Open enrollment to purchase health insurance for 2025 is here, and this year, as many as 100,000 people are newly eligible to apply.
As of November, some individuals with Deferred Action for Childhood Arrivals (DACA) and certain other lawfully present immigration statuses can purchase private health insurance through the federal marketplace, the online network of health insurance plans available via the Affordable Care Act (ACA), or “Obamacare.”
The newly qualifying families and individuals will also be eligible for two subsidies to pay for health insurance purchased from the federal marketplace, as long as they meet income and tax requirements.
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The expanded eligibility comes as key provisions of the ACA, including subsidies like the premium tax credit are set to expire by the end of 2025 unless Congress acts.
It's also important to note that a new court ruling means DACA recipients in 19 states won't be eligible to enroll in ACA insurance. (More on that below).
In the meantime, here’s what you need to know about who can apply for ACA healthcare during the 2025 open enrollment season.
Coverage now extends to some 'lawfully present' immigrants
As of November 1, 2024, some DACA recipients and lawfully present immigrants can now apply for private health insurance plans under the Affordable Care Act’s marketplace, like HealthCare.gov.
According to the federal marketplace, the term “lawfully present” includes, but is not limited to individuals who:
- Have a valid non-immigrant VISA or are of qualified non-citizen immigration status
- Hold a humanitarian status or other protected status
- Have a legal status, such as temporary resident status, LIFE Act, or Family Unity individuals
However, it's important to note that millions of Dreamers across 19 states have just been barred from getting health insurance.
As Kiplinger has reported, a North Dakota federal judge’s ruling prevents Deferred Action for Childhood Arrivals (DACA) immigrants in Kansas, along with 18 other states including Florida, from purchasing health insurance from the federal marketplace.
The temporary order could impact over 162,000 Dreamers in those states and as many as 87,620 in Texas alone.
For more information on the injunction and to learn which states now bar DACA ACA access, see our report: 19 States Cut Off Dreamers From ACA Insurance.
You may also be eligible for subsidized coverage
Depending on your income and tax filing status, (and if you live in a state where DACA ACA access is still legal), you can also be eligible for two types of subsidies available through the Marketplace:
- The Premium Tax Credit
- Cost Sharing Reductions
As reported by Kiplinger, the premium tax credit helps qualifying individuals and families afford healthcare plans from the federal marketplace. As a refundable credit, you can get some or all of the credit as a tax refund. That means, if the credit lowers your tax bill to zero, the IRS can apply the remaining portion of the credit to your tax refund.
If you are eligible for the premium tax credit, you’ll have several options for using your credit as you are enrolling:
- Receive it as a tax credit when you file your return
- Choose an advance premium tax credit and use the credit to pay your insurer in exchange for a lower monthly premium
- Split it, and use some of the credit as an advance to lower your insurance premium and the remaining amount as a tax refund
What about cost-sharing reductions?
Once you fill out your application on the Marketplace, you’ll also be told if you’re eligible for an additional discount known as cost-sharing reductions (CSRs).
If you qualify for cost-sharing reductions, you must pick a plan in the Silver level to receive extra savings on out-of-pocket costs related to your healthcare, such as co-pays, deductibles, coinsurance, and out-of-pocket maximums.
Those who are eligible for cost-sharing reductions are required to:
- Be eligible for the premium tax credit
- Have an income between 100% and 250% of the federal poverty level
Does your state have other health programs?
Your state of residence can also impact the affordability of your health insurance. The Affordable Care Act allows states to create a Basic Health Program (BHP), which provides health insurance for low-income residents also eligible to apply for coverage under the federal marketplace.
To be eligible, you must have an income between 133% and 200% of the federal poverty level.
States that have implemented the Basic Health Program include:
- Minnesota
- Oregon
(Note: New York suspended its BHP on April 1, 2024.)
Were you looking for Medicaid or CHIP but didn’t qualify?
If you’re not eligible for federally-funded Medicaid, you may be eligible for state-funded Medicaid or similar programs.
When to enroll for Affordable Care Act coverage
Newly eligible DACA recipients and individuals will have a 60-day special enrollment period from November 1, 2024, through January 15, 2025.
- Generally, people who apply during open enrollment have to wait until January 1 to use their health insurance.
- However, the newly eligible DACA enrollees can start using their health insurance as soon as December 1, if they sign up for Marketplace coverage by November 30, 2024.
- Likewise, if you enroll for coverage on or before January 15, you can start using your coverage on February 1, 2025.
You can enroll online at HealthCare.gov, your state’s Health Insurance Marketplace, or by calling the Marketplace call center at 1-800-318-2596. However, certain dates for enrollment may change if you seek coverage through a state-based Marketplace.
Bottom line: Why does the 2025 open enrollment matter
Under previous Centers for Medicare & Medicaid (CMS) rules, DACA recipients were excluded from the definition of lawfully present immigrants. In May 2024, a new rule expanded eligibility terms to allow DACA recipients to enroll in private healthcare insurance through the Affordable Care Act’s marketplace and enroll in the Basic Health Program. Although a federal judge has blocked access in 19 states, DACA recipients in other states so far remain eligible.
According to the U.S. Department of Health & Human Services, more than one-third of DACA recipients don’t have health insurance. Now that CMS expanded its eligibility requirements over 100,000 uninsured DACA recipients could enroll during this year’s open enrollment period.
As mentioned, newly eligible individuals will also have access to federal and state subsidies that can make their access to health insurance more affordable.
Could some subsidies be at risk?
Some provisions under the Affordable Care Act are set to expire by the end of 2025 unless Congress acts, meaning millions of people are at risk of losing access to affordable healthcare.
It remains to be seen how the newly elected Congress will address the future of the ACA next year, and if the program will retain crucial help like the premium tax credit.
Also, the DACA ACA program is still subject to litigation, so it's hard to say how long recipients will have healthcare access through the marketplace.
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