Happy Open Enrollment 2025! 🎉 We may be some of the only people who treat Open Enrollment as a major holiday. We can't help it. We love this time of year! But we understand that not everyone shares our enthusiasm, so we produced this short guide to help you navigate Open Enrollment. If this is your first time buying individual health insurance, this article will be your best friend.
Updated October 1, 2024, in anticipation of Open Enrollment 2025!
| This 2025 Open Enrollment Guide is for employees who have been offered an HRA by their employer and are looking for guidance as they shop for individual health insurance that can be reimbursed with an HRA like the Qualified Small Employer HRA (QSEHRA) and the Individual Coverage HRA (ICHRA). |
Every year, we hear many of the same questions from individuals just like you who are having to navigate the health care system outside of a traditional group plan. Don't worry! We have many resources, including this guide, to help you.
As you learn about topics like Open Enrollment, individual insurance, and HRAs, please remember that our platform will walk you through the entire process and help you choose a plan that will not only work for you but one that will also work with your HRA 2025.
Here are a few of the high-level questions, as well as several associated questions, this guide addresses in detail:
Our platform will walk you through the entire process and help you choose a plan that will not only work for you but one that will also work with your HRA.
Open enrollment is the annual period when individuals like you can enroll in a health insurance plan. For 2025, it's from November 1st to January 15th in most places, although there are a few exceptions. Some states are permanently extended through January 31st, like California, Nevada, New Jersey, New York, Rhode Island and Washington D.C. Massachusetts has permanently extended through January 23rd.
For coverage beginning on January 1st, however, the deadline to enroll is December 15th nationally, regardless of when open enrollment ends.
If you enroll after December 15th, but before the January 15th deadline, your coverage will begin February 1st in most states.
If you're over 65 and enrolled in Medicare, you get a head start from October 15th through December 7th to review and make any changes to your Medicare coverage, which will go into effect January 1st .
Health insurers limit the open enrollment period to prevent adverse selection. Adverse selection happens when sick people sign up for a health plan, but healthy people don’t, which throws the amount of risk a health plan takes on out of balance when insuring someone.
During open enrollment, insurance plans are available from major medical insurance companies to purchase from "the marketplace" or "exchange." These plans are referred to as "on-exchange" plans. Most states use the federal exchange, Healthcare.gov. Some states, like California, New York, Pennsylvania, and a few other states, have their own state-run exchanges and enrollment systems.
When you shop at Healthcare.gov, you’re only seeing “on-exchange” plans. However, insurance companies only make a fraction of their plans available “on exchange." If you go directly to an insurance company’s website, you’ll see their “off-exchange” plans.
The Take Command platform is a great place to start shopping because you can look at ALL of the available plans side by side (including “off-exchange” plans) to compare - and see which plans are “Easy-Enroll”. True to the name, Easy Enroll plans have easy, fast enrollment (Take Command takes care of it!) and our team can support you with the Carrier! Look for the Easy Enroll tag for added peace-of-mind.
If you're ready to start shopping, you can view all of your options side by side on our platform.
The Affordable Care Act created a health insurance exchange, or online marketplace, where individuals can shop for individual health insurance plans and compare their health plan options. This is known to most as Healthcare.gov. Individuals are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange.
Because your employer is offering you a health reimbursement arrangement, now is the time to purchase your plan for coverage starting on January 1st, 2025. It's important to note that you'll need to enroll by December 15th, 2024 for coverage that starts January 1st, 2025. Open enrollment continues through January 15th for February 1st start dates. As mentioned above, the dates may vary slightly in some states.
Open Enrollment is the time when you can buy a compliant plan that is qualified for your HRA (either a qualified health plan for ICHRA or a Minimum Essential Coverage plan for QSEHRA). If you're a client already using our platform, there will be a to-do list on your dashboard. If you are new here, we will walk you through onboarding which will include shopping for a plan. After Open Enrollment begins in November, you'll receive an email to log in and get started shopping for individual health insurance.
It can be a little overwhelming! Before you shop, start by thinking about what's important for you and what health needs you anticipate for the year. Good questions to ask yourself include, Is it more important to have a low premium or a low deductible? Do you regularly see a specialist that needs to stay in-network? Do you have a lot of prescriptions that you'll need covered? Are you anticipating any medical needs this year (i.e., ongoing physical therapy, surgery, or pregnancy?)
It's good to think these things through, because what really drives costs–and therefore your plan choice–are the things you know about: prescriptions, doctor visits, therapy, medical equipment, etc. If you’re healthy, maybe you plan on none of these things–which is just as important to know. Unpredictable costs, like catching a cold, spraining an ankle, or a hospitalization, shouldn't impact your plan choice.
Our shopping portal allows you to enter a provider's name to see which plans show them as in-network and see if specific prescriptions are covered in a plan's drug formulary.
More than 75% of your healthcare costs in the next year are predictable based on your needs.
Here's some good news for simplicity: any given plan sold during Open Enrollment will be priced exactly the same no matter where you find it. If you find a plan you like, say a Blue Cross Blue Shield silver plan on Healthcare.gov, it will legally be priced the same whether you purchase it on the Exchange, or from a broker friend.
The prices on our individual health insurance shopping portal will show you the best prices for all of your health plan options.
Gather round, friends. This is a really important question. Why? Because not all plans integrate with HRAs, meaning that not all plans will be reimbursed through an HRA and not all plans will qualify you to participate in your company's HRA. Best to get this right the first time.
Here's an easy, quick list to get started:
ICHRA-compliant plans:
Plans that don't work with ICHRA include sharing ministries, TRICARE, short term and indemnity plans, and other employer sponsored group plans (either from spouse, COBRA, or retirement plan).
QSEHRA-compliant plans:
Here is a post on plans that integrate with QSEHRA and plans that integrate with ICHRA to help you weigh your options.
Confused?
Here's the good news: Any plan that you purchase on the Exchange will be compliant with your HRA. Major medical off-exchange plans that are available during Open Enrollment will qualify as well.
And here's more good news: our platform will hold your hand through this entire process.
Pro-tip: To see if a plan integrates with your HRA, check for a metal tier (silver, platinum, bronze) in the name or description of the plan. That's a good sign.
Great news! Medicare is reimbursable with your HRA. Remember, you must have coverage of Part A and Part B together or Part C. Part B by itself doesn't qualify.
To make this easier, we've partnered with Chapter to make the Medicare enrollment process a breeze. Chapter is a white glove service that will help you find the right Medicare Advantage and Medicare Supplemental plans that are designed to help cover the costs of various deductibles, co-payments and coinsurance charges that Medicare alone does not include.
All you'll have to do is choose a coverage option from leading insurance companies based on where you live and your individual needs, then submit proof of coverage to Take Command, along with receipts for eligible care, and get reimbursed tax-free.
Learn more on our Medicare partnership with Chapter here.
Important: Medicare Open Enrollment runs October 15th to December 7th. This is the time to evaluate existing Medicare coverage and your chance to make changes to your Medicare coverage.
First of all, be an informed shopper. Download our PDF on "Health Insurance 101," where you'll find the basic definitions of key terms you'll need to know while shopping for health insurance (like formulary!). Understanding health insurance jargon will keep you out of trouble and reduce those stress levels.
Another thing to be aware of is that if you are shopping outside of an exchange, for example through a broker, watch out for plans that say indemnity or short term as they don't qualify for QSEHRA or ICHRA. For QSEHRA, some plans like this can be supplemented to qualify but they will not work for ICHRA.
Also important: If you're leaving a company and COBRA is an option, 99% of the time, COBRA is a bad deal. Don’t just accept it because it’s easy. You can be billed for up to 102% of the total cost of coverage; 100% of the cost of your previous plan plus a 2% administrative fee!
If you’re happy with your individual plan and the insurance company is offering it again in 2025, you can renew your plan in most cases.
If you had an “Easy Enroll” plan with Take Command in 2024, you may see the option to renew your plan when you log in to shop. In some cases you may not see this option. If your company has an ICHRA with AutoPay, you can shop and choose the same plan for 2025. If you've had changes that affect your premium amount like adding/removing dependents or moving, you will likely need to shop in order to choose the same plan.
Before keeping the same plan, take some time to consider your family’s health needs for 2025, which doctors you need to keep in-network, and what prescription coverage is important. If the same plan from last year still meets your needs, then simply renew or choose it again!
Remember, it never hurts to browse other plans to make sure your existing plan is still your preferred plan.
To get started shopping for a plan, head on over to our individual health insurance shopping page to compare plans side by side and find one that will work for you and your HRA.
Yes!
If you’re changing insurance companies for 2025, make sure you call and cancel your old plan from 2024 before they auto-renew - and charge you for a January 2025 premium!
Even if you will have the same insurance company in 2025 as in 2024, but are changing the specific plan itself, we recommend calling and confirming that they only have your new plan on file for 2024. You don’t want to pay for two plans! Note that some carriers process payments in the middle of the month, so early December is the best time to cancel a 2024 plan.
Remember that you are keeping your 2024 plan effective through the end of December as your new 2025 plan will become effective January 1, 2025.
Premium tax credits, also known as PTCs, are refundable credits (or subsidies) that helps eligible individuals and families cover the costs of premiums for their health insurance purchased through the ACA Marketplace, or Exchange. To receive a premium tax credit, you must meet certain requirements.
One way to pay too much for health insurance is to leave money on the table. We see many individuals assume they're not eligible for tax credits when they actually are. Depending on where you live, a family of 3 or 4 that makes $90,000 a year will likely qualify for a tax credit.
Our individual health insurance shopping portal will help you calculate your premium tax credits if you qualify.
Generally speaking, tax credits are tied to size and income. They also vary across zip codes. You may qualify for premium tax credits if you:
Take Command Health can help you figure out how much you are eligible for on our individual health insurance shopping portal.
This is a tricky one. The way HRAs and PTCs interact depends on what type of HRA you have.
For QSEHRA: We will start by explaining how QSEHRAs and Premium Tax Credits work together. Scroll down to skip ahead if you have an ICHRA.
In general, QSEHRA allowance will reduce premium tax credits dollar for dollar.
Basically the employee will be exchanging the tax benefit from the government with the tax benefit from the employer. The employee may still access their tax credits if the benefit is less than the premium tax credit available to them.
As an example, if you are eligible for a $500 tax credit and your employer offers a $400 QSEHRA allowance, your PTC will be reduced to $100 ($500-$400).
It is very important that employees purchasing a plan through the marketplace and receiving a premium tax credit notify their insurance provider immediately about their small business HRA benefit. The insurance provider will recalculate the employee tax credit with the QSEHRA benefit. Failure to report the QSEHRA to your insurer will result in having to pay back the tax credits to the IRS during tax time.
FOR ICHRA: If you have an ICHRA, here's what you should know about PTCs and ICHRA.
Employees can choose to participate in ICHRA or receive a PTC. You cannot have both.
A nice feature of the individual coverage HRA is that as an employee, you have the option to participate in your employer's ICHRA or opt-out annually through the opt-out provision. This is different then ICHRA's predecessor, QSEHRA, which does not allow employees to opt-out.
If you accept the Individual Coverage HRA, you cannot claim any premium tax credits for the year for either yourself or any family members. If you opt-out of the Individual Coverage HRA for the year, you may be able to claim premium tax credits.
The Exchange will then determine if the ICHRA offered is deemed affordable or unaffordable for you. In cases where an employee has opted out of ICHRA and the HRA is considered unaffordable the employee is allowed to claim premium tax credits for themselves and dependents. In cases where the employee has opted out of ICHRA and the coverage is deemed affordable the employee may not claim any premium tax credits for themselves or dependents.
When individuals enroll in an Exchange plan, the Exchange will ask if the individual is offered any coverage through their employer. This includes coverage through the Individual Coverage HRA. Employees will be required to give notice to the Exchange of their ICHRA offering.
During the onboarding process with Take Command, we will help you understand these nuances and determine what's best for you.
First stop, look at your plan documents on your portal. The employee notice, specifically, will have great information on what to do about your PTCs that's tailored to you and your exact plan. Also check out the following resources:
An on-exchange, or marketplace plan, is a health insurance plan that's purchased on the ACA marketplace or federal exchange (a.k.a. Healthcare.gov.) or, in some states, state-run exchanges. Any of these are considered marketplace plans and are eligible for premium tax credits.
Off-exchange plans are offered by major medical providers and purchased directly through them instead of from the exchange.
Our individual health insurance shopping portal shows both on- and off-exchange options.
In general, there are other plans outside of the ACA plans and the off-exchange plans mentioned above. But remember, you need to have a plan that qualifies for reimbursement through your employer's HRA. For QSEHRA, there are some alternative insurance plans that qualify if certain conditions are met. We can guide you through the process of weighing your options and connect you with a partner we trust.
If you're enrolled in an ICHRA, however, you'll need an individual medical plan. We recommend you utilize open enrollment to shop for an on- or off-exchange major medical plan that integrates with ICHRA.
What the metal tiers are telling you is how much the plan covers and how much it costs.
Here's the gist:
Bronze:
Silver:
Gold:
Platinum:
Check out our handy blog post on what the metal tiers mean for more information.
A premium is the monthly cost for your health insurance. The premium is what your monthly allowance for an HRA will cover.
A deductible is the amount of covered healthcare costs you pay before your health insurance begins to cover the costs. If you have a $2,000 deductible, you'll be paying $2,000 out of pocket before insurance kicks in.
Pro-tip: Your monthly premium does not count toward your deductible.
An HMO (or “health maintenance organization”) is generally the most affordable, but least flexible network type. Here a few key concepts of a HMO:
A PPO (or “preferred provider organization”) is generally the most flexible, yet most expensive network type. Here a few key concepts of a PPO:
An EPO (or “exclusive provider network”) is a hybrid of a HMO and a PPO. Here a few key concepts of an EPO:
A POS (or "point of service”) is also a hybrid of a HMO and a PPO. Here are a few key concepts of a POS:
You can only change plans and buy on-exchange plans during Open Enrollment (from November 1st through January 15th) unless you meet certain conditions that qualify you for a Special Enrollment Period. These circumstances include having a baby, getting married, getting divorced, or changing jobs. In other word, big life changes.
If you are offered an HRA for the first time from your employer, that qualifies you for a Special Enrollment Period as well, where you'll have 60 days to sign up for a health plan that meets your HRA requirements.
Pro-tip: We recommend you take advantage of Open Enrollment to sign up for a plan. You'll have more options.
Read our posts on Special Enrollment Periods for QSEHRA or Special Enrollment Periods for ICHRA for more info.
There are two ways to enroll in dental insurance.
Here's a helpful post for more information about our dental partnerships.
This is an exciting time, and we're honored to a part of this process with you. If you have any other questions as you begin the process, please reach out. We are here to help you! And for those of you who are ready to being, please login to our portal and we'll walk you through the process.
Happy Open Enrollment, everybody! 🎉