ACA Open Enrollment 2025 – The Ultimate Guide

Autumn is here, and that means it’s time for pumpkins, apple cider, and the ACA annual open enrollment period.

If you need to change your ACA health coverage — sometimes called “Obamacare” — this is the time to do it. You may add or remove dependents, change details, like your income or marriage status, buy a more comprehensive plan to suit your medical needs, or shop the insurance marketplace for more affordable health care options.

And the experienced team of insurance agents at Einsurance.com is here to help.

Today, we answer all your most frequent questions about ACA open enrollment period in 2025. Keep reading to discover:

• When is the ACA open enrollment for 2025?
• Types of health insurance available to US residents
• About Healthcare Open Enrollment 2025
• When do children get their own health insurance?
• How to apply for Obamacare by myself
• “Can I keep my doctor if I change health insurance during open enrollment?”
• More about state-run health insurance marketplaces
• What is a formulary? Does it matter to me?

First things first. If you only need to know the ACA open enrollment dates, find them below.

When is the ACA Open Enrollment for 2025?

If you need to make changes during open enrollment for 2025, note of these important dates:

• November 1, 2024, is the first day of ACA open enrollment
• December 15, 2024, is the last day you can make any changes to your health insurance for coverage starting January 1, 2025
• And January 15, 2025, is when the open enrollment ends and the last day to enroll in or make any changes for the year with coverage starting February 1, 2025

In other words, the changes you make this fall won’t affect your health plan until 2025.

Historically, these dates have been the same every year. Some state-run exchanges have different schedules. Please check here to make sure that you enroll on time.

During the ACA open enrollment period, you may:

• Add or remove dependents
• Look for a more affordable plan
• Shop for a more expensive plan that will cover your changing medical needs
• Or change other important details on your plan, like your address and phone number

Also, know that some states may extend or alter these dates if they provide state-run health plans. California residents, for instance, have Covered California, and the open enrollment period runs from November 1 through January 31.

Some consumers know they need to make changes to their health insurance plan, but they’re not sure who to contact or how to do it. If you’re not sure what sort of health insurance plan you have, let’s take a moment to sort it out.

Types of Health Insurance Available to US Residents

Americans may have group health insurance through their employer, a metal tier plan (Gold, Silver, Bronze etc.) through their state’s ACA insurance marketplace, Medicare (Medi-Cal), or Medicaid. It’s confusing, we know! Let’s take a glimpse at each type of health coverage.

What is ACA / Obamacare?

When President Obama signed the Affordable Care Act (ACA) into law in 2010, his goal was to make healthcare available for more Americans. Prior to that time, many consumers struggled to find health insurance because they had pre-existing conditions, were unemployed, or simply couldn’t afford any plans on the market.

Chances are, you have an ACA plan if you:

• Used the internet to buy health insurance through your state’s insurance marketplace
• Have a healthcare plan described as “Bronze, Silver, Gold or Platinum”
• Went to a local health insurance agent to buy a plan for yourself and your family, outside of any employment situation

One significant point of the ACA is the metal tier system. Understanding it will help you choose the right health insurance, and we’ve written about health insurance metal tiers extensively in the past.

The Metal Tier Plan for US Health Insurance

The metal tiers all reflect the same level of insurance across all providers. For example, a Bronze Plan sold by Company A is nearly identical to a Bronze Plan at Company B.

The same can be said for all Silver plans, all Gold plans and all Platinum plans. They will all offer the same coverage and deductible levels from one company to the next. The only difference is the price, so it pays to shop around.

Think of it like buying a can of Coca Cola. A can of Coke, from any place you buy it, will have the same ingredients. Some places charge more.

If you need to make changes to your ACA health insurance policy, you must do it during the annual open enrollment period. “Open enrollment 2025” starts on November 1, and depending on your state, may run through December 15, or a later date.

During open enrollment 2025, you can:

• Enroll or unenroll
• Change plan level
• Change provider
• Add or remove dependents
• Change key details of your policy, like your name or address

What is a Group Health Insurance Plan?

Group health insurance is usually offered through an employer. If you buy health insurance with a discount through your job, this is the type of insurance you have.

Federal & State Plans: Medicare, Medicaid, Medi-Cal

Medicare

Seniors aged 65 and older usually qualify for Medicare if they’ve paid into the system through payroll deductions throughout their lifetime. This is not ACA / Obamacare, and you can enroll in Medicare during a seven-month window around your 65th birthday.

Medicaid (Medi-Cal in CA)

Medicaid is a federal-state program for individuals with certain disabilities, low-income families, pregnant women, and others with unique needs. This is not part of ACA / Obamacare, and in California, it is called Medi-Cal.

Explore the table below to figure out which sort of health insurance you have, and how to reach those providers.

There are a few other types of health insurance available. Active duty service members, veterans and their families may have TRICARE. If you have TRICARE, you don’t need to enroll in Obamacare.

About Healthcare Open Enrollment 2025

Regardless of the type of health insurance you have, autumn is the time to make changes. The “health insurance year” runs concurrently for all plans. In other words, the Medicare open enrollment for 2025 runs at the same time as group insurance open enrollment, which is the same as Obamacare open enrollment.

It’s a busy time of year for health insurance agents!

When Do Children Get Their Own Health Insurance?

Currently, children can stay on their parents’ health insurance plans until they are 26. They do not even need to live with their parents to keep this coverage.

However, once you hit that milestone, you will need to find health insurance yourself. You can do that during the ACA open enrollment period, which begins November 1.

Now, let us discuss how to enroll for ACA health insurance / Obamacare if this is your first time.

How to Apply for Obamacare by Myself

If this is your first time applying for health insurance, you might feel intimidated. Fear nothing! The professionals at Einsurance are here to walk you through the process.

First, note the dates. The health insurance open enrollment period begins November 1. We suggest you make this a priority before the holidays go into full swing. We’ve seen many consumers get overwhelmed with holiday activity and forget to make their important health insurance deadlines.

Next, gather your documents. You will need:

• Your Social Security number (though not always)
• Your ID card
• A good mailing address
• Any prescriptions you take regularly (this can help you decide which plan to buy)
• And your doctor’s name if it is important that you stay with the same provider

Then, use the internet to search for “Health Insurance in [your state].” Or try our handy online quoting tool at Einsurance.com. We can match you with insurance agents offering affordable health insurance.

Buying Health Insurance: Which Metal Tier Plan Should I Choose?

As licensed insurance agents, this is a question we get a lot during the open enrollment for health insurance.

But we are all individuals, and there is no set formula that says, “buy this plan at this age.”

However, if you are young and healthy, a Bronze plan will offer the lowest monthly payments. But remember, expensive prescriptions, therapy, surgeries, and healthcare visits will cost more.

Conversely, if you’re older, have several health issues and take several expensive medications, a Gold or Platinum plan may be a better choice. These plans cost more every month, but they cover more of your needs.

You may prefer a more expensive monthly premium if you’re living with a health condition such as:

• Heart conditions
• Kidney conditions
• A history of cancer
• Respiratory disease, like mesothelioma
• Diabetes
• Dementia, Alzheimer’s, or Parkinson’s diseases

Remember to get several quotes! All Bronze plans will cover the same things, but the prices can be different from one provider to the next.

Can I Keep My Doctor if I Change Health Insurance During Open Enrollment?

This is another common question, but we cannot answer it directly.

If staying with the same doctor is important, you need to ask them which insurance they accept. Some only take Medicare, others only work with ACA / Obamacare plans. Some only work with a few select insurers in their area. It just depends on your doctor!

Luckily, this is an easy call to make. The office staff will know which insurers they accept, so give them a call.

More About State-Run Health Insurance Marketplaces

The Affordable Care Act — Obamacare — is a federal system. But every state can create their own health insurance marketplace.

According to Healthcare.gov, the following states and districts are offering websites with state-run plans:

• California
• Colorado
• Connecticut
• Washington DC
• Georgia
• Idaho
• Kentucky
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New Mexico
• New York
• Pennsylvania
• Rhode Island
• Vermont
• Virginia
• Washington (state)

Note that Georgia is offering a state marketplace for the first time for 2025. If you are a Georgia resident looking to enroll in Obamacare during this open enrollment period, you can do it online, or contact the team at Einsurance for fast, affordable healthcare quotes.

Finally, let’s explore a key point about health insurance options and the open enrollment period. We’re talking about prescription medications and formularies.

What is Formulary? Does it Matter to Me?

Earlier in this piece, we mentioned the importance of your medications when choosing a health insurance plan during the open enrollment period 2025. This is because insurers keep formularies — lists of prescriptions they will cover at X prices — and you need to know your medication is covered.

Remember that all metal tier plans are equal. They all cover some types of antibiotics, some types of pain medications, and certain other common drugs. It’s the price you’ll pay from one insurer to the next that is the main difference.

However, some prescriptions are not available in generic forms and others aren’t covered without paperwork from your doctor. It can get complicated, but in short, if you take several medications, be sure to mention these when shopping for health insurance during the ACA open enrollment period 2025.

You might discover it’s better to buy a more expensive tier (say, a Silver or Gold plan), or work with a certain insurer who covers your specific drugs.