ACA Benefit Changes in 2025: What Consumers Need to Know
Innovation Direct Group (IDG)
O&O Media, Approved and Compliant Creatives / Advertising
Recent changes to the Affordable Care Act (ACA) impact eligibility, costs, and enrollment options in 2025. Thanks to provisions in the Inflation Reduction Act of 2022, a U.S. federal law that aimed to reduce the federal government budget deficit among other things, extended subsidies, new enrollment opportunities, and updated regulations make healthcare more accessible for millions of Americans.
Understanding these changes is crucial for consumers to maximize their healthcare benefits and find the most affordable coverage. According to KFF, ACA Marketplace enrollment reached over 21 million people in 2024 due to enhanced subsidies, and enrollment is projected to rise to 22.8 million in 2025.
These individuals will be directly affected by the continuation of premium tax credits, new eligibility rules for Deferred Action for Childhood Arrivals (DACA) recipients, stricter regulations on short-term health insurance, and insurer changes in 18 states. If these enhanced subsidies expire after 2025, ACA enrollment would drop by 3.9 million people, highlighting the significance of ongoing financial assistance in maintaining coverage levels.
ACA Benefit Changes in 2025
Several important changes to ACA benefits in 2025 will impact eligibility, costs, and coverage options for millions of consumers.
Premium Tax Credits Extended
The Inflation Reduction Act extended enhanced premium tax credits through 2025, ensuring that enrollees continue receiving subsidies to lower their monthly premiums. These tax credits, which vary based on household income, make ACA plans more affordable for individuals and families.
Increased Affordability Threshold for Employer-Sponsored Plans
The IRS raised the affordability percentage for employer-sponsored health plans from 8.39% to 9.02% of an employee's household income. As a result, more employees may qualify for ACA subsidies if their employer-sponsored insurance is deemed too expensive.
Expanded Enrollment for DACA Recipients
For the first time, individuals covered under DACA can enroll in ACA Marketplace plans. Previously ineligible, these individuals can now access premium tax credits and cost-sharing reductions in most states. However, Georgia residents must use the state's separate enrollment platform.
Improved Account Management on Healthcare.gov
The Centers for Medicare & Medicaid Services (CMS) implemented an updated account management system to improve the user experience for ACA enrollees. These changes make it easier to update information, track applications, and compare plans.
Marketplace Insurer Changes in 18 States
In 2025 at least 19 states will experience ACA Marketplace insurer changes including new insurers entering the market and existing insurers exiting. States with insurer entries are, in alphabetical order, Arizona, Florida, Indiana, Iowa, Maryland, Michigan, Nebraska, New Hampshire, Ohio, South Carolina, Tennessee, Texas, and Wyoming. States with insurer exits include, in alphabetical order, Arizona, Illinois, Indiana, Kansas, New Mexico, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, and Washington.
These changes could affect plan availability, pricing, and subsidy calculations, especially if a benchmark Silver plan changes due to new or exiting insurers. Consumers should review their options carefully during Open Enrollment to ensure they are getting the best plan for their needs.
Stricter Limits on Short-Term Health Insurance
New federal regulations limit the sale of short-term health insurance policies to three or four months, eliminating long-term short-term plans. These policies, which typically offer limited benefits and exclude preexisting conditions, are now less accessible as an alternative to ACA coverage.
State-Funded Subsidy Changes
California, Colorado, New Mexico, and New York have made adjustments to state-funded subsidies in 2025 to improve affordability for residents enrolled in ACA Marketplace plans. People in these states should check their updated subsidy eligibility and new financial assistance programs.
California expanded its cost-sharing reduction (CSR) program, which helps lower out-of-pocket costs for Silver plan enrollees with incomes up to 250% of the Federal Poverty Level (FPL). As a result, all Covered California enrollees now qualify for at least the Enhanced Silver 73 plan, which has reduced out-of-pocket costs and no deductibles.
In Colorado, the income cap for enhanced CSRs was temporarily raised to 250% FPL in 2024, but has reverted to 200% FPL in 2025. Additionally, Colorado continues to offer state-funded premium subsidies for undocumented immigrants with incomes up to 300% FPL. However, enrollment in this program reached capacity quickly in previous years, making it a competitive option for eligible residents.
New Mexico expanded its state-funded premium subsidies, now available to residents earning up to 400% FPL. Additionally, the cost-sharing reduction (CSR) program (called the State Out-of-Pocket Assistance program, or SOPA) now provides platinum-level benefits (90% actuarial value) to residents earning up to 400% FPL (up from 300% in 2024). New Mexico labels these plans as "turquoise" plans to differentiate them from federally supported ACA plans.
In 2025 New York introduced state-funded subsidies for the first time. These subsidies provide additional cost-sharing reductions for ACA enrollees earning up to 400% FPL. The program also offers extra financial support for diabetes management and expanded assistance for pregnant and postpartum individuals.
These state-based subsidies work alongside federal ACA subsidies to further lower the cost of premiums and out-of-pocket expenses for eligible residents.
Who Qualifies for ACA Coverage in 2025?
To enroll in an ACA Marketplace plan, individuals must meet the following criteria:
An estimated 16.4 million people will receive tax credits for ACA coverage in 2025, making Marketplace plans more affordable for lower- and middle-income families.
How to Enroll in an ACA Plan
Consumers can enroll in Marketplace plans during the following periods:
To enroll, visit HealthCare.gov or use a state-based exchange if applicable.
Recommendations for Consumers
To make the most of ACA coverage and financial assistance in 2025, consumers should consider the following recommendations.
Sources:
Further Thoughts
As Q1 2025 comes to a close, recent ACA changes have already begun shaping the healthcare landscape. Consumers are benefiting from extended premium tax credits, expanded eligibility for DACA recipients, improved account management tools, and stricter regulations on short-term health plans. Additionally, shifts in Marketplace insurers and state-funded subsidy adjustments have impacted coverage options in multiple states.
For more insights and innovative solutions in digital marketing, visit Innovation Direct Group.
#customerexperience #digitalmarketing #innovationdirectgroup