Open Enrollment for 2025 health insurance plans has arrived. Policies are also available if you’re experiencing a Qualifying Life Event.
For others, short-term health insurance plans are an alternative to bridge small gaps. If you’re unsure, contact us to discuss the best coverage options.
Open Enrollment begins November 1, 2025 and ends January 15, 2026. In order to have a January 1 effective date, applications must be submitted by December 15th.
In September of last year, a new Special Enrollment Period was created. It applies to states using Healthcare.gov. It allows for year-round enrollment in Affordable Care Act plans for eligible applicants.
In order to qualify, your income cannot exceed 150% of the Federal Poverty Level. You must also be eligible for a tax credit covering a benchmark plan’s cost on the Marketplace.
There are no limitations on how often this new SEP can be used. Enrolling in a Silver Plan is advisable if you qualify (based on your income and household size). These plans offer the lowest cost-sharing amounts and have no monthly premiums. Contact us to learn more.
Oher year-round enrollment opportunities include recent loss of Medicaid or a Qualifying Life Event. There are nuances to these situations, so it’s advisable to discuss your case with a knowledgeable broker before submitting an application.
Not only has the Open Enrollment window been extended this year, but tax credit eligibility has also increased. This means more people will qualify for lower health insurance rates on the Federal Marketplace.
These savings apply to those who expect to make between 100-400% of the Federal Poverty level based on the size of their family. Your estimated income for this year determines your subsidy. If your income looks to be significantly different, then it’s imperative that you report that to the Marketplace. We can help.
And certain applicants will also qualify for cost-sharing reductions on their chosen health insurance as well. This means your out-of-pocket costs like deductibles, coinsurance and copayments will be less. Plan premiums and out-of-pocket exposure will be less the closer you are to 100% of the Federal Poverty Level. It’s based on a sliding scale.
If your estimated household income is less than 100% of the FPL, you may qualify for Medicaid. You can inquire with your State officials about Medicaid eligibility.
If you are outside of open enrollment, proof of a qualifying life event is necessary to buy insurance on the Marketplace. There is a long list of qualifying life events that qualify – view the list here. If you are involuntarily losing creditable health coverage, you can buy insurance on or off the Federal Exchange.
The Exchange/Marketplace is the best place to go if you qualify for a tax credit based on your income – or if you have preexisting conditions. There is no medical underwriting and your premiums will be less if you’re below certain income thresholds.
On the exchange, we work with several insurance companies, including Ambetter, Anthem BCBS, CareSource, Cigna, Bright Health, Health Net, Humana, Medical Mutual of Ohio, Molina, Oscar, and a few others.
If you are not experiencing a Qualifying Life Event, then purchasing a short-term health plan may be your only option. We work with several insurance companies that offer short-term policies, including Anthem Blue Cross and Blue Shield, Aetna, Medical Mutual, United Healthcare, and many others.
The Affordable Care Act has changed the way we buy insurance. In some areas, there are fewer options with smaller networks. If you’re losing group insurance, then you may be finding this out for the first time.
Most plans sold on the Exchange are HMOs. This means you must stay in their network to receive care. If you are outside of the network for anything other than an emergency, you might be responsible for the entire amount.
PPOs are still available from many short-term providers. In fact, some of our clients are buying short-term plans that last for two to three years.
There is not a right or wrong way to buy health insurance for yourself or your family, but you may want our guidance. Navigating the Exchange on your own can be difficult. We can help you see if your doctors are in network with the plans in your area. We can also assist with pricing any prescriptions you’re concerned about.
We recognize that you may wish to quickly enroll in a medical coverage plan without agent assistance. We have provided links for our independent clients. With us, you are buying directly from the health insurance provider at no additional cost. You get the advantage of comparing health insurance plans from several competing carriers before purchasing coverage.
Costs will vary depending on the carrier and selected health plan. There are no fees or surcharges to use our software in order to purchase health insurance online.
You are buying directly from the insurance company. We will be your agency of record, but this does not add any extra cost to your coverage whatsoever. You’ll be able to see all Exchange plans available in your area. And our software will also allow you to apply for any tax credit available to you and/or your family.
If you wish to call us, we will be happy to answer your specific questions regarding the differences between various health insurance plans. You may find the process of buying online easier once talking with one of our knowledgeable agents.
Some of our clients are better suited for Marketplace plans, while others may prefer short-term plans that can last for several months – or up to three years in certain states.
We are here to help. Contact us today to discuss your needs, budget, and concerns.
