US Health Insurance Market Annual Update
Annual US Health Insurance Market Update
As we approach the ACA/Obamacare open enrollment period for 2025 individual health insurance and the annual renewal for most small business group health plans, I am providing information regarding changes that are happening in the market in 2025 to help you get prepared to find the BEST possible health plan for your situation and needs.
I also know that if you are on an ACA/Obamacare individual plan you may have already received your current plan’s renewal information for next year, so I hope this also provides some context to the planned rate increases or decreases, plan changes and cancellations, etc. that you are seeing.
Below you will find updates and changes that are happening at the federal level as well as links to more information in the states where US Insurance Solutions is currently licensed. Click the link for your home state to get more information about what is happening where you live.
Please review this information and then, if you haven’t already done so, go to my online calendar (and at the bottom of this page) and set an appointment for us to talk about your options for next year.
General Update
In 2024 the focus of the current presidential administration has continued to be on expanding the ACA/Obamacare markets. The biggest move that was made was the finalizing of a rule to limit the term of Short Term Medical plans to a maximum of 4 months per person per insurance company per year. That rule went into effect on September 1, 2024.
Since we are in a presidential election year, we will need to wait for the results to find out what will happen with the health insurance market in 2025 and beyond.
Alternative Health Plan Solutions Updates
As noted above, the rule limiting the duration (term) of Short Term Medical plans went into effect on September 1, 2024.
Under the new rules, plans that claim to be “short-term” health insurance are limited to just three months, or a maximum of four months, if extended – instead of the current three-year maximum. And, under the rules, plans are required to provide consumers with a clear disclaimer that explains the limits of their benefits, including to existing consumers currently enrolled in these plans.
We will continue to offer Short Term Medical plans from the same top companies. Pivot Health is now offering a plan in select states where one can apply for 2 or 3 plans with 4-month durations in one application. Since they work with 3 different insurance companies, they can make this offer. With this option, there will be a new plan every 4 months from a different insurance company. Therefore, the plans will have slightly different overall coverage. There will also be a new deductible that starts with each new 4-month term. However, the big advantage is if someone has a serious health issue in one term, that issue will be covered by the subsequent policies. This is the only option we are aware of that will allow coverage of either 8 or 12 months in one application.
Off Exchange ACA Compliant Major Medical Individual Plans
NEW OPTIONS: While Short Term Medical plans will be changing and won’t be a good long-term option, I now have two programs that offer multiple health plans that will work well for certain people in most states. These plans are comprehensive major medical coverage and compliant with ACA/Obamacare mandates. They each utilize a nationwide PPO network, so they offer a much better choice of providers than most ACA/Obamacare plans. All plans have a maximum out of pocket limit that will be $1,850 per year LESS than the maximum out of pocket for 2025 non-HSA qualified ACA/Obamacare plans. For HSA qualified plans the maximum out of pocket limit will be $1,500 per year LESS than the maximum out of pocket for 2025 HSA qualified ACA/Obamacare plans.
The standard rates for these plans are competitive with the full price without a subsidy on current, similar ACA/Obamacare plans for people in the 45-64 age range who do not qualify for a tax credit subsidy to purchase ACA/Obamacare plans.
Both programs are health underwritten. One program has a simple set of 11 questions. If you can answer “No” to all of them, you are approved at the current rates. If not, you are declined. The other asks more questions and final rates can be rated up or down based on health, or one can be declined. If approved, both programs cover all pre-existing conditions from day one with no limitations.
I will be reaching out to current and former clients that I have identified who could benefit from changing to one of these plans. However, if you read this and you want to learn more about these plans, please reach out to me.
Health Insurance Buffet – Alternative Individual Plans
Given the above new rule, I will remove the Short Term Medical plans from my Health Insurance Buffet program in the states where they are currently a good long-term option.
Primary (Main Course) plans – The new options mentioned above are now included as primary options. In addition, we continue to offer our two main Fixed Benefit plan companies, Philadelphia American and Manhattan Life plans in many states.
Supplemental (Side Dish) plans – We also have expanded plan offerings and enhancements to available accident, critical illness and hospital indemnity plans. You can see many of these on our US Supplemental Coverage page.
Your Health Insurance “Plate” – We always work to provide you with the most comprehensive coverage we can offer to fit in your budget. We do that by combining the available Primary and Supplemental plans in your state into the best available package.
As noted on our US Insurance Solutions home page, if you are looking for a better, more affordable individual/family health plan and make too much money to get a tax credit subsidy from the government, one of our NAHP alternative individual health plan solutions may be just what you need!
Alternative Small Group Health Plans
If you own (or work for) a small business with under 50 employees, and meet certain criteria, one of our NAHP alternative group health plans could be a better option than an ACA/Obamacare, fully insured group health plan.
NOTE: We are seeing more companies that have traditionally offered fully insured small group plans offering alternative, Level Funded small group plan options.
Again, click on the link for your home state (below) to learn more about the alternative health plan changes and updates where you live.
On the other hand, for individuals who are eligible for a tax credit subsidy to help pay their premium and/or have significant health issues I can help find the best ACA/Obamacare individual plan.
Also, for small businesses who don’t have enough people for an alternative plan and/or have people with significant health issues in their group, I can help find the best fully insured ACA/Obamacare small group plan. Please review the following…
Federal ACA/Obamacare Changes
The following are some of the main changes and updates happening with ACA/Obamacare plans.
Individual Plans
Insurance companies participating in ACA/Obamacare individual markets:
We are seeing what I would consider a small expansion for 2025. A few new companies coming on board in select states and some modest expansion into more states and counties within existing states for the existing companies.
The following is information on the 2025 markets for most companies we represent.
Aetna – In 2025 Aetna will participate in the same states, but will expand to more counties in FL, IL, IN, KS, MO, NC, OH and TX
See the breakdown of counties here
Ambetter – Ambetter is in currently in 27 states. In 2025 Ambetter will be expanding to 33 counties in Iowa. Those counties are: Benton, Buchanan, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clinton, Crawford, Dubuque, Floyd, Fremont, Hancock, Hardin, Henry, Ida, Jackson, Jefferson, Kossuth, Lee, Linn, Louisa, Mahaska, Mills, Monona, Monroe, Montgomery, Pottawattamie, Ringgold, Shelby, Sioux, Van Buren, Washington and Woodbury.
Ambetter will also be exiting New Mexico in 2025.
Cigna – In 2025 Cigna will be exiting Pennsylvania, South Carolina and Utah. They will now be in 11 states (AZ, CO, FL, GA, IL, IN, MS, NC, TN, TX, and VA).
Medica – Medica currently offers their individual/family plans in 10 states. In 2025, Medica will be exiting Arizona. You can see a list of continued IFB plan offerings for 2025
Molina Healthcare – Molina currently offers their individual/family plans in 14 states (CA, FL, ID, IL, KY, MI, MS, NM, OH, SC, TX, UT, WA and WI). In 2025 Molina will remain in the same states listed above, but they will expand to 5 new counties in FL and KY, 15 counties in OH and 10 counties in TX.
Oscar Insurance Corp – Oscar currently offers their individual ACA plans in the following states**: AZ, FL, GA, KS, IA, IL, MI, MO, NJ, NC, NY, NE, OH, OK, PA, TN, TX, and VA. View and download Oscar’s full 2025 National footprint.
United Healthcare – In 2025, United Healthcare is expanding their ACA/Obamacare plans to four new states: Indiana, Iowa, Nebraska and Wyoming.
This expansion brings their total ACA footprint to 27 states for next year: Alabama, Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Michigan, Missouri, Mississippi, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin and Wyoming.
U.S. Health and Life/Ascension – will stop selling plans in all available states at the end of 2024.
NEW COMPANIES:
Antidote Health – Antidote delivers a new member experience that makes it easy for you to take care of your health. Their plans fit the budgets and care needs of self-employed, contractors and entrepreneurs, featuring top-quality network providers. Antidote Health will be available in select counties in AZ and OH in 2025.
Taro Health – Taro Health plans are built on the foundation of free, unlimited primary care and mental health visits. In 2025 Taro will offer plans in ME and OK.
Wellpoint – Wellpoint is part of Elevance, which also includes the Anthem Blue Cross Blue Shield companies. In 2025 Wellpoint will have plans available in FL, TX, and MD.
**Not all markets in all states
Changes to out-of-pocket limits and deductibles:
For the FIRST time in the history of the ACA, the maximum deductible and out of pocket limits for Obamacare compliant plans are going down a small amount on non-HSA plans! Plans that are HSA qualified will have the maximum limit rise by $250. The government sets a limit on how much these maximums can be. Family maximums can be twice as high as the maximum amount in a plan covering just one person (a “self-only plan”).
For 2025, the self-only maximum deductible and out of pocket limit can be up to $9,200 and the family maximum, up to $18,400. For high-deductible plans that are compatible with Health Savings Accounts (HSAs) they are lower with limits up to $8,050 for individuals and $16,100 for families.
The maximum contribution limits to an HSA are $4,300 for an individual and $8,550 for a family. As always, there is an additional $1,000 “catch up” contribution amount for each individual age 55 and above.
IMPORTANT NOTE: These ever increasing deductibles and out of pocket maximums on ACA/Obamacare plans are a great reason to consider adding one or more supplemental plans from our Health Insurance Buffet (above) to help minimize your out of pocket costs for many healthcare services. If you qualify for the enhanced tax credit subsidy, you can use some of that subsidy to cover the premium on the supplemental plans.
Small Group Plans
While it looks like there are companies having small increases or small decreases in rates in the ACA/Obamacare small group market there seem to be more companies with rate increases near or over 10%.
I am continuing to see more companies and plan administrators offering alternative Level Funded health plan options. Including many of the traditional fully insured plan companies.
NOTE: In the State Changes section below I have outlined all the proposed rate changes I could find in your state for both individual and small group health insurers.
State by State Changes and Updates
As noted above, please click on the link for your state for more details on what is happening with both the Alternative Health Plans market and ACA/Obamacare plans where you live.
U.S. Insurance Solutions is here to help
Remember, you are NOT in this alone…I am here to help! As your Personal Health Insurance Advisor, my goal is to make your life easier by taking the hassle out of finding the right health plan for your situation and needs.
To discuss your health insurance options and make sure you have the best possible health plan for your situation, please go to the link above with the image that says CALL ME and schedule a call with me on a day and time that works for you, and I will call you to review your options.