The official 2025 Open Enrollment Guide + FAQs

Happy Open Enrollment 2025! 🎉 We may be some of the only people who treat Open Enrollment as a major holiday. We can’t help it. We love this time of year! But we understand that not everyone shares our enthusiasm, so we produced this short guide to help you navigate Open Enrollment. If this is your first time buying individual health insurance, this article will be your best friend.

Updated October 1, 2024, in anticipation of Open Enrollment 2025! 

Every year, we hear many of the same questions from individuals just like you who are having to navigate the health care system outside of a traditional group plan. Don’t worry! We have many resources, including this guide, to help you.

As you learn about topics like Open Enrollment, individual insurance, and HRAs, please remember that our platform will walk you through the entire process and help you choose a plan that will not only work for you but one that will also work with your HRA 2025.

Here are a few of the high-level questions, as well as several associated questions, this guide addresses in detail: 

Our platform will walk you through the entire process and help you choose a plan that will not only work for you but one that will also work with your HRA.

If you’re over 65 and enrolled in Medicare, you get a head start from October 15th through December 7th to review and make any changes to your Medicare coverage, which will go into effect January 1st .

Why is Open Enrollment limited to specific dates?

Health insurers limit the open enrollment period to prevent adverse selection.  Adverse selection happens when sick people sign up for a health plan, but healthy people don’t, which throws the amount of risk a health plan takes on out of balance when insuring someone.

Where can you buy individual insurance?

During open enrollment, insurance plans are available from major medical insurance companies to purchase from “the marketplace” or “exchange.” These plans are referred to as  “on-exchange” plans. Most states use the federal exchange, Healthcare.gov. Some states, like California, New York, Pennsylvania, and a few other states, have their own state-run exchanges and enrollment systems. 

When you shop at Healthcare.gov, you’re only seeing “on-exchange” plans. However, insurance companies only make a fraction of their plans available “on exchange.” If you go directly to an insurance company’s website, you’ll see their “off-exchange” plans.

The Take Command platform is a great place to start shopping because you can look at ALL of the available plans side by side (including “off-exchange” plans) to compare – and see which plans are “Easy-Enroll”. True to the name, Easy Enroll plans have easy, fast enrollment (Take Command takes care of it!) and our team can support you with the Carrier! Look for the Easy Enroll tag for added peace-of-mind.

If you’re ready to start shopping, you can view all of your options side by side on our platform.

What is “the marketplace” or “exchange”? 

The Affordable Care Act created a health insurance exchange, or online marketplace, where individuals can shop for individual health insurance plans and compare their health plan options. This is known to most as Healthcare.gov. Individuals are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange.

Why is Open Enrollment significant for me?

Because your employer is offering you a health reimbursement arrangement, now is the time to purchase your plan for coverage starting on January 1st, 2025. It’s important to note that you’ll need to enroll by December 15th, 2024 for coverage that starts January 1st, 2025. Open enrollment continues through January 15th for February 1st start dates. As mentioned above, the dates may vary slightly in some states.

Open Enrollment is the time when you can buy a compliant plan that is qualified for your HRA (either a qualified health plan for ICHRA or a Minimum Essential Coverage plan for QSEHRA). If you’re a client already using our platform, there will be a to-do list on your dashboard. If you are new here, we will walk you through onboarding which will include shopping for a plan. After Open Enrollment begins in November, you’ll receive an email to log in and get started shopping for individual health insurance.

• Major medical plans: Major Medical plans are those compliant with the Affordable Care Act (ACA) and qualify as Minimum Essential Coverage. If you purchased your plan through Healthcare.gov or your state’s public marketplace, your plan is a Major Medical plan, and your reimbursement through QSEHRA will be tax-free.
• Student insurance
• Your spouse’s plan (varies by QSEHRA plan): If you’re covered by your spouse’s group insurance plan there are some nuances to know regarding premium reimbursement. First, only the portion of the group premium that is  not paid for by your spouse’s company is eligible for reimbursement. Second, most group plans are already paid on a pre-tax basis from your spouse’s paycheck. This is great! However, the IRS doesn’t want you to “double dip” and also get a pre-tax QSEHRA reimbursement, so your QSEHRA claim for your premium may be paid on a taxable basis (plan depending). If you can verify that your premium is paid post-tax by your spouse (very rare), then you can still be reimbursed tax-free through QSEHRA!
• Government plans: Medicare, Medicaid, CHIP (children’s health insurance programs), TRICARE, and VA Care are all eligible healthcare plans and qualify as Minimum Essential Coverage. If you are on one of these plans and pay a monthly premium out of pocket, those can be reimbursed through QSEHRA tax-free.
• Dental Insurance & Vision Insurance Plans: Monthly premiums paid for individual and dental insurance plans can be reimbursed tax-free through QSEHRA. If you have dental and vision benefits through your spouse’s employer, only the portion of the group premium that is  not paid  for  by your spouse’s company is eligible for reimbursement. In addition, if your spouse pays the premiums for your dental and insurance plans pre-tax, you can only be reimbursed for these premiums on a taxable basis. 
• Limited Benefit Plans: Limited Benefit Plans are usually significantly cheaper than Major Medical plans but only provide a fixed amount of benefits (vs. unlimited benefits). These plans include short-term plans, fixed indemnity plans, accident plans, and any other plan that pays a medical benefit. As long as you also have a Minimum Essential Coverage health plan, and the limited benefit plan pays a medical benefit to the provider (not a cash benefit to you), the premiums on these plans can be reimbursed tax-free through QSEHRA. 

Here is a post on plans that integrate with QSEHRA and plans that integrate with ICHRA to help you weigh your options. 

Confused?

Here’s the good news: Any plan that you purchase on the Exchange will be compliant with your HRA. Major medical off-exchange plans that are available during Open Enrollment will qualify as well.

And here’s more good news: our platform will hold your hand through this entire process. 

Pro-tip: To see if a plan integrates with your HRA, check for a metal tier (silver, platinum, bronze) in the name or description of the plan. That’s a good sign. 

What if I’m on Medicare with my HRA?

Great news! Medicare is reimbursable with your HRA. Remember, you must have coverage of Part A and Part B together or Part C.  Part B by itself doesn’t qualify.

To make this easier, we’ve partnered with Chapter to make the Medicare enrollment process a breeze. Chapter is a white glove service that will help you find the right Medicare Advantage and Medicare Supplemental plans that are designed to help cover the costs of various deductibles, co-payments and coinsurance charges that Medicare alone does not include.

All you’ll have to do is choose a coverage option from leading insurance companies based on where you live and your individual needs, then submit proof of coverage to Take Command, along with receipts for eligible care, and get reimbursed tax-free.

Learn more on our Medicare partnership with Chapter here.

Important: Medicare Open Enrollment runs October 15th to December 7th. This is the time to evaluate existing Medicare coverage and your chance to make changes to your Medicare coverage.

What are some things you should avoid while shopping for a plan?

First of all, be an informed shopper. Download our PDF on “Health Insurance 101,” where you’ll find the basic definitions of key terms you’ll need to know while shopping for health insurance (like formulary!). Understanding health insurance jargon will keep you out of trouble and reduce those stress levels. 

Another thing to be aware of is that if you are shopping outside of an exchange, for example through a broker, watch out for plans that say indemnity or short term as they don’t qualify for QSEHRA or ICHRA. For QSEHRA, some plans like this can be supplemented to qualify but they will not work for ICHRA. 

Also important: If you’re leaving a company and COBRA is an option, 99% of the time, COBRA is a bad deal. Don’t just accept it because it’s easy. You can be billed for up to 102% of the total cost of coverage; 100% of the cost of your previous plan plus a 2% administrative fee! 

For QSEHRA: We will start by explaining how QSEHRAs and Premium Tax Credits work together. Scroll down to skip ahead if you have an ICHRA. 

In general, QSEHRA allowance will reduce premium tax credits dollar for dollar.

Basically the employee will be exchanging the tax benefit from the government with the tax benefit from the employer. The employee may still access their tax credits if the benefit is less than the premium tax credit available to them. 

As an example, if you are eligible for a $500 tax credit and your employer offers a $400 QSEHRA allowance, your PTC will be reduced to $100 ($500-$400). 

It is very important that employees purchasing a plan through the marketplace and receiving a premium tax credit notify their insurance provider immediately about their small business HRA benefit.  The insurance provider will recalculate the employee tax credit with the QSEHRA benefit. Failure to report the QSEHRA to your insurer will result in having to pay back the tax credits to the IRS during tax time.

FOR ICHRA: If you have an ICHRA, here’s what you should know about PTCs and ICHRA.

Employees can choose to participate in ICHRA or receive a PTC. You cannot have both.

A nice feature of the individual coverage HRA is that as an employee, you have the option to participate in your employer’s ICHRA or opt-out annually through the opt-out provision. This is different then ICHRA’s predecessor, QSEHRA, which does not allow employees to opt-out. 

If you accept the Individual Coverage HRA, you cannot claim any premium tax credits for the year for either yourself or any family members. If you opt-out of the Individual Coverage HRA for the year, you may be able to claim premium tax credits.

The Exchange will then determine if the ICHRA offered is deemed affordable or unaffordable for you. In cases where an employee has opted out of ICHRA and the HRA is considered unaffordable the employee is allowed to claim premium tax credits for themselves and dependents. In cases where the employee has opted out of ICHRA and the coverage is deemed affordable the employee may not claim any premium tax credits for themselves or dependents. 

When individuals enroll in an Exchange plan, the Exchange will ask if the individual is offered any coverage through their employer. This includes coverage through the Individual Coverage HRA. Employees will be required to give notice to the Exchange of their ICHRA offering. 

During the onboarding process with Take Command, we will help you understand these nuances and determine what’s best for you.

How can you get more information about Premium Tax Credits?

First stop, look at your plan documents on your portal. The employee notice, specifically, will have great information on what to do about your PTCs that’s tailored to you and your exact plan. Also check out the following resources:

Check out our handy blog post on what the metal tiers mean for more information. 

What are insurance “premiums” and “deductibles”?

A premium is the monthly cost for your health insurance. The premium is what your monthly allowance for an HRA will cover.

A deductible is the amount of covered healthcare costs you pay before your health insurance begins to cover the costs. If you have a $2,000 deductible, you’ll be paying $2,000 out of pocket before insurance kicks in. 

Pro-tip: Your monthly premium does not count toward your deductible. 

What are the differences between the network types (HMO, PPO, EPO)?

An HMO (or “health maintenance organization”) is generally the most affordable, but least flexible network type. Here a few key concepts of a HMO:

• You are required to select a primary care physician (or the insurance company can assign one for you) who is your first-stop for health needs. You will need a referral from your primary care physician to see a specialist.
• If you choose to see a doctor outside of the network or without a referral, you will generally have to pay all costs out-of-pocket unless it is a true medical emergency or you have no other options.
• The physician network is local.

A PPO (or “preferred provider organization”) is generally the most flexible, yet most expensive network type. Here a few key concepts of a PPO:

• You do not need to select a primary care physician and you do not need referrals to see a specialist.
• If you see an in-network provider, you will only be responsible for paying a portion of the bill (based on your plan’s coverage structure).
• If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an in-network provider.
• You will have access to out-of-state providers that are considered in-network.

An EPO (or “exclusive provider network”) is a hybrid of a HMO and a PPO. Here a few key concepts of an EPO:

• EPOs are more flexible than an HMO, and are typically less expensive than a PPO.
• Like a PPO, you do not need a referral to get care from a specialist.
• Like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan’s network.

A POS (or “point of service”) is also a hybrid of a HMO and a PPO. Here are a few key concepts of a POS:

• POS plans are more flexible than an HMO, and are typically less expensive than a PPO.
• Like an HMO, you will need a referral from your primary care physician in order to see a specialist.
• Like a PPO plan, you will have access to out-of-network providers (at an increased cost).

Can I change health insurance plans in the middle of the year?

You can only change plans and buy on-exchange plans during Open Enrollment (from November 1st through January 15th) unless you meet certain conditions that qualify you for a Special Enrollment Period. These circumstances include having a baby, getting married, getting divorced, or changing jobs. In other word, big life changes.

If you are offered an HRA for the first time from your employer, that qualifies you for a Special Enrollment Period as well, where you’ll have 60 days to sign up for a health plan that meets your HRA requirements. 

Pro-tip: We recommend you take advantage of Open Enrollment to sign up for a plan. You’ll have more options.

Read our posts on Special Enrollment Periods for QSEHRA or Special Enrollment Periods for ICHRA for more info. 

What about dental insurance? 

There are two ways to enroll in dental insurance.

1. The Marketplace: Dental plans sometimes are included in health plans sold on the Marketplace or state-based exchanges. When you compare plans on our window shopping tool or even on Healthcare.gov, you’ll be able to see which ones include dental coverage. In these cases, your premium would cover both health and dental coverage. 
2. Separate dental plans: If your health plan does not include dental coverage, you may to purchase a separate dental insurance plan. Just remember, if you pick a separate dental plan, you’ll pay a separate premium. This is in addition to the premium you pay for your individual health insurance plan. Sometimes, when you’re shopping on the Exchange, you’ll see an option to add a dental plan. This will provide further options for you. For our clients, we have researched quality individual health insurance plans through Renaissance and AmFirst that we recommend to use with an HRA. 

Here’s a helpful post for more information about our dental partnerships.

Next Steps

This is an exciting time, and we’re honored to a part of this process with you. If you have any other questions as you begin the process, please reach out. We are here to help you! And for those of you who are ready to being, please login to our portal and we’ll walk you through the process.

Happy Open Enrollment, everybody! 🎉