Don't Let ACA Anxiety Cost You Coverage in 2025

It’s ACA enrollment season, and people are feeling a lot of anxiety. Active marketplace health insurance plan selections are down by 27% compared to this time last year, according to data released by CMS. A major reason for the lack of action is that Americans are feeling uncertain about the future of the ACA, and this lack of certainty is leading to analysis paralysis.

It’s perfectly reasonable to feel overwhelmed by all the potential “what-ifs” of the future of American healthcare. But pushing through that frozen state and moving towards action is in your own self-interest. Not only can making your plan selection for 2025 ensure that you have coverage for the year ahead, but it also has the real potential to save you money on your monthly premiums.

Addressing ACA anxiety

It is true that the incoming administration will likely attempt to repeal the ACA, which could push up premiums or even disqualify many Americans from coverage. It’s even possible that this attempt will be successful.

Many Americans are worried that if the ACA is repealed this year, plan prices will spike or coverage levels will change. It’s important to know that even if these predictions do come true, there is no penalty for cancelling your plan should the health insurance landscape change. You will want to be mindful about how you do or don’t claim subsidies, but generally speaking if you call up your insurer to cancel your plan in the future, you won’t be on the hook for the rest of the year.

TIP: Any time you cancel a marketplace plan, you’ll also want to let the government know so they stop sending your insurer subsidies.

As well-founded as this anxiety may be, it’s a concern for the future — not for today. For the moment, the ACA still exists. People with pre-existing conditions can still get health insurance with comparatively reasonable premiums, Medicaid expansion still serves low- to lower-middle-income Americans in most states, and you still have the ability to choose the health insurance plan that best serves your family, complete with mandatory coverage for things like preventative care.

We don’t know when the incoming administration will begin any attempts at ACA repeal. It may end up being a 2025 issue, but it could also be lower on the priority list and not affect your health insurance this year at all.

What happens if you don’t participate in open enrollment season

One thing we do know for sure in the midst of such uncertainty is that not actively participating in open enrollment season is likely to have negative consequences. If you’re a new enrollee who lets this opportunity pass you by, you could end up going through the entire year without any health insurance at all. Missing enrollment deadlines is the primary reason Americans went uninsured in 2024.

If you already have a marketplace plan, a lack of action means that you’re highly likely to be enrolled in the ‘same plan’ by your current insurance provider. There’s a few things to watch out for with passive re-enrollment, though.

First, even if your plan is truly identical in terms of coverage and deductibles, marketplace premiums this year are going up. Overall, they’re 4% higher than last year. Depending on the subsidies you receive, this could make a plan that was doable for your budget last year a bit less affordable.

However, it’s extremely common for health insurers to change your plan from year to year. Even if the plan has the same name, coverage or deductibles could change in addition to premium increases. If you’re not actively participating in your plan selection during open enrollment season due to analysis paralysis, these changes could catch you off guard.

Finally, if you’re anticipating a change in income compared to the numbers you submitted during open enrollment last year, it could impact your subsidies. If you’re making less, reporting that decrease could help you secure larger subsidies, effectively lowering the premiums you pay on a monthly basis. If your income is going up, you’ll still want to report it. If you don’t and your subsidies aren’t adjusted, you could end up with a higher-than-necessary tax bill when you file your 2025 taxes.

There’s still time to participate in open enrollment

Participating in open enrollment allows you to shop for the plan that best suits your family’s medical needs in terms of coverage, and ensures it’s actually within your budget in terms of premiums and deductibles. In the most extreme cases, participating in open enrollment can be the difference between having health insurance or not having it at all.

The deadline to secure coverage effective January 1, 2025, was December 18, 2024. If you’ve missed this deadline, don’t panic. Your January coverage may be unretractable, but you still have a few weeks left to claim or change your coverage for the rest of the year.

The deadline for coverage beginning February 1, 2025, is January 15, 2025. So if you participate in open enrollment before January 15, you can still exercise agency over your health insurance plan for the rest of the year.

After January 15, though, open enrollment is officially over. Any changes or enrollment options will be closed for the rest of the year unless you qualify for a special enrollment period.

How to prepare for the worst

Now that you’ve taken control of your 2025 health insurance plan and premiums, it is okay to start thinking about what might happen if the worst does come to pass and the ACA is repealed. If you are anticipating low healthcare expenses this year, one option would be to enroll in a high-deductible healthcare plan (HDHP) with a Health Savings Account (HSA) attached. Money invested in your HSA can be used tax-free for future healthcare expenses, whether you need that money in old age or five years due to changes in the healthcare market.

For those who aren’t a great fit for an HDHP with an HSA, there are other steps you can take to prepare. Let’s take a look at two groups of people who are highly likely to be affected: Self-employed people with pre-existing conditions and low- to lower-middle-income adults in general.

Self-employed Americans with pre-existing conditions

If you’re self-employed with a pre-existing condition and the ACA is repealed, you might want to start thinking about updating your resume as you keep an eye on the legislature. That’s because prior to the ACA, people with pre-existing conditions could only really effectively get health insurance if they were a traditional employee and coverage was offered to them through work. Most insurers wouldn’t take you on unless it were through an employer plan and those that did accept you typically charged rates that were so high the vast majority of Americans couldn’t afford the coverage.

Another option would be to expand your business so that you could purchase a group plan to cover you and your employees. The viability of this option will only apply to select businesses, though. The majority of America’s small businesses only generate enough revenue to support a single employee or household.

Neither of these options means that you have to up and quit on your solopreneur endeavors this very moment. But if you’re worried about what would happen if the ACA were repealed, at least prepping your resume to re-enter W-2 employment may help you feel some semblance of control.

Low- to lower-middle-income Americans

In addition to the marketplace, the ACA also expanded Medicaid coverage in U.S. states that chose to participate. This allowed millions of uninsured adults to secure free or low-cost coverage — some for the first time in their lives.

The ACA also placed requirements on more employers to offer health insurance to their full-time employees. This requirement affected many lower-wage workers. When they didn’t qualify for Medicaid, it was usually because the employer now had to extend some type of relatively affordable coverage through work.

That means that securing a traditional job isn’t necessarily a foolproof way to secure insurance through an employer if there is a repeal of the ACA. Some employers — especially those who pay closer to minimum wage — may no longer be required to provide it if a repeal is successful. If you’re after employer-sponsored insurance, you may want to look towards higher education so you’re more likely to secure a higher-paying job in the event of a repeal, as higher-paying positions were more likely to offer health insurance prior to the ACA.

College in America is expensive, but if you’re lower- or lower-middle income, filling out the FAFSA can help. This opens up funding opportunities like Pell and FSEOG grants, which can sometimes pay for the full cost of a community college or even state college or university education, sometimes with a little extra money to spare for living expenses. Grants are money that you don’t have to pay back, so you wouldn’t necessarily have to worry about student loans.

Starting your education today can help you get better prepared not only in terms of your health insurance in the event of an ACA repeal, but it is also statistically likely to significantly boost your income over your lifetime.

Uncertainty is stressful, but you can still take control

We may see a revocation of the ACA over the next few years. But it hasn’t happened yet. To a certain extent, you still have some measure of control. Take steps like actively choosing your health insurance plan during enrollment season this year, and considering what moves you might make in the future should the ACA be repealed.

Brynne Conroy is an award-winning personal finance writer, creator of the popular women’s finance site, Femme Frugality, and author of The Feminist Financial Handbook, which was an Amazon #1 New Release across multiple categories including Poverty and LGBTQ Demographic Studies. Her work has been cited in academic texts, and she’s spoken at venues such as Vanderbilt University, the Financial Planning Association and the 529 Conference. Here at PocketSmith, Brynne covers personal finance within American financial systems.