Open Enrollment Guide for 2025 Coverage

Open enrollment for health insurance got you feeling confused? We hear you!

You’ve got dates to remember, plans to compare and sometimes higher costs to budget for. Worse—the information you need is usually scattered all over the internet.

But it's also a great opportunity to find the right health insurance plan at the right price. So before you jump straight into the deep end, let’s sort some things out.

We included everything you need to know in one place, so you can bookmark and reference it any time. That way, you can feel confident about your 2025 health insurance decisions.

What Is Open Enrollment?

First things first: What is open enrollment? Open enrollment is the once-a-year window of time when you can sign up for your employee benefits like health insurance. It also refers to the period when you can buy marketplace health insurance run by the federal or state government.

Open enrollment is a big deal because it’s the only time you can sign up for these things under normal circumstances and it happens just once a year. The only exceptions are if you have what’s called a qualifying event (aka you lose coverage, have a baby, get married, or start a job—hopefully not in that order).

You don’t want to miss it!

Matthew T. can attest to that from his own personal experience he shared with the Ramsey Baby Steps Facebook Community.

“I spent the last 20 years of my life without health insurance,” he said. On April 1 of this year, at age 40, Matthew signed up for a high-deductible, low-premium health plan.

“Fast-forward 30 days (you read that right), I began experiencing pain in my neck, which radiated up the back left side of my head.”

After several tests, doctors diagnosed Matthew with a serious brain condition that required immediate treatment and a three-day hospital stay. Total cost: $169,912!

“Insurance kicked in and I am responsible for $8,550,” he said. What a huge difference!

How Long Is Open Enrollment for Health Insurance?

This is such an important season—so mark your calendar! How long do you have? Well that depends on who you’re getting your health insurance through.

• If you’re going through your employer, your open enrollment period will be set by them and the carrier they choose—probably somewhere around two weeks.
• If you’re going to the federal-run open market, you’ll have two-and-a-half months (November 1–January 15).
• If you’re getting marketplace health insurance, but your state runs it, your window will be different depending on the state you live in. But they tend to be a similar length to the federal open enrollment period.
• If you're getting Medicare, your open enrollment goes from October 15 through December 7.

Do You Have to Apply for Health Insurance Every Year?

What if you really love your health insurance and don’t want to make any changes—do you have to apply again? Not really. In most cases, if you don’t take any action during open enrollment by December 15, the marketplace will automatically renew your coverage to start January 1.

But hang on! We don’t recommend this. Things can change year to year, both in the marketplace and with you: New carriers might’ve entered the market, existing ones might’ve expanded their service areas, or your qualification for a premium tax credit could’ve changed. You want to make sure you’re getting the best coverage possible.

Open enrollment is the best time to reevaluate your situation and actively reapply. That way you know you’re taking advantage of everything available for the upcoming year.

If you get your health insurance through your employer, you’ll probably need to sign up every year. Check with your employer to make sure!

When Is 2024 Open Enrollment for 2025 Health Insurance Coverage?

Before we dive into specific dates and deadlines, you need to know where you’ll be getting your coverage from. If you’re not getting it through your employer, you’ll need to explore your health coverage options through a health insurance marketplace. Depending on your income, family size and other factors, you could qualify for discounts on coverage you get through these marketplaces. Let’s hope so!

Since most states rely on the federal marketplace (aka exchange) to offer health insurance plans, it’s a popular option. But there are currently 18 states plus Washington, D.C., that run their own health insurance exchanges, so you’ll want to check out our map below to figure out which marketplace your state uses.

First, let’s talk about open enrollment deadlines for the states that use the federal marketplace. For the last couple years, the U.S. government extended the enrollment deadline. And they’re doing it for 2025 as well, pushing the deadline out from December 15, 2024, to January 15, 2025. That gives you an extra month to enroll! Just be aware that if your goal is to get covered in time for January 1, you need to enroll by December 15. Any enrollments between December 16 and January 15 will begin coverage on February 1.

Next, the states that run their own health insurance exchanges have individual enrollment deadlines and plan effective dates. Let’s look at those dates in detail along with the states that use the federal marketplace.

Dates and Deadlines for 2025 Health Insurance Coverage

The map and chart below show the open enrollment and plan effective dates for all 50 states and Washington, D.C.

Source: Kaiser Family Foundation¹ State-run exchange plan information subject to change.

If you're still unsure about your state-run exchange’s plan effective date, check with your state’s marketplace for further details.

State-Run Open Enrollment for 2025 Plans

Source: healthinsurance.org.¹ State-run exchange plan information subject to change.

If you're still unsure about your state-run exchange’s plan effective date, check with your state’s marketplace for further details.

Health Insurance Changes for 2025?

For folks already signed up for health insurance, the open enrollment period can bring up some anxiety. You’re thinking, Will things change for the new year and disturb my perfectly ironed-out health plan? Probably the biggest worry on everyone’s mind is a rate hike. We can relate!

 Across the board, rates are expected to increase. Premiums for Affordable Care Act marketplace plans are predicted to go up between 2% and 10%, with a median of 7%.²

But even with that increase, skipping health insurance is simply too big a risk for you and your family to take. Take a look at your budget and see where you can save a little to cover the extra cost. And don’t forget about looking into a premium tax credit!

What Information Do I Need to Enroll in a 2025 Health Plan?

Now that you know when you need to enroll, let’s go over what you need to know before you enroll.

Don’t worry. You won’t have to learn anything complicated or dig up ancient paperwork. You’ll just need to follow some simple guidelines before signing up for a year-long commitment. We’re going to break each one down.

Identification

You’ll need some basic personal information for everyone you want to include in your plan:

• First and last name
• Email address
• Birth date
• State of residence
• Social Security number
• Estimated income for the year you want coverage (include all household members even if they don’t need health insurance)

Cost

Whether you’re enrolling in a plan just for yourself or for your entire family, you’ll need to understand some basic health insurance industry jargon. It’ll help you select the best plan for the best price. Before you sign anything, make sure you’re clear on these terms.

• Premium: A premium is the dollar amount you pay to an insurance company for an insurance policy. Premiums are usually paid on a monthly or yearly basis, but quarterly and every six months aren’t unheard of. For employer plans, your premiums are usually deducted from your pay.
• Deductible: A deductible is the dollar amount you must pay out of pocket before your insurance company starts chipping in.
• Copay: The copay is the dollar amount you pay each time you need a specific medical service (copays don’t usually contribute to your deductible).
• HMO or PPO: HMO and PPO are types of insurance plans—HMO stands for health maintenance organization and PPO stands for preferred provider organization.
• Coinsurance: Coinsurance is the percentage of the cost you pay after you reach your deductible.
• HSA: HSA stands for Health Savings Account. Essentially, it’s a tax-advantaged savings account dedicated to health care costs.

The more you understand these terms, the easier it’ll be to lower your insurance bill. For example, understanding the relationship between premiums and deductibles could save you a boatload of money. Why? Because choosing to pay a higher deductible usually knocks your monthly premiums down.

But before you sign up for a $10,000 deductible, let’s talk about when this works and when it doesn’t.

Coverage

While health insurance is an essential part of your financial plan, the right health insurance policy looks different for different families. Go over all your options to see what makes sense for you, your family and your money goals.

If you’re healthy with a healthy emergency fund to match, you could opt for that high-deductible health plan (HDHP) that qualifies you for an HSA to save on premiums. On the other hand, if you or your family members need more regular care, a lower deductible might make sense for you.

Spend some time on this decision and do your research. Remember, you’ll have to stick with the plan you choose for a full year.

What Are My Health Insurance Options?

You can get health insurance through an employer or the open market. If you’re using the last option, you’ll get it through the federally run market—unless you live in one of those special states that runs their own health insurance market.

From there, you choose between different plans like a HDHP or a PPO. If you’re going through your employer, you should have a few plans to choose from. Buying from the open market means you have all options available. Here they are:

• Health maintenance organization (HMO): HMO plans limit you to doctors within a certain network. They’re usually the strictest plans but can have lower premiums.
• Preferred provider organization (PPO): PPO plans are similar to HMOs but give you a little more flexibility. You’ll pay less for medical care if you use a provider within the plan’s network. You are allowed to access out-of-network providers, but they’re more expensive. 
• Exclusive provider organization (EPO): EPO plans limit you to in-network providers, except for emergencies.
• Point of service (POS): POS plans offer benefits like lower medical bills if you use doctors, hospitals and health care providers in the plan’s network. Keep in mind, though, you’ll need a referral from your primary care doctor in order to see a specialist.
• High-deductible health plan (HDHP): HDHP plans are exactly what they sound like. You pay a higher-than-normal deductible, but you get much lower premiums. An HDHP also makes you eligible to save money in a pretax HSA.
• Short-term plan: Short-term plans are temporary health insurance policies that bridge the gap when you’re between jobs. They usually last from three months to just under a year.
• Catastrophic plans: Catastrophic plans have lower premiums and high deductibles, so you’d foot the bill for most of your medical expenses. But you’d be protected if, for example, you had unexpected, huge medical bills from being injured in a car accident. These plans are typically limited to those aged 30 and under, but age-limit exceptions can also be made for financial hardship applicants.

When it comes to marketplace health care plans, there are five different levels of coverage—catastrophic, bronze, silver, gold and platinum. These tiers give you different options for how much your plan will pay out versus how much you’ll pay. They do not affect the quality of care you have available.

With a catastrophic plan, you pay the most out of pocket, and with a platinum plan on the other end of the spectrum, insurance pays for 90% of your costs. As you might guess, the platinum plans have the most expensive premiums. Most folks opt for the bronze, silver or gold.

What Happens if I Miss the Open Enrollment Deadline?

If you don’t sign up for health insurance during the normal enrollment period (November 1, 2024–January 15, 2025), it’s possible you won’t be able to enroll or change your health insurance plan until the following year’s enrollment period.

Really? Yes, really.

As we touched on earlier, the only time you can make changes or sign up after the deadline is if you experience a major life event (marriage, birth, job loss, etc.). Events like that trigger nervous tics. No, wait—they trigger a special enrollment period (SEP—pronounced as a word, just like it’s spelled) where you can update your health insurance choices for the year. How convenient!

But to enroll outside the normal timeline, you first need to qualify. The health insurance industry calls these events qualifying life events. Another qualifying factor could be exceptional circumstances like a natural disaster.³ Let’s go over the life changes that qualify for a SEP.

Loss of Prior Health Coverage

Losing your health insurance can be scary, but the good news is that any of the following events will qualify you for a SEP:

• Losing your job
• Turning 26 years old
• Getting canceled by a private carrier
• Losing your eligibility for government-funded coverage

Moving

Whether you’re moving out of state or to a different town in the same state, you could qualify for a SEP if your move is permanent. If you have questions, the U.S. Department of Health and Human Services (HHS) maintains up-to-date guidelines for the use of a permanent move for SEP eligibility.

Marriage

Congrats! Finding the love of your life is cause for celebration. Even better? You might qualify for a SEP so you can officially add your spouse to your health insurance.

Household Change

A happy family event like giving birth or adopting a child qualifies for a SEP. More celebrations are in order! You can now add your new family member to your existing health insurance plan.

A not-so-happy event like death or divorce can also trigger a SEP. But only if the event results in a loss of coverage.

Timing

If you’re enrolled in a federal marketplace health care plan, and you qualify for a SEP, you have 60 days before and 60 days after the qualifying event to enroll or change your health insurance details.⁴ Once that window closes, the SEP is over and you’ll need to submit an application for a new SEP.

Let’s say you’re enrolled in a state-run plan. In your case, the SEP timing requirements are managed by your individual state. If you’re unsure about your state’s SEP dates, check with your state’s marketplace for further details.

Job-based health care plans have their own SEP timing requirements that are also different from the federal marketplace. Companies must provide a SEP of at least 30 days.⁵

Our advice? Regardless of where you get your health insurance, don’t put off a SEP application. If you qualify for a SEP, sign up or make changes to your plan as soon as possible. The longer you wait, the longer you’ll be without the health insurance you need, and the longer you’ll be risking financial disaster.

Questions to Ask Your Employer

We collected questions employees most often ask about employer-sponsored health plans. We can’t provide specific details about your employer’s health plan, but we can guide you toward the questions you should ask to get the answers you need.

1. What are the plan’s enrollment and effective dates?

Most enrollment periods for company-sponsored health insurance plans are scheduled in November, and the plan effective date is usually January 1 of the following year. But companies do have some wiggle room here. Be sure to ask your company’s plan administrator what the specific enrollment/effective dates are for your company.

2. How does the plan manage prescription drug costs?

Changes in health insurance provider drug coverage happen all the time. Before you enroll in or change your health plan, find out if your employer has added or excluded coverage that could affect how much you pay for your prescriptions.

3. What’s the cost for covering my spouse and children?

If you previously had coverage for a working spouse, ask your company’s plan administrator if they’re adding or increasing a surcharge for your spouse’s coverage. Also, companies can make changes in employee premium contributions to cover dependent children. Ask about that too.

4. Can I go to my preferred doctor and hospital?

Some employers change health insurance companies, plans or provider networks to keep costs down. This can mean that your preferred doctors and hospitals might not be available on your plan anymore. Ask your plan administrator about this so you can adjust if needed.

5. Does this company do anything to help employees save money on health care costs?

Everyone is concerned about health care costs. Companies too. In fact, some companies have made changes specifically designed to lower health care costs for their employees, including lower out-of-pocket costs, lower premiums for low-wage workers, and some have even made contributions to employee HSAs. Ask your company’s plan administrator if your employer has taken any actions like this to help you save money.

Choosing the Best Health Insurance for You

That was a lot of info! And if you’re feeling a bit overwhelmed, we get it. Health insurance is complicated. There are so many different options that it can be hard to figure out which one is your best bet. And you want to make sure you get the right coverage.

To help you accomplish that, we've put together a list of practical next steps you can take right away to get health insurance done now.