Affordable Care Act (ACA) Changes for 2025
The Big Beautiful Bill included several changes to the Affordable Care Act (ACA), but they don't all happen right away.
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It's important to know about the changes happening this year so you can prepare. If you get a discount on a health insurance plan because of your income, you have to show proof of your income on your tax return within a year, instead of within two. If you got a discount that's more than what you should have gotten, you'll have to pay back the extra at tax time, no matter how little you make.
Financial help changes
Some of the biggest changes to the Affordable Care Act in 2025 have to do with discounts and financial help.
Previously, if you got a discount on your monthly rate because of your income, you had two years to show what your actual income was on your tax return. Now, though, you have to show proof of your income within a year.
If your income was more than expected, it means that the discount you got was more than what you should have gotten. You have to pay back the extra amount, no matter how low your income is. Previously, there was a cap on the amount you had to pay back.
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.
More changes to health insurance discounts are coming in future years.
For example, starting in 2028, you won't be able to get rate discounts until you've confirmed your income. That means that you'll pay the full price for a health plan until your discount is confirmed, even if you have a low income.
This is likely going to make it very difficult for people with low incomes to get health insurance. Many households likely don't have the money to buy a full-price plan and wait for the discount.
This rule also effectively ends the process that lets some people continue their health plan each year without having to apply, called automatic enrollment. Because you have to prove your eligibility for the discounts, you won't be able to automatically continue the plan you've had the previous year.
Extra discounts in Vermont
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.
Updated 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.
Enrollment changes
State marketplaces now have to use standard open enrollment dates or meet strict criteria for using other dates.
Additionally, 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 its 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.
Open enrollment will be shorter in 2026, when you're shopping for a plan for 2027.
For states that use HealthCare.gov, open enrollment will run from Nov. 1 to Dec. 15, 2026. States that have their own marketplaces will have a bit more flexibility to choose their dates. However, open enrollment in these states has to start by Nov 1. and end by Dec. 31, and it can't be longer than nine weeks in a row.
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.
Rollback of enrollment times for people with low incomes
Previously, if you made less than $22,590 per year as a single person, you could sign up for health insurance on HealthCare.gov at any time.
But now, if you have a low income, you have to wait for open enrollment, which is set for Nov. 1, 2025, through Jan. 15, 2026. However, you can still get health insurance at any time if you meet other requirements, like losing your job or moving to a new state. This is called a "special enrollment period." Starting in 2026, you have to prove your eligibility for these periods. For example, you might have to show proof of your new address to confirm that you've moved.
Coverage changes
A new rule for 2025 Obamacare plans requires people to be able to get certain doctor appointments within a certain time frame.
You can also get a health savings account (HSA) with a Bronze or Catastrophic plan for the first time.
Appointment time standards
Starting on Jan. 1, 2025, health insurance plans have to ensure 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.
HSAs available with Catastrophic and Bronze plans
Catastrophic and Bronze plans, the two lowest levels of health insurance on the marketplace, are now considered high-deductible health plans (HDHPs). This means that you can get an HSA when you have a Bronze or Catastrophic plan on the marketplace.
HSAs let you save pretax money in a special account that is earmarked for medical care. These accounts make it easier for you to manage your share of your medical bills when you have a plan with a high deductible.
You can use the HSA to pay for your deductible, copay and coinsurance amounts and prescriptions. You can even use HSAs for over-the-counter medical items, like contact solution and bandages. HSAs can also be invested, so the money can grow over time. And HSA dollars always roll over from year to year, so you don't lose them if you don't have many medical expenses.
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. However, the current administration has reversed this change, which means DACA recipients can't get Obamacare coverage this year.
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.
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. The Big Beautiful Bill significantly changed the ACA starting in 2026, with things like a shorter open enrollment window and needing to prove you're eligible for discounts. The changes will roll out slowly over several years.
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 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 include a shorter enrollment window, and more changes are expected to happen in the following years.
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.
Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.
