What you need to know about ACA open enrollment

Each November is when you need to start thinking about your health insurance status and plan for any updates to your coverage. Whether you’re considering health insurance as an individual or family, it’s essential to be prepared for the Open Enrollment Period for coverage through the Affordable Care Act. 

The ACA Open Enrollment Period for 2025 health insurance plans runs in most states from Nov. 1, 2024, to Jan. 15, 2025. In some states, those periods may vary.

What is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA), sometimes referred to as Obamacare, is a federal statute signed into law by the Obama administration. The law was designed to increase healthcare coverage for Americans, primarily by expanding Medicaid services and eligibility, creating state-based health plan marketplaces, and changing how insurance companies offer coverage for people with preexisting conditions. 

Implemented in 2010, core aspects of Obamacare are still in place. Health insurance marketplaces, sometimes called health insurance exchanges, still exist for people to use. However, in 2017 the law was amended by Congress during the Trump administration to remove the individual mandate—the tax penalty for people choosing not to have health insurance. 

That said, there are some states that enforce their own penalties for not having health insurance. Residents of New Jersey, the District of Columbia, California, Rhode Island, and Massachusetts can face tax penalties for not maintaining insurance.

RELATED: Is there a penalty for being uninsured?

How do I enroll?

During the Open Enrollment Period, there are several ways to obtain coverage.

• Visit healthcare.gov. You will either follow instructions to enroll on that site, or follow a link to your state’s marketplace.
• Call healthcare.gov for assistance enrolling at 1-800-318-2596.
• Find a local office for help with your application.
• Download, complete, and mail in an application form.

RELATED: How to get health insurance

Who qualifies for open enrollment?

To obtain coverage during the Open Enrollment Period, you must be a U.S. citizen (or have legal immigration status), live in the United States, and not be incarcerated.

Depending on your income level, you may be eligible for a cost-sharing subsidy, which is designed to lower the cost of health coverage. Subsidy (or premium tax credit) eligibility is based on your income. The standard rule is that you have to earn at least 100% of the federal poverty level, but not more than 400% of the poverty level.

Qualifying income levels change each year due to inflation, and you will be able to check your eligibility on Nov. 1 through the ACA website, healthcare.gov. 

When is open enrollment?

Each year there is a window of time when you can enroll in an ACA plan. This period is called the annual Open Enrollment Period. 

The Open Enrollment Period (OEP) for coverage starting Jan. 1, 2025 runs from Nov. 1, 2024, to Jan. 15, 2025 (enroll by Dec. 15, 2024, for Jan. 1, 2025 coverage).

Some states offer extended open enrollment periods. Below is a table that details their specific open enrollment deadlines. This changes year-to-year, so be sure to double check with your state to see if enrollment periods have been expanded.

Can you sign up for health insurance after open enrollment?

You may be wondering what happens if you do not apply for a healthcare plan during the OEP. For the majority of people, if you miss the window, you may have to go without health insurance coverage until the following year. 

However, there are Special Enrollment Periods (SEPs). SEPs are a time outside the regular enrollment period when some individuals can apply for health coverage. You may be eligible for an SEP if you experienced a qualifying life event (QLE) that prevented you from getting a healthcare plan by the enrollment deadline. 

It’s worth noting that anyone can apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any time throughout the year. If you require temporary coverage—for example, if you’re in between jobs—you may be eligible for a short-term limited duration insurance plan. 

RELATED: How to get health insurance after open enrollment ends

How does the ACA affect my prescription medications?

If you choose to purchase health insurance during the Open Enrollment Period, you’ll quickly notice that not all insurance plans are created equal. How much and what medications are covered can vary significantly between plans. 

That’s why at SingleCare, whether you have insurance or not, you can benefit from our savings card. Show it at the pharmacy where you purchase your medications, and the staff will be able to determine which is the most affordable health insurance option and the most cost-effective for you—your insurance price, or the SingleCare price. 

RELATED: 10 ways to save on healthcare costs

Given that nearly 43% of American adults are inadequately insured, you’re not alone if you’re looking for ways to decrease the price of your medication. SingleCare can help you save up to 80% on your prescriptions, even if you have no health insurance. Click here to learn more and start saving on your next refill with our free savings card. 

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