Affordable Care Act (ACA) Changes for 2025
The most notable change to Affordable Care Act (ACA) plans in 2025 is that you might be able to get doctor appointments faster.
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That's because the ACA now requires plans to provide appointments within specific time frames for behavioral health, primary care and specialist doctor appointments. Other changes include standard enrollment dates for state marketplaces and more financial help in some states.
Enrollment changes
State marketplaces now have to use standard open enrollment dates or meet strict criteria for using other dates.
Additionally, people with low incomes have more options for when they can get coverage, and a few states have switched from HealthCare.gov to state marketplace websites.
Open enrollment date changes
Starting in 2025, states that use their own marketplace websites have to give you at least 11 consecutive weeks to sign up for insurance during what's called "open enrollment."
In most states, open enrollment is already from Nov. 1 to Jan. 15 each year. But some states had different dates. Under the new rules, if a state had different dates for open enrollment, it can only keep those dates if the open enrollment window is at least 11 consecutive weeks.
These states are "grandfathered" into the old rules, which means they can keep their open enrollment dates as long as they are 11 consecutive weeks:
- California: Nov. 1 to Jan. 31
- Idaho: Oct. 15 to Dec. 16
- Massachusetts: Nov. 1 to Jan. 23
- New Jersey: Nov. 1 to Jan. 31
- New York: Nov. 1 to Jan. 31
- Rhode Island: Nov. 1 to Jan. 31
- Washington, D.C: Nov. 1 to Jan. 31
If a state wants to start a new state marketplace or change the dates of their open enrollment, it has to use the Nov. 1 and Jan. 15 time frame each year.
Pregnant women in New York can also now get a health insurance plan at any time. Previously, new mothers could only get a new plan after having a baby, during a window of time called a "special enrollment period." But now, if you find out you're pregnant and live in New York, you can sign up for a plan on New York's state marketplace, New York State of Health, no matter what time of year it is.
New state marketplaces
Georgia started using its new state marketplace, Georgia Access, for the first time during 2024 open enrollment. If you live in Georgia, you'll no longer use HealthCare.gov to shop for and buy plans. Everything is now done on the Georgia Access site.
Illinois is also transitioning to a state marketplace. If you live in Illinois, you'll keep using HealthCare.gov until November 2025, when the new state marketplace, called Get Covered Illinois, will be available.
More time to enroll for people with low incomes
If you make less than $22,590 per year as a single person, you can sign up for health insurance on HealthCare.gov at any time.
That means you don't have to wait for open enrollment. You can get coverage right away, although you might have to show proof of your income.
This rule might not apply to states that use their own marketplace sites instead of HealthCare.gov. These states have the option of allowing people with low incomes to sign up at any time, but they aren't required to allow it.
Coverage changes
A new rule for 2025 Obamacare plans requires people to be able to get certain doctor appointments within a certain timeframe.
Deferred Action for Childhood Arrivals (DACA) recipients were also able to apply and get ACA coverage this year.
Coverage on Obamacare plans largely remains the same for 2025. However, coverage requirements may change quickly in the coming months and years as legal challenges to the Affordable Care Act (ACA) work their way through the court system. If you're concerned about your coverage, talk to your company to make sure you understand your plan.
Appointment time standards
Starting on Jan. 1, 2025, health insurance plans have to make sure that you can get certain doctor appointments within a reasonable amount of time. The new law requires that 90% of the appointments be available within the required time frame.
- Behavioral health appointments: 10 business days
- Routine doctor visits: 15 business days
- Specialty appointments for non-urgent reasons: 30 business days
To make sure that plans meet these requirements, they're required to work with a third-party business to conduct "secret shopper" tests of their system. This means that someone will call to set appointments and report back if they were able to get an appointment within the time frame.
If a plan doesn't conduct a secret shopper survey, doesn't report the results of the survey or falls below the 90% threshold for appointment times, they have to add more doctors and hospitals to their network so that patients can get appointments more quickly.
Coverage for Deferred Action for Childhood Arrivals (DACA) recipients
DACA recipients were able to apply for and get Obamacare coverage for the first time during the 2024 open enrollment period.
Deferred Action for Childhood Arrivals (DACA) recipients are immigrants who arrived in the U.S. as children. DACA protects them from being deported and gives them the ability to work for temporary periods of time.
However, 19 states sued over the law and in December, a federal judge decided that those states didn't have to allow DACA recipients to apply for ACA coverage. If you live in one of the following states, you can't apply for or buy Obamacare coverage if you are a DACA recipient.
- Alabama
- Arkansas
- Florida
- Idaho
- Indiana
- Iowa
- Kansas
- Kentucky
- Missouri
- Montana
- Nebraska
- New Hampshire
- North Dakota
- Ohio
- South Carolina
- South Dakota
- Tennessee
- Texas
- Virginia
The Trump administration has suggested that DACA recipients should no longer be allowed to access health insurance through HealthCare.gov or state marketplaces. This change is not official yet, but could be made official before the 2025 open enrollment period.
If you are a DACA recipient, it's a good idea to pay close attention to the news before fall 2025. If this proposal is accepted, you won't be able to buy a marketplace plan for 2026.
Financial help changes
If you live in Vermont, you might get more financial assistance to help pay for health insurance in 2025.
That's because the state is offering higher subsidies in 2025. These subsidies are for people with lower incomes and they make health insurance cheaper each month.
Marketplace subsidies could change for the 2025 open enrollment period, which means you might pay more for coverage in 2026.
Since 2021, more people have been able to get rate discounts. That's because subsidies were expanded as part of the Inflation Reduction Act. However, those expanded subsidies expire at the end of 2025. If Congress doesn't renew them, most people will pay a higher rate for health insurance from HealthCare.gov or a state marketplace in 2026.
Cost-sharing reductions
Both California and New York have changed what are called "cost-sharing reductions" to make health care cheaper for people with low incomes.
Cost-sharing reductions are a type of discount you can only get on a Silver plan. They let you pay less when you go to the doctor by making your deductibles, copays, coinsurance and out-of-pocket maximum cheaper.
In 2025 in California, anyone can get a deductible-free Silver 73 plan, a type of Silver plan with cost-sharing reductions, no matter how much they make. That means your plan starts paying your medical bills right away. For 2025, all cost-sharing plans in California come without a deductible.
New York made three major changes to its cost-sharing reductions for 2025.
- Higher income limits: You can now get cost-sharing reductions if you make between $15,060 and $60,240 per year as a single person. In most states, the cap is $37,650 per year as a single person. These increased limits only apply to Silver plans.
- New discounts for diabetes care: No matter what plan tier you buy, you shouldn't have to pay anything yourself for care related to diabetes. This includes doctor visits, tests, medications and supplies.
- New discounts for pregnancy and postpartum care: Starting in 2025, you shouldn't have to pay anything for some pregnancy or postpartum medical care, including doctor visits, medications and prenatal tests. However, you do still have to pay a portion of the bill for hospital care, including the cost for childbirth. You can get this discount with a Bronze, Silver, Gold or Platinum plan.
Frequently asked questions
What happens to the Affordable Care Act in 2025?
The biggest changes to the Affordable Care Act in 2025 include standard dates for open enrollment, longer enrollment times for people with low incomes and required shorter wait times for certain doctor appointments.
What is the ACA threshold for 2025?
Anyone can buy an ACA plan, no matter how much they make, if they can't get coverage through their job or if that coverage is too expensive. You can get rate discounts if you make between $15,060 and $60,240 as a single person.
What happens to ACA in 2026?
Unless Congress renews the larger rate discounts that were put in place in 2021, they'll expire at the end of 2025. That means health insurance could be more expensive in 2026 for almost everyone who gets a plan from HealthCare.gov or a state marketplace. Other changes to the Affordable Care Act for 2026 could develop as new laws are passed and rulings are made on current court cases.
Sources
The info on changes to the Affordable Care Act in 2025 came from the Association of American Medical Colleges (AAMC), the Centers for Medicare & Medicaid Services (CMS), Covered California, Georgia.gov, HealthCare.gov, Kaiser Family Foundation, New York State of Health, NY.gov and Vermont.gov.
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