The official 2025 Open Enrollment Guide + FAQs

Joyful Open Enrollment 2025! We could also be a number of the solely individuals who deal with Open Enrollment as a significant vacation. We will not assist it. We love this time of 12 months! However we perceive that not everybody shares our enthusiasm, so we produced this brief information that will help you navigate Open Enrollment. If that is your first time shopping for particular person medical insurance, this text might be your greatest pal.

Up to date October 1, 2024, in anticipation of Open Enrollment 2025! 

Yearly, we hear lots of the identical questions from people identical to you who’re having to navigate the well being care system exterior of a standard group plan. Don’t fret! We now have many sources, together with this information, that will help you.

As you find out about subjects like Open Enrollment, particular person insurance coverage, and HRAs, please do not forget that our platform will stroll you thru your complete course of and aid you select a plan that won’t solely be just right for you however one which may even work along with your HRA 2025.

Listed here are a couple of of the high-level questions, in addition to a number of related questions, this information addresses intimately: 

Our platform will stroll you thru your complete course of and aid you select a plan that won’t solely be just right for you however one which may even work along with your HRA.

Part 1: What’s Open Enrollment?

What’s Open Enrollment?

Open enrollment is the annual interval when people like you’ll be able to enroll in a medical insurance plan. For 2025, it is from November 1st to January fifteenth in most locations, though there are a couple of exceptions. Some states are completely prolonged via January thirty first, like California, Nevada, New Jersey, New York, Rhode Island and Washington D.C. Massachusetts has completely prolonged via January twenty third. 

For protection starting on January 1st, nevertheless, the deadline to enroll is December fifteenth nationally, no matter when open enrollment ends.

In the event you enroll after December fifteenth, however earlier than the January fifteenth deadline, your protection will start February 1st in most states.

In the event you’re over 65 and enrolled in Medicare, you get a head start from October 15th through December 7th to review and make any changes to your Medicare coverage, which will go into effect January 1st .

Why is Open Enrollment limited to specific dates?

Health insurers limit the open enrollment period to prevent adverse selection.  Adverse selection happens when sick people sign up for a health plan, but healthy people don’t, which throws the amount of risk a health plan takes on out of balance when insuring someone.

Where can you buy individual insurance?

During open enrollment, insurance plans are available from major medical insurance companies to purchase from “the marketplace” or “exchange.” These plans are referred to as  “on-exchange” plans. Most states use the federal exchange, Healthcare.gov. Some states, like California, New York, Pennsylvania, and a few other states, have their own state-run exchanges and enrollment systems. 

When you shop at Healthcare.gov, you’re only seeing “on-exchange” plans. However, insurance companies only make a fraction of their plans available “on exchange.” If you go directly to an insurance company’s website, you’ll see their “off-exchange” plans.

The Take Command platform is a great place to start shopping because you can look at ALL of the available plans side by side (including “off-exchange” plans) to compare – and see which plans are “Easy-Enroll”. True to the name, Easy Enroll plans have easy, fast enrollment (Take Command takes care of it!) and our team can support you with the Carrier! Look for the Easy Enroll tag for added peace-of-mind.

If you’re ready to start shopping, you can view all of your options side by side on our platform.

What is “the marketplace” or “exchange”? 

The Affordable Care Act created a health insurance exchange, or online marketplace, where individuals can shop for individual health insurance plans and compare their health plan options. This is known to most as Healthcare.gov. Individuals are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange.

Why is Open Enrollment significant for me?

Because your employer is offering you a health reimbursement arrangement, now is the time to purchase your plan for coverage starting on January 1st, 2025. It’s important to note that you’ll need to enroll by December 15th, 2024 for coverage that starts January 1st, 2025. Open enrollment continues through January 15th for February 1st start dates. As mentioned above, the dates may vary slightly in some states.

Open Enrollment is the time when you can buy a compliant plan that is qualified for your HRA (either a qualified health plan for ICHRA or a Minimum Essential Coverage plan for QSEHRA). If you’re a client already using our platform, there will be a to-do list on your dashboard. If you are new here, we will walk you through onboarding which will include shopping for a plan. After Open Enrollment begins in November, you’ll receive an email to log in and get started shopping for individual health insurance.

Section 2: How To Buy Individual Insurance

How do you buy individual insurance?

It can be a little overwhelming! Before you shop, start by thinking about what’s important for you and what health needs you anticipate for the year. Good questions to ask yourself include, Is it more important to have a low premium or a low deductible? Do you regularly see a specialist that needs to stay in-network? Do you have a lot of prescriptions that you’ll need covered? Are you anticipating any medical needs this year (i.e., ongoing physical therapy, surgery, or pregnancy?)

It’s good to think these things through, because what really drives costs–and therefore your plan choice–are the things you know about: prescriptions, doctor visits, therapy, medical equipment, etc. If you’re healthy, maybe you plan on none of these things–which is just as important to know. Unpredictable costs, like catching a cold, spraining an ankle, or a hospitalization, shouldn’t impact your plan choice. 

Our shopping portal allows you to enter a provider’s name to see which plans show them as in-network and see if specific prescriptions are covered in a plan’s drug formulary.

More than 75% of your healthcare costs in the next year are predictable based on your needs.

How do you know you’re getting the best price for your plan?

Here’s some good news for simplicity: any given plan sold during Open Enrollment will be priced exactly the same no matter where you find it. If you find a plan you like, say a Blue Cross Blue Shield silver plan on Healthcare.gov, it will legally be priced the same whether you purchase it on the Exchange, or from a broker friend. 

The prices on our individual health insurance shopping portal will show you the best prices for all of your health plan options. 

How do you know if the plan you want to buy qualifies for your company’s HRA?

Gather round, friends. This is a really important question. Why? Because not all plans integrate with HRAs, meaning that not all plans will be reimbursed through an HRA and not all plans will qualify you to participate in your company’s HRA. Best to get this right the first time. 

Here’s an easy, quick list to get started:

ICHRA-compliant plans:

Plans that don’t work with ICHRA include sharing ministries, TRICARE, short term and indemnity plans, and other employer sponsored group plans (either from spouse, COBRA, or retirement plan). 

QSEHRA-compliant plans:

• Major medical plans: Major Medical plans are those compliant with the Affordable Care Act (ACA) and qualify as Minimum Essential Coverage. If you purchased your plan through Healthcare.gov or your state’s public market, your plan is a Main Medical plan, and your reimbursement via QSEHRA might be tax-free.
• Pupil insurance coverage
• Your partner’s plan (varies by QSEHRA plan): In the event you’re coated by your partner’s group insurance coverage plan there are some nuances to know concerning premium reimbursement. First, solely the portion of the group premium that’s  not paid for by your partner’s firm is eligible for reimbursement. Second, most group plans are already paid on a pre-tax foundation out of your partner’s paycheck. That is nice! Nevertheless, the IRS doesn’t need you to “double dip” and in addition get a pre-tax QSEHRA reimbursement, so your QSEHRA declare on your premium could also be paid on a taxable foundation (plan relying). In the event you can confirm that your premium is paid post-tax by your partner (very uncommon), then you’ll be able to nonetheless be reimbursed tax-free via QSEHRA!
• Authorities plans: Medicare, Medicaid, CHIP (kids’s medical insurance applications), TRICARE, and VA Care are all eligible healthcare plans and qualify as Minimal Important Protection. In case you are on one in every of these plans and pay a month-to-month premium out of pocket, these will be reimbursed via QSEHRA tax-free.
• Dental Insurance coverage & Imaginative and prescient Insurance coverage Plans: Month-to-month premiums paid for particular person and dental insurance policy will be reimbursed tax-free via QSEHRA. When you’ve got dental and imaginative and prescient advantages via your partner’s employer, solely the portion of the group premium that’s  not paid  for  by your partner’s firm is eligible for reimbursement. As well as, in case your partner pays the premiums on your dental and insurance policy pre-tax, you’ll be able to solely be reimbursed for these premiums on a taxable foundation. 
• Restricted Profit Plans: Restricted Profit Plans are often considerably cheaper than Main Medical plans however solely present a hard and fast quantity of advantages (vs. limitless advantages). These plans embody short-term plans, fastened indemnity plans, accident plans, and some other plan that pays a medical profit. So long as you even have a Minimal Important Protection well being plan, and the restricted profit plan pays a medical profit to the supplier (not a money profit to you), the premiums on these plans will be reimbursed tax-free via QSEHRA. 

Here’s a publish on plans that combine with QSEHRA and plans that combine with ICHRA that will help you weigh your choices. 

Confused?

Here is the excellent news: Any plan that you simply buy on the Change might be compliant along with your HRA. Main medical off-exchange plans which are obtainable throughout Open Enrollment will qualify as properly.

And this is extra excellent news: our platform will maintain your hand via this whole course of. 

Professional-tip: To see if a plan integrates along with your HRA, test for a metallic tier (silver, platinum, bronze) within the identify or description of the plan. That is signal. 

What if I am on Medicare with my HRA?

Nice information! Medicare is reimbursable along with your HRA. Bear in mind, it’s essential to have protection of Half A and Half B collectively or Half C.  Half B by itself would not qualify.

To make this simpler, we have partnered with Chapter to make the Medicare enrollment course of a breeze. Chapter is a white glove service that may aid you discover the fitting Medicare Benefit and Medicare Supplemental plans which are designed to assist cowl the prices of assorted deductibles, co-payments and coinsurance fees that Medicare alone doesn’t embody.

All you may need to do is select a protection choice from main insurance coverage corporations based mostly on the place you reside and your particular person wants, then submit proof of protection to Take Command, together with receipts for eligible care, and get reimbursed tax-free.

Be taught extra on our Medicare partnership with Chapter here.

Necessary: Medicare Open Enrollment runs October fifteenth to December seventh. That is the time to judge current Medicare protection and your probability to make modifications to your Medicare protection.

What are some issues you need to keep away from whereas searching for a plan?

First of all, be an informed shopper. Download our PDF on “Health Insurance 101,” the place you may discover the fundamental definitions of key phrases you may must know whereas searching for medical insurance (like formulary!). Understanding medical insurance jargon will hold you out of hassle and cut back these stress ranges. 

One other factor to concentrate on is that if you’re buying exterior of an trade, for instance via a dealer, be careful for plans that say indemnity or brief time period as they do not qualify for QSEHRA or ICHRA. For QSEHRA, some plans like this may be supplemented to qualify however they won’t work for ICHRA. 

Additionally essential: In the event you’re leaving an organization and COBRA is an choice, 99% of the time, COBRA is a foul deal. Don’t simply settle for it as a result of it’s simple. You will be billed for as much as 102% of the entire price of protection; 100% of the price of your earlier plan plus a 2% administrative payment! 

How do I renew/hold my identical particular person plan?

In the event you’re completely happy along with your particular person plan and the insurance coverage firm is providing it once more in 2025, you’ll be able to renew your plan generally.

In the event you had an “Easy Enroll” plan with Take Command in 2024, you might even see the choice to resume your plan once you log in to buy. In some instances you might not see this selection. If your organization has an ICHRA with AutoPay, you’ll be able to store and select the identical plan for 2025. In the event you’ve had modifications that have an effect on your premium quantity like including/eradicating dependents or shifting, you’ll possible want to buy to be able to select the identical plan. 

Earlier than protecting the identical plan, take a while to contemplate your loved ones’s well being wants for 2025, which medical doctors it’s good to hold in-network, and what prescription protection is essential. If the identical plan from final 12 months nonetheless meets your wants, then merely renew or select it once more! 

Bear in mind, it by no means hurts to browse different plans to ensure your current plan remains to be your most well-liked plan.

To get began searching for a plan, head on over to our particular person medical insurance buying web page to check plans facet by facet and discover one that may be just right for you and your HRA.

Do I must cancel my outdated well being plan?

Sure!

In the event you’re altering insurance coverage corporations for 2025, ensure you name and cancel your outdated plan from 2024 earlier than they auto-renew – and cost you for a January 2025 premium!

Even when you should have the identical insurance coverage firm in 2025 as in 2024, however are altering the particular plan itself, we advocate calling and confirming that they solely have your new plan on file for 2024. You don’t need to pay for 2 plans! Notice that some carriers course of funds in the course of the month, so early December is the perfect time to cancel a 2024 plan.

Bear in mind that you’re protecting your 2024 plan efficient via the top of December as your new 2025 plan will develop into efficient January 1, 2025.

Part 3: What are Premium Tax Credit?

What are Premium Tax Credit?

Premium tax credit, often known as PTCs, are refundable credit (or subsidies) that helps eligible people and households cowl the prices of premiums for his or her medical insurance bought via the ACA Market, or Change. To obtain a premium tax credit score, it’s essential to meet sure necessities.

One technique to pay an excessive amount of for medical insurance is to depart cash on the desk. We see many people assume they are not eligible for tax credit after they really are. Relying on the place you reside, a household of three or 4 that makes $90,000 a 12 months will possible qualify for a tax credit score.   

Our particular person medical insurance buying portal will aid you calculate your premium tax credit in the event you qualify. 

How have you learnt in the event you qualify for Premium Tax Credit?

Typically talking, tax credit are tied to dimension and earnings. They additionally fluctuate throughout zip codes. It’s possible you’ll qualify for premium tax credit in the event you: 

• Fall inside a sure earnings vary
• Can’t be claimed as a dependent 
• Don’t file a tax return utilizing the submitting standing of Married Submitting Individually
• Have medical insurance protection via {the marketplace} or trade.
• Usually are not in a position to get inexpensive protection via an eligible employer-sponsored group plan that gives MEC.
• Usually are not eligible for protection via a authorities program, like Medicaid, Medicare, CHIP or TRICARE.
• Pay the share of premiums not coated by advance credit score funds.

Take Command Well being will help you determine how a lot you’re eligible for on our particular person medical insurance buying portal. 

How will your HRA have an effect on your Premium Tax Credit?

This can be a tough one. The means HRAs and PTCs work together depends upon what sort of HRA you have got. 

For QSEHRA: We are going to begin by explaining how QSEHRAs and Premium Tax Credit work collectively. Scroll all the way down to skip forward you probably have an ICHRA. 

Usually, QSEHRA allowance will cut back premium tax credit greenback for greenback.

Mainly the worker might be exchanging the tax profit from the federal government with the tax profit from the employer. The worker should entry their tax credit if the profit is lower than the premium tax credit score obtainable to them. 

For instance, if you’re eligible for a $500 tax credit score and your employer affords a $400 QSEHRA allowance, your PTC might be decreased to $100 ($500-$400). 

It’s very essential that staff buying a plan via {the marketplace} and receiving a premium tax credit score notify their insurance coverage supplier instantly about their small enterprise HRA profit.  The insurance coverage supplier will recalculate the worker tax credit score with the QSEHRA profit. Failure to report the QSEHRA to your insurer will lead to having to pay again the tax credit to the IRS throughout tax time.

FOR ICHRA: When you’ve got an ICHRA, this is what you need to find out about PTCs and ICHRA.

Staff can select to take part in ICHRA or obtain a PTC. You can’t have each.

A pleasant characteristic of the person protection HRA is that as an worker, you have got the choice to take part in your employer’s ICHRA or opt-out yearly via the opt-out provision. That is completely different then ICHRA’s predecessor, QSEHRA, which doesn’t permit staff to opt-out. 

In the event you settle for the Particular person Protection HRA, you can’t declare any premium tax credit for the 12 months for both your self or any members of the family. In the event you opt-out of the Particular person Protection HRA for the 12 months, you might be able to declare premium tax credit.

The Change will then decide if the ICHRA provided is deemed inexpensive or unaffordable for you. In instances the place an worker has opted out of ICHRA and the HRA is taken into account unaffordable the worker is allowed to say premium tax credit for themselves and dependents. In instances the place the worker has opted out of ICHRA and the protection is deemed inexpensive the worker could not declare any premium tax credit for themselves or dependents. 

When people enroll in an Change plan, the Change will ask if the person is obtainable any protection via their employer. This contains protection via the Particular person Protection HRA. Staff might be required to present discover to the Change of their ICHRA providing. 

In the course of the onboarding course of with Take Command, we’ll aid you perceive these nuances and decide what’s greatest for you.

How will you get extra details about Premium Tax Credit?

First cease, have a look at your plan paperwork in your portal. The worker discover, particularly, may have nice info on what to do about your PTCs that is tailor-made to you and your precise plan. Additionally take a look at the next sources:

Part 4: Different Open Enrollment FAQs

What’s an “on-exchange” or “marketplace” plan?

An on-exchange, or market plan, is a medical insurance plan that is bought on the ACA market or federal trade (a.ok.a. Healthcare.gov.) or, in some states, state-run exchanges. Any of those are thought of market plans and are eligible for premium tax credit.

What’s an “off-exchange” plan?

Off-exchange plans are provided by main medical suppliers and bought straight via them as an alternative of from the trade. 

Our particular person medical insurance buying portal reveals each on- and off-exchange choices. 

Can I purchase a plan that is not offered on the trade? Are there different choices in addition to Obamacare (ACA)?

Usually, there are different plans exterior of the ACA plans and the off-exchange plans talked about above. However bear in mind, it’s good to have a plan that qualifies for reimbursement via your employer’s HRA. For QSEHRA, there are some various insurance policy that qualify if sure circumstances are met. We are able to information you thru the method of weighing your choices and join you with a associate we belief. 

In the event you’re enrolled in an ICHRA, nevertheless, you may want a person medical plan. We advocate you make the most of open enrollment to buy an on- or off-exchange main medical plan that integrates with ICHRA. 

What do the metallic tiers imply? (Bronze, Silver, Gold, Platinum)

What the metallic tiers are telling you is how a lot the plan covers and the way a lot it prices.

Here is the gist:

Bronze:

• You hardly ever get sick or want medical companies, aside from an annual checkup and perhaps a drugs or two.
• You might be very wholesome and never aged.
• If shopping for a household plan, your kids are grown and wholesome and don’t take part in dangerous actions.  
• Count on to pay 40% out of pocket, 60% paid by your plan

Silver:

• Your loved ones members have one or two gentle circumstances that require some medicine and specialist visits, however nothing needing shut monitoring or frequent care.
• Your loved ones members are able-bodied and underneath 70.
• Any children are elementary age or older and wholesome, and play few or no sports activities that always trigger harm.
• Count on to pay 30% out of pocket, 70% paid by your plan

Gold:

• You or a member of the family has a power situation, sees medical doctors continuously or wants costly medicine that will be unattainable to afford out of pocket.
• Your kids are preschool age or youthful, needing frequent pediatrician visits.
• It’s possible you’ll be older or at the next danger for colds and flu than most individuals.
• Count on to pay 20% out of pocket, 80% paid by your plan

Platinum:

• You or a member of the family has an costly power situation and takes a number of drugs.
• You search pressing or emergency care greater than as soon as per 12 months on common, continuously want exams to handle a situation or see medical doctors greater than as soon as per 30 days.
• You might be older or at very excessive danger for colds, flu, or accidents.
• Count on to pay 10% out of pocket, 90% paid by your plan

Try our useful weblog publish on what the metallic tiers imply for extra info. 

What are insurance coverage “premiums” and “deductibles”?

A premium is the month-to-month price on your medical insurance. The premium is what your month-to-month allowance for an HRA will cowl.

A deductible is the quantity of coated healthcare prices you pay earlier than your medical insurance begins to cowl the prices. When you’ve got a $2,000 deductible, you may be paying $2,000 out of pocket earlier than insurance coverage kicks in. 

Professional-tip: Your month-to-month premium doesn’t depend towards your deductible. 

What are the variations between the community sorts (HMO, PPO, EPO)?

An HMO (or “health maintenance organization”) is mostly probably the most inexpensive, however least versatile community sort. Right here a couple of key ideas of a HMO:

• You might be required to pick a major care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You will have a referral out of your major care doctor to see a specialist.
• In the event you select to see a health care provider exterior of the community or with no referral, you’ll usually need to pay all prices out-of-pocket except it’s a true medical emergency or you haven’t any different choices.
• The doctor community is native.

A PPO (or “preferred provider organization”) is mostly probably the most versatile, but most costly community sort. Right here a couple of key ideas of a PPO:

• You do not want to pick a major care doctor and you do not want referrals to see a specialist.
• In the event you see an in-network supplier, you’ll solely be liable for paying a portion of the invoice (based mostly in your plan’s protection construction).
• In the event you select to see a health care provider who’s exterior the popular community, you’ll usually need to pay a bigger portion of the invoice than you’ll for an in-network supplier.
• You’ll have entry to out-of-state suppliers which are thought of in-network.

An EPO (or “exclusive provider network”) is a hybrid of a HMO and a PPO. Right here a couple of key ideas of an EPO:

• EPOs are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like a PPO, you do not want a referral to get care from a specialist.
• Like an HMO, you’re liable for paying out-of-pocket in the event you search care from a health care provider exterior your plan’s community.

A POS (or “level of service”) can also be a hybrid of a HMO and a PPO. Listed here are a couple of key ideas of a POS:

• POS plans are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like an HMO, you’ll need a referral out of your major care doctor to be able to see a specialist.
• Like a PPO plan, you should have entry to out-of-network suppliers (at an elevated price).

Can I alter medical insurance plans in the course of the 12 months?

You’ll be able to solely change plans and purchase on-exchange plans throughout Open Enrollment (from November 1st via January fifteenth) except you meet sure circumstances that qualify you for a Particular Enrollment Interval. These circumstances embody having a child, getting married, getting divorced, or altering jobs. In different phrase, large life modifications.

In case you are provided an HRA for the primary time out of your employer, that qualifies you for a Particular Enrollment Interval as properly, the place you may have 60 days to enroll in a well being plan that meets your HRA necessities. 

Professional-tip: We advocate you benefit from Open Enrollment to enroll in a plan. You may have extra choices.

Learn our posts on Particular Enrollment Durations for QSEHRA or Particular Enrollment Durations for ICHRA for more information. 

What about dental insurance coverage? 

There are two methods to enroll in dental insurance coverage.

1. The Market: Dental plans typically are included in well being plans offered on the Market or state-based exchanges. While you examine plans on our window buying software and even on Healthcare.gov, you can see which of them embody dental protection. In these instances, your premium would cowl each well being and dental protection. 
2. Separate dental plans: In case your well being plan doesn’t embody dental protection, you might to buy a separate dental insurance coverage plan. Simply bear in mind, in the event you decide a separate dental plan, you’ll pay a separate premium. That is along with the premium you pay on your particular person medical insurance plan. Typically, once you’re buying on the Change, you may see an choice so as to add a dental plan. This can present additional choices for you. For our shoppers, we now have researched high quality particular person medical insurance plans via Renaissance and AmFirst that we advocate to make use of with an HRA. 

Here is a useful publish for extra details about our dental partnerships.

Subsequent Steps

That is an thrilling time, and we’re honored to part of this course of with you. When you’ve got some other questions as you start the method, please attain out. We’re right here that will help you! And for these of you who’re able to being, please login to our portal and we’ll stroll you thru the method.

Joyful Open Enrollment, everyone!