2025 Benefits Open Enrollment: Q&A
From expanded healthcare plans to financial flexibility for your family, see how reviewing your insurance options early can ensure you make the most of your benefits package—before enrollment ends.
The upcoming benefits open enrollment period is more than just a routine task—it’s a chance to shape the well-being of you and your family for the year ahead. This is the time to review your options carefully and ensure you’re making the best decisions for your health, finances, and future goals in 2025.
Whether you’re exploring Health Insurance Marketplace options, which now feature expanded plans and financial assistance, or considering commercial health insurance with diverse coverage possibilities, it’s important to evaluate available resources to ensure you get the most out of your benefits.
And since a small change in your benefits coverage could impact your access to respiratory and infusion care, nutrition supplies, equipment, and specialty medications, it’s best to make informed decisions now. Here are some of the most common questions and answers to help you stay ahead of your health next year.
What is health insurance and why do I need it?
Health insurance helps pay for medical expenses, including care, prescriptions, and infusion treatments. Your insurance coverage can be funded through a state or federal plan (Medicaid, Medicare, Tricare) or a private plan (employer, partner’s employer, parent, Affordable Care Act plan).
What if I can’t afford insurance?
You may qualify for a discounted rate based on your income through the Health Insurance Marketplace (also known as an Affordable Care Act (ACA) plan). PromptCare also works with several nonprofit organizations that may offer premium assistance. Additionally, you may be eligible for Medicaid or Medicare.
When do I need to sign up for insurance coverage?
Open enrollment through the Affordable Care Act Health Insurance Marketplace is Nov. 1 – Dec. 15, 2024, for a plan that starts Jan. 1, 2025. Enrollment extends to Jan. 15, 2025, for plans starting Feb. 1, 2025. Enroll at healthcare.gov or call 800-318-2596.
The enrollment period for Medicare coverage is Oct. 15 – Dec. 7, 2024. Watch this video to learn more about changes to Medicare Part D coverage.
If you plan to enroll in your employer’s insurance plan, reach out to your Human Resources Department for deadlines. You can also enroll in Medicaid at any time.
What things should I consider for public insurance?
Medicaid: Ensure Medicaid has your current address on file, as they will mail renewal paperwork to your most recent known address. Complete and return the forms, along with any requested documents, promptly to avoid losing your coverage.
Medicare: Understanding how your medications are billed is crucial. Certain medications are billed through Medicare Part B, which requires a 20 percent copay. Medigap or Medicare supplement plans can help cover this cost. Other medications are billed through Medicare Part D, which also comes with a copay. Medicare has made some changes to their Part D copays, which are explained in this video.
Medicare Advantage plans, or Medicare Part C, offer the same medically necessary coverage as Medicare Parts A and B, with added benefits like dental and vision. These plans also include Part D, so you won’t need to pay multiple premiums. Before choosing between traditional Medicare and an Advantage plan, make sure your providers, services, and prescriptions are covered, and review the plan costs.
What should I look for when considering a plan?
When considering a plan, it’s important to confirm costs and coverage for:
- Your doctors
- Specialty pharmacy
- All medications
- Premiums
- Copays
- Coinsurance
- Deductibles
- Out-of-pocket expenses
You can find this out by calling the insurance company directly or speaking with your HR Department if considering an employer plan.
Additionally, insurance companies make changes to their benefits. If you plan to renew your existing insurance for the following year, make sure to confirm coverage for your current providers, services, and prescriptions.
Learn More
PromptCare’s Community Resources team is here to answer your questions about marketplace exchange plans, commercial insurance, Medicare and Medicaid replacement, state Medicaid plans, and supplemental coverage.
877-776-6782
By Jessica Crews-Simpson, Community Resources Supervisor
