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| High-Deductible Health Plan Limits for 2025 | ||
|---|---|---|
| Individual Coverage | Family Coverage | |
| Minimum Deductible | $1,650 | $3,300 |
| Maximum Out-of-Pocket Limit Allowed | $8,300 | $16,600 |
| Maximum HSA Contribution | $4,300 | $8,550 |
Closely Inspect Plan Networks
Research plans for convenience to nearby in-network doctors, clinics, and facilities. By searching for someone who offers convenient locations, you’ll avoid wasting time and money. You’ll also be more likely to get the preventive and everyday care you need to stay healthy and avoid more expensive problems later on.
When you use the Marketplace to search for plans, some of the information provided may be outdated, including coverage networks, said Brooker.
When researching whether your providers or medications are covered, you may need to call insurers for the most up-to-date information—or ask your insurance agent to do it. “Healthcare.gov relies on data files given to them by insurance companies, which are notoriously bad and inaccurate,” Brooker said.
Apply for Federal Subsidies
This is the move that can save you big if you qualify. Premium tax credits that lower how much you have to pay for Obamacare premiums were included in the Affordable Care Act. The American Rescue Plan Act of 2021 made the credit available to more people for 2021 and 2022, and those changes were extended through 2025 as a result of the Inflation Reduction Act.
As a result, 92% of enrollees get a premium tax credit and half get a cost-sharing reduction (which lowers your out-of-pocket maximum). Four in five 2025 ACA enrollees should be able to find coverage for $10 a month or less after subsidies. You can apply for the credits by reporting your income and other information using the Health Insurance Marketplace.
Note that 2025 might be the last year you can get these enhanced tax credits, which are on the chopping block for the 2026 health insurance year. Congress must extend the expanded aid for it to continue beyond 2025.
Research State Subsidy Programs
Some states, including California, New Mexico, and New York, also offer state-based subsidy programs that will expand in 2025. In California, an individual making up to $75,000 could get help with premiums in 2025, according to Covered California.
Review your Marketplace information for income estimates based on your 2025 income, not 2024. Also, review your household member count. Count yourself, your spouse, and anyone else you claim for tax purposes, even if they don’t need insurance coverage. Income and household factors can impact your qualification for discounts.
Review New DACA Qualifications
If you’re an immigrant protected under the Deferred Action for Childhood Arrivals (DACA), your insurance costs may go down if you’re eligible for premium tax credits and cost-sharing reductions.
Before Nov. 1, 2024, DACA recipients can’t enroll in health coverage through the Marketplace or a state-provided Basic Health Program. As of Nov. 1, DACA recipients are considered lawfully present for Marketplace plan-related eligibility and enrollment.
However, a lawsuit is also challenging this new extension.
Guard Your Personal and Plan Info
New changes taking effect in 2024 limit how brokers can sign you up for an ACA plan due to complaints from consumers and honest brokers. Some unscrupulous agents and brokers signed consumers up for coverage without their knowledge or switched them into a new plan, costing consumers time and money.
The Marketplace Call Center at 1-800-318-2596 can resolve coverage issues if you were unknowingly enrolled in or switched to a plan.
From January 2024 through August 2024, the Centers for Medicare & Medicaid Services (CMS) received 90,863 complaints that consumers had their Marketplace plan changed without their consent and 183,553 consumer complaints of being enrolled in Marketplace coverage without their permission.
“Out of more than 90,000 complaints, CMS has suspended or terminated 1,478 brokers,” Brooker said. “I’m hopeful that with the new consent requirements, accountability from CMS, and the removal of bad actors, we’ll achieve stability in the market, allowing brokers to refocus on the needs of consumers without these unacceptable complications.”
Don’t disclose personal information in response to social-media health insurance ads offering cash, gifts, or other perks. According to CMS, these could be attempted scams.
Reach Out to a Broker For Help
Brooker pointed out that a qualified health insurance broker can take many of the steps above for you or help you do so. A health insurance broker or agent can help you figure out how to calculate income, even if you’re self-employed or retired but not yet qualified for Medicare.
“Insurance is confusing, so let the people who’ve figured it out help you.”
He suggested asking a broker which insurers they work with and sell. Ideally, you want maximum access to most carriers to benefit from choices. In some areas, insurance companies only work with in-house staff, while others may work with up to 50 carriers across multiple states.