Newsletter

ACA ENROLLMENT BREAKS RECORDS AGAIN IN 2025

This article, written by Rebecca Pifer for Insurance Dive, was published on January 21.

An Obamacare sign outside of Leading Insurance Agency, which offers Affordable Care Act plans in Miami. 

Joe Raedle via Getty Images

About 24.2 million people signed up for Affordable Care Act plans during the open enrollment period for 2025 — an all-time high, blowing past last year’s previous record of 21.3 million.

The enrollment figures were announced by the Biden administration on January 17, three days before President Donald Trump was sworn into office, ushering in a Washington notably less friendly to the ACA. The Trump administration is expected to chip away at the 15-year-old law, including introducing alternative plans and reducing funding for programs that help people navigate the exchanges (see second article, below).

Still, much of the enrollment growth was in Republican states, including Florida, Texas and Georgia, which makes it more difficult for Trump to take drastic action targeting the ACA without angering conservative voters, according to experts.

Enrollment for 2025 got off to a slow start at the beginning of the open sign-up period in the fall. Some Americans who put off insurance elections said they were concerned how the Trump administration might affect their coverage. However, the pace of sign-ups picked up before enrollment concluded in January — and most people with existing ACA coverage were automatically reenrolled in plans, according to regulators.

Major Republican States Saw The Largest Increases In ACA Enrollment

The following table shows 2025 ACA enrollment and change from prior year by U.S. state:

Experts are split on whether Trump will preserve more generous tax cuts that are credited for swelling ACA enrollment by millions of people since the coronavirus pandemic. Absent congressional action, the subsidies are set to expire at the end of this year.

Republicans are on the hunt for spending cuts to pay for the President’s promised tax breaks, making it unlikely the subsidies survive this year in their current form. However, because of the razor-thin Republican majority in Congress and political popularity of the ACA, some experts think the subsidies will be extended but shrunk so that fewer people are eligible.

Top healthcare regulators in the Biden administration called on Congress to preserve the subsidies on their way out the door.

“Congress must do its job so those millions of Americans remain covered,” Xavier Becerra, Biden’s HHS Secretary, said in a statement February 14.

The future of the subsidies isn’t expected to be resolved until the back half of the year, creating uncertainty for insurers offering plans in the exchanges. But in the meantime, continued enrollment growth is a boon for insurers like marketplace giant Centene, which has chalked up much of its recent revenue and earnings growth to the ACA marketplaces.

High enrollment in ACA plans is also positive for hospitals, doctors’ offices and other providers, as it lowers the risk of uncompensated care.

TRUMP ADMINISTRATION SLASHES FUNDING FOR ACA NAVIGATORS

Another article, written by Rebecca Pifer, appeared on Insurance Dive on February 18.

The CMS on February 14 announced a record cut in funding for community groups that help consumers learn about and select ACA plans.

Dive Brief:

• The Trump administration has slashed funding for groups that help consumers navigate the Affordable Care Act exchanges by 90%, in the largest cut since the program began over one decade ago.

• The ACA Navigator program will receive $10 million in funding annually going forward, down from $98 million last year, the CMS announced February 14. The cuts, which apply only to navigators working in the federal exchanges, will save $360 million over the next four years, according to the agency.

• Regulators argued the cuts will translate into lower premiums for consumers, while patient advocates and healthcare researchers said the move will make it significantly more difficult for Americans to understand and access the right coverage for their health needs.

Dive Insight:

President Donald Trump significantly slashed funding for navigators during his initial term as president, cutting funding from $63 million to $36 million in 2017 before further lowering it to just $10 million in later years.

The cuts resulted in layoffs and stymied outreach initiatives among navigators, community groups that receive federal grants to educate consumers about their health insurance options on the ACA exchanges.

However, funding was later restored by President Joe Biden, which — along with more generous subsidies for ACA plans — spurred record sign-ups in the exchanges. Enrollment in ACA coverage surpassed 24 million individuals for 2025.

Now, the Trump administration is once again arguing that navigators don’t enroll enough people to justify the tens of millions of dollars they receive each year in funding.

Navigators only enrolled 92,000 people for the 2024 plan year — fewer than 1% of overall plan selections in the federal exchanges — at a cost exceeding $1,000 per person, according to the CMS.

“Overall, Navigator performance data shows that the current level of funding does not represent a reasonable return on investment,” the CMS said on February 14.

However, navigators do more than just sign people up for ACA plans.

Navigators provide people who aren’t familiar with the insurance market with a wide variety of assistance on how to understand and use the exchanges, including helping them verify their income to qualify for subsidies.

Navigators also educate the public on their insurance options, with a focus on reaching out to minority groups and underserved communities to close coverage gaps. They help people access care after they obtain insurance, including billing and claims issues, and work with employers on ACA compliance.

In addition, navigators help people transition across coverage types, including helping people enroll in Medicaid and the Children’s Health Insurance Program. In 2024, navigators enrolled roughly 290,000 people in the safety-net programs, according to health policy research firm Kaiser Family Foundation (KFF).

“Navigators help people with some of the most complex situations understand their health plan options and assist them in getting needed care,” said Anthony Wright, executive director of patient advocacy group Families USA, in a statement February 14.

Reducing navigator funding, along with other Republican actions meant to shrink Medicaid and the ACA, “will erode the record number of coverage and enrollment gains we’ve achieved over the past years,” Wright continued.

The cuts suggest the Trump administration plans to take a similar approach to the ACA as its first go-around in Washington, when the president chipped away at the law through executive actions after failing to repeal it entirely.

However, culling ACA navigation now could have an outsized impact on insurance coverage in the U.S., given the potential confluence of ACA plan subsidies expiring absent congressional action and increasingly likely cuts to Medicaid.

The HHS is also currently working on a new proposed rule focused on “program integrity” for the ACA, in the department’s only non-statutory regulation currently under review at the White House’s budget office.

The specifics of the rule remain to be seen. But early regulations from Trump’s first term made it harder for people to enroll in ACA coverage by shortening the signup period and letting states determine their own standards in areas like network adequacy, Katie Keith, the director of Georgetown University’s Health Policy and the Law Initiative, said on X.

Over President’s Day weekend, the President also followed through on threats to fire thousands of federal health employees, including workers at the CMS focused on improving Medicare and Medicaid, according to Politico.

The cuts come roughly one week after the CMS confirmed it’s working with the Department of Government Efficiency, billionaire Elon Musk’s initiative to ferret out fraud in government spending, to find a “more effective and efficient use of resources.”

QUALIFYING LIFE EVENTS TO ENROLL IN AN AFFORDABLE CARE ACT PLAN

The Open Enrollment Period for enrolling In an Affordable Care Act plan ended as of January 15 on healthcare.gov, and individuals and families can enroll now only if they have a “qualifying life event.” This document, prepared by a major carrier, contains information about qualifying life events, the period of time from the date of the event in which a person must enroll (generally 30 or 60 days depending on the event), as well as alternatives to ACA programs.

By clicking on the link you will identify most qualifying life events. Note, however, that a dependent can remain on a parent’s plan until age 30 in Florida (instead of age 26), and there also is a qualifying life event for an individual or family if 2025 projected individual/family income is between 100 and 150% of the Federal Poverty Level in Florida and other non-Medicaid expansion states (in states that have enacted Medicaid expansion, income must be between 138% and 150% of the Federal Poverty Level).

If you are not enrolled in an Affordable Care Act plan and would like to determine if you are eligible to enroll or if you would like to explore non-ACA alternatives, please call us at 786-970-0740.

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.