A guide to open enrollment 2025

The end of the year brings a whirlwind of holidays, gatherings, and periods of reflection. Amidst all the chaos, it’s easy to forget one important part of housekeeping: open enrollment. 

Even if you’re happy with your healthcare coverage, knowing when open enrollment is can be important to getting the most out of your healthcare program. And if you miss the window, making a change midyear can be challenging. 

So, when is open enrollment, and what should you do during it? Read on to learn more.  

What is open enrollment? 

As a refresher, open enrollment is the annual period during which people can make changes to their healthcare coverage or enroll in coverage. It applies to both people purchasing plans on the marketplace and employees enrolled in employer-sponsored plans.  

Open enrollment typically lasts a few weeks, beginning in the fall and ending at the start of the new year. The federal government sets open enrollment dates for the marketplace, but employers determine their own open enrollment dates if they offer employee coverage. 

When does healthcare open enrollment typically start? 

Deadlines via Healthcare.gov

While dates can vary based by state, in most cases, Open Enrollment is between November 1 to January 15 of the following year. 

Once open enrollment begins on November 1, people can enroll or change their existing coverage. If they enroll or make changes before December 15, their new plan will begin at the start of the new year. Any changes or enrollment made past December 15 won’t take effect until February 1 of the new year.  

Open enrollment ends on January 15, 2025. Once that date has passed, people can’t change their healthcare coverage unless they qualify for a Special Enrollment Period. In most cases, switching healthcare at any time is not possible. 

For example, if an employee decided to change to different coverage under their employer-sponsored plan on November 20, 2024, their new plan would begin January 1, 2025. However, if they made the change on December 17, 2024, they wouldn’t begin new coverage until February 1, 2025. 

It’s similar to a person enrolled in the marketplace. If they changed their coverage on December 1, 2024, they would see the change reflected in their coverage on January 1, 2025. If they didn’t choose a new plan until January 14, 2025, it would not go into effect until February 1, 2025.

If someone is enrolled in the marketplace or through an employer-sponsored healthcare plan and doesn’t elect to make any changes during open enrollment, they’ll typically be enrolled in the same plan in the new year. 

Plan eligibility

The types of changes and adjustments available to someone’s existing coverage will vary based on where they get their insurance. 

During open enrollment, health insurance marketplace users can choose any plan available in their area. Coverage may come in tiers, including Bronze, Silver, Gold, and Platinum. Depending on household income and size, a person or family may be eligible for subsidies or financial assistance. However, note that if someone accepts subsidies or assistance, they must decline their ICHRA.  

Employer-sponsored plans could include various options, ranging from HMOs and PPOs to high-deductible plans. Similarly, open enrollment could be a time to enroll in additional benefits offered by an employer, including dental or vision coverage. 

If an employer opts for nontraditional health care coverage like an ICHRA, employees shop for coverage in the marketplace with an allowance granted by their employer. In that case, they can pick any plan that is available to them.  

Who can enroll outside of open enrollment?

Depending on what type of coverage a person has, they may be able to enroll year-round. 

For those seeking enrollment on the marketplace, these groups qualify for year-round open enrollment:

• People applying for low-cost or free coverage through Medicaid or CHIP (Children’s Health Insurance Program)

• Applicants eligible for the low-income Special Enrollment Period

• American Indians and Alaska Natives

• Basic Health Program users in Oregon, New York, or Minnesota

• Massachusetts residents enrolling in the ConnectorCare program

• People eligible for Connecticut’s CoveredCT

However, those getting healthcare through the marketplace or work can only change their coverage during open enrollment. The only exception is during a Special Enrollment Period or Qualifying Life Event.

In addition, offering an ICHRA to employees for the first time at any time of the year counts as a SEP.

How do I help employees prepare for open enrollment?

With the year winding down, open enrollment can sneak past employees if they aren’t properly prepared. Here are some tips to remind your employees, even if they’re not certain they’ll switch plans:

• Analyze your healthcare spending. Take a look at your healthcare expenses in the past year. Are you paying too much out of pocket? For example, you may be paying for therapy out of pocket, or your budget for prescription medication might’ve risen considerably. Look at these pain points and costly transactions--this might influence your decision to choose a new plan.

• Review the existing plan. Is your coverage helping you achieve your health goals? Or are expensive co-pays keeping you from visiting specialists? If you’re unhappy with elements of your plan, it may be time to visit alternative coverage. 

• Compare plans. If you have the option of multiple plans to choose from, compare your existing plan’s coverage with other plans. Take a look at premiums, deductibles, co-pays, and eligible networks to determine if a similarly-priced plan might offer better benefits. Do similar plans reduce any costs you’ve incurred in the past year?

• Look forward. Are there plans for next year that require more robust coverage? For example, someone might be trying for a baby or electing to have surgery in the next 12 months. Those life events could call for more expensive premiums that have better coverage down the line. While we can’t always predict the future, you might want a plan with more comprehensive coverage if you anticipate health costs rising in the next year.  

Open enrollment with ICHRA

ICHRA may not follow the same industry dates as open enrollment, but an employer can kick off a SEP for their team the first time they offer the coverage. When it comes to open enrollment under an ICHRA, employees can access many healthcare plans on the ACA marketplace. With an ICHRA, employers can grant employees an allowance to pick the best plan that works for them.

Want to give employees the freedom to enroll in the coverage that fits them best? Thatch is democratizing the healthcare process. Learn how to offer better benefits for less with an ICHRA.