Reader TTS

People interested in signing up for health coverage through the Affordable Care Act’s (ACA) health insurance marketplace can start shopping on Nov. 1 when open enrollment begins. It’s also

the time for current enrollees to compare and change plans. The enrollment period for the federal HealthCare.gov marketplace ends on Dec. 15 for coverage that begins on Jan.1 and on Jan. 15

for coverage that starts on Feb.1. Nineteen states and the District of Columbia operate their own marketplaces, and in some of these states, the open enrollment period differs from the

federal window. For example, open enrollment for ACA plans in Massachusetts runs through Jan. 23; in New Jersey and New York it ends Jan. 31.   PREMIUMS ARE INCREASING, BUT SUBSIDIES ARE

STICKING AROUND The average monthly premiums for marketplace plans are expected to increase by about 4 percent in 2025, but rate changes vary widely by state, according to data from the

health policy nonprofit KFF. Inflation, including rising hospital rates, and growing demand for pricey diabetes and weight loss medications such as Ozempic and Wegovy are among several

factors driving the changes, a KFF analysis found. For many people, premium hikes will be offset by enhanced federal subsidies that have been extended through 2025. Cynthia Cox, the director

of KFF’s ACA program, says about 92 percent of people who sign up for marketplace plans qualify for a subsidy. Four in five customers will be able to find ACA coverage for $10 or less a

month, according to the Centers for Medicare & Medicaid Services (CMS), which administers the ACA.  The subsidy you get depends on your income and choice of health plan. People with

incomes above 400 percent of the federal poverty level ($60,240 for an individual) may be eligible for subsidies with a silver-level ACA plan if their premiums exceed 8.5 percent of their

income. The eligibility threshold is lower for people with lower incomes. “Let's say you have an older couple and maybe they even have adult children on their plan, you could easily

have a very high income and still get a subsidy on the marketplace,” since premiums can be higher for older adults, Cox explains. KFF has a calculator that can help you estimate insurance

premiums and subsidies for 2025 coverage. ACA PLANS: WHAT ARE THE OPTIONS? There are four main categories of ACA plans: * Bronze * Silver * Gold * Platinum Bronze plans tend to have the

lowest monthly premiums and the highest deductibles and copays. Silver plans are the most popular, with generally moderate premiums and copays. If you qualify for a subsidy, you’ll need to

enroll in a silver plan to get the savings. With gold and platinum plans, you pay less out of pocket but more for your monthly premium. MORE INSURER PARTICIPATION Choice for ACA enrollees

continues to grow. CMS says 97 percent of HealthCare.gov consumers will have access to at least three health insurance issuers for 2025. That’s “a pretty significant change from just a few

years ago,” when insurer participation was low in some areas, Cox says. “Now there's very widespread insurer participation,” she adds — a likely result of the subsidies that were

expanded in 2021 and extended through 2025. What happens to the subsidies in 2026 depends on congressional action. “With them in place, we've seen enrollment double in the last few

years, and that has also made the marketplace more attractive for insurance companies,” Cox says. ACA enrollment jumped from 11.4 million in 2020 to 21.4 million in 2024, a KFF analysis

found.