By: Amanda Gottlieb and Jackie Le Grand
Date: 11/1/24
Headline: It’s Open Enrollment Season. Here’s What to Consider for 2025.
Every year around this time, open enrollment begins for individuals and families to select their healthcare coverage options for the following year. Staying informed about your plan and coverage options will empower you to take charge of your health and feel more confident that you made the right decisions.
If you have Medicare or Medicare Advantage, click here to learn more about this coverage and the changes for 2025.
If you have Medicaid coverage and have any questions or need to update your information, click here.
If you have employer or marketplace insurance, keep reading to learn what to consider this open enrollment season.
Timing and Deadlines
If you get your health insurance through healthcare.gov, your open enrollment will run from November 1, 2024 to January 15, 2025. If you live in a state that runs its own health insurance marketplace, there may be some slight differences in the timeframe, but most open enrollment periods begin on November 1. No matter which state you live in, visit https://www.healthcare.gov/ to find your state’s enrollment period and start shopping for insurance or see if you are eligible for Medicaid. For the 2025 plan year, more cost help is available than in past years, even for people who were not eligible in the past. This includes some families with employer-sponsored health insurance. Be sure to visit https://www.healthcare.gov/more-savings/ to see if you may be eligible for this cost help.
If you receive healthcare through an employer, your human resources department will communicate when your enrollment period is (typically in November or early December). They should also note whether enrollment is passive or active, which will determine if any actions need to be taken on your part. By staying informed, you will allow yourself ample time to understand any plan changes or differences in costs that your employer may have announced.
No matter where you get your health insurance, pay close attention to deadlines!
Plan Types
With open enrollment comes the opportunity to reevaluate what plan is most suitable for your individual and family needs. Plan types offered typically include high deductible health plans (HDHP), preferred provider organizations (PPO) and health maintenance organizations (HMO) – all of which have different coverage types, benefits, and costs. For the type 1 diabetes (T1D) community, understanding your deductible responsibility, out-of-pocket costs for drugs, devices, and supplies and if your preferred doctors are in-network are all factors to consider before making a selection. Even if you know you’ll have the same plan again for 2025, you should check if any of your current prescription formularies* have changed because it could affect how your T1D management tools are covered. (*Formularies are the lists of prescriptions, both brand name and generic, that your insurance plan covers. They are usually divided into tiers or categories which help you understand what brands are covered and what their cost will be.) If there will be changes to the formulary, you may need to get a prescription for a new brand of product from your provider when the new year arrives.
How Much Will This Cost Me?
Cost is an important factor that many consider when it comes to choosing health coverage. Especially for those impacted by T1D, balancing cost with choice and robust coverage can seem challenging. If you are still unsure about costs and specific medication coverage, talk to your HR department, or get help from Healthcare.gov to get your questions answered if you’re enrolled in a marketplace plan. If you have different plan options, writing or typing out a table to look at all the different costs across the plans may make it easier to weigh the different plans. Include monthly premiums, deductibles, insulin copays, CGM, and pump supply costs, glucagon costs, and an estimate of how many times you might visit a doctor or other provider and pay a copay.
Breakthrough T1D also has resources to help! For more information and tools for understanding insurance while living with T1D, visit our Health Insurance Guide.
