Buying Health Insurance for 2025
With more financial help than ever, broader access, enhanced protections, and reduced barriers to care, now is the perfect time to get covered.
Looking to buy health insurance for 2025? It’s a good idea to get up to speed on the new rules and policies that affect health insurance, and how to get or stay covered. So, here’s what you need to know.
More Financial Help Than Ever to Pay for Health Insurance
Beginning in 2024, California kicked off its first-ever state-funded enhanced Cost Sharing Reduction (CSR) program. These new subsidies eliminated deductibles for over 800,000 Californians. Those enrolled in a Silver CSR plan also saw lowered costs on prescriptions and on copays for such things as emergency care and doctors visits. This financial help made health insurance more affordable for Californians at or below 250 percent of the federal poverty level. This program is expanding in 2025. Californians with an income above 200 percent of the poverty level who are enrolled in a Silver CSR plan will now have no deductibles and lower out-of-pocket costs. Those under 200 percent will continue to have access to the highest level of benefits.
Nearly 90 percent of Covered California’s enrollees are receiving financial help, and many are paying $10 or less per month for their health insurance. Nearly 25 percent of current enrollees are estimated to have a $0 premium in 2025, a jump from 20 percent in 2024. And if their enrollment and income levels remain steady, nearly 60 percent of current enrollees will see no change, or they will see a reduction in their monthly premium with the financial help they receive.
More Dental Plans From Covered California
Covered California enrollees will have more choice among dental insurance plans with the addition of the new insurance company, Humana, which will begin statewide coverage in 2025. Dental plans are also available from Anthem Blue Cross, Blue Shield of California, California Dental Network, and Delta Dental of California.
The standard health benefits for Covered California enrollees include dental coverage for members under the age of 19, and adults can purchase family dental coverage as an “add-on” to their health plan. While this insurance is not eligible for financial help, the family dental coverage is available to anyone who wants it, regardless of any pre-existing oral health conditions. Covered California offers both dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans.
New Law Limits Health Industry Costs
The state’s first cap on the health industry has been approved, limiting health care cost increases to 3% by 2029. This means that hospitals, doctors, and health insurers need to find ways to cut costs to prevent spending from exceeding the target. Between 2015 and 2020, the money Californians spent on health care went up about 5.4% each year. This rule aims to promote health equity and access for all, especially for the state’s underserved communities. Increased health spending most often translates to higher out-of-pocket costs for consumers in the form of premiums, deductibles, and copays. The annual spending benchmark would require health care providers to limit spending growth to 3.5% for 2025, and decrease it over five years to 3% by 2029.
California Protects & Expands Access to IVF
Having a baby via in vitro fertilization is about to become more accessible for many Californians. The new law makes the right to fertility care and in vitro fertilization (IVF) protected in the Golden State. It requires large group health plans—those covering more than 100 people—to cover the diagnosis and treatment of infertility. This includes a maximum of three egg retrievals and unlimited embryo transfers. The new law does not apply to people who get their health coverage from religious employers or to those enrolled in Medi-Cal. The new law also broadens the definition of infertility to include same-sex couples, bringing reproductive equity to the state’s LGBTQ+ population.
DACA Recipients Now Eligible for Obamacare
DACA recipients who meet all other eligibility requirements can now enroll in Obamacare (officially called the Affordable Care Act) beginning November 1, 2024. As part of the Affordable Care Act, California created Covered California, a free service that connects people with high-quality health insurance and the financial help to pay for it. Newly eligible individuals will qualify for special enrollment for 60 days. Those who enroll during November will have their coverage start on December 1, 2024. Those who enroll during December will have their coverage begin on January 1, 2025. You can still apply after the 60-day period in January during open enrollment, when coverage will begin on February 1, 2025.
Improving Early Detection of Breast Cancer
A new law now requires mammography facilities to notify patients about the density of their breasts in an effort to improve early detection of breast cancer. Breast density may increase the risk of breast cancer and also make it harder to detect, requiring additional imaging. This affects about half of women over 40 in the United States.
Reduced Barriers to Mental Health, Substance Use Disorder Benefits
New rules build on the promise of the Mental Health Parity and Addiction Equity Act of 2008. The law requires health plans and insurance companies that provide mental health or substance use disorder benefits to treat these benefits equally with medical and surgical benefits. This means they can't impose stricter rules on mental health or substance use disorder coverage compared to other medical services. The new rules offer more protections against stricter limits on mental health and substance use disorder benefits compared to medical and surgical benefits. These stricter limits can include requirements such as needing approval before treatment, trying certain medications first, or rules about which providers can join a network. In simple terms, getting help for anxiety should be as straightforward as getting treatment for a hurt shoulder, and getting medication for depression should be just as easy as getting medication for high cholesterol. The final rules also prevent plans from using biased or unfair information that could make it harder to access mental health and substance use disorder care when setting limits on treatment.
Lifesaving HIV Medications and Care for Low Income Individuals
The Ryan White HIV/AIDS Program is getting more than $1.4 billion in funding to ensure that individuals with HIV who are also low-income will receive the lifesaving medication, care, and supporting services they need. The Health Resources and Services Administration of the U.S. Department of Health and Human Services provides these benefits through their AIDS Drug Assistance Program which helps pay for HIV medication, copays, coinsurance, and monthly health insurance premiums that cover HIV medication. Without this financial help, medication alone could cost individuals more than $40,000 a year. Over half of the people diagnosed with HIV in the U.S. receive services through this program every year. In 2022, 89.6 percent of Ryan White HIV/AIDS Program clients receiving medical care were virally suppressed, compared to 69.5 percent in 2010.
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Just like purchasing health insurance, your needs and those of your family’s may change from year to year. We are here to help. Find out quickly and easily how much financial help you could get to pay for health insurance. Explore your options now to get the coverage you need — or feel free to contact us at any time.
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