Elevance Health, Oscar Health and Molina Healthcare reduced premiums on average compared to 2024. Stephens attributes that to growing competition in this market.

Competition

At least three health insurance companies are offering exchange plans for 2025 in 82% of counties, up from 78% during the previous sign-up campaign. For example, UnitedHealth Group entered the Indiana, Iowa, Nebraska and Wyoming markets for 2025 and now sells UnitedHealthcare marketplace policies in 30 states.

Yet there may be fewer total plans for sale in some markets because 2025 is the second year in which the Centers for Medicare and Medicaid Services has encouraged standardization and limited how many different policies insurers may offer at each metal, network and service are level.

“The number of plans being offered that are minimally different from each other has gone down dramatically over the past couple of years. Choice overload has gotten a little bit better and the market is stable,” said David Anderson, a professor at the University of South Carolina Arnold School of Public Health.

In addition, Oregon launched Oregon Health Plan Bridge as an alternative for people with incomes up to 200% of the federal poverty level, or about $30,100 for a single person. Oregon is the third state after New York and Minnesota to create a Basic Health Plan such as this under the ACA.

Fraud

CMS tightened oversight of brokers and other third-party marketers after more than 200,000 consumers reported being switched into a news plans without their consent this year. The agency now requires marketers and customers to call marketplace customer service together to change policies.

Network adequacy

In April, CMS finalized a regulation designed to improve access to care for exchange enrollees. Insurers must guarantee that members will not have to wait longer than 10 business days for a mental health appointment, 15 business days for routine primary care visits or 30 business days to see a specialist.

Special enrollment periods

The same final rule provides greater flexibility for low-income people to use the federally managed health insurance exchanges. Starting next year, people who earn up to 150% poverty — about $22,600 for a single person — may enroll at any time. This policy is optional for state-based marketplaces.

ICHRAs

Insurers such as Oscar Health, Centene and Highmark Health see the exchanges as a pathway to the employer-sponsored health benefits market. These insurers are pitching individual coverage health reimbursement arrangements, or ICHRAs, to businesses seeking to limit healthcare expenditures. Under these arrangements, employees receive vouchers they can apply to exchange plans of their choosing, although they are not also eligible for premium tax credits regardless of income.

For this open enrollment period, health insurance companies must report when their members are new ICHRA customers. CMS aims to use the data to evaluate the effects of these arrangements on the risk pool.

‘Dreamers’

In May, President Joe Biden finalized a policy opening the exchanges and the subsidies to people whose parents illegally brought them to the U.S. as children and who qualify for the Deferred Action for Childhood Arrivals program, or DACA. The government projects about 100,000 uninsured “Dreamers” will sign up for coverage.

Nineteen Republican state attorneys general are suing to repeal this policy, however, which could invalidate those enrollments.

“What happens if the judge steps in and says, ‘No, the Biden administration policy is invalid?’ What happens to the coverage for people who have signed up, or if they’ve started to get premium tax credits?” said Sabrina Corlette, co-director of the Georgetown University Center on Health Insurance Reforms.

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