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Autumn is here, and that means it’s time for pumpkins, apple cider, and the ACA annual open enrollment period.

If you need to change your ACA health coverage — sometimes called “Obamacare” — this is the time to do it. You may add or remove dependents, change details, like your income or marriage status, buy a more comprehensive plan to suit your medical needs, or shop the insurance marketplace for more affordable health care options.

And the experienced team of insurance agents at Einsurance.com is here to help.

Today, we answer all your most frequent questions about ACA open enrollment period in 2025. Keep reading to discover:

First things first. If you only need to know the ACA open enrollment dates, find them below.

When is the ACA Open Enrollment for 2025?

If you need to make changes during open enrollment for 2025, note of these important dates:

• November 1, 2024, is the first day of ACA open enrollment
• December 15, 2024, is the last day you can make any changes to your health insurance for coverage starting January 1, 2025
• And January 15, 2025, is when the open enrollment ends and the last day to enroll in or make any changes for the year with coverage starting February 1, 2025

In other words, the changes you make this fall won’t affect your health plan until 2025.

Historically, these dates have been the same every year. Some state-run exchanges have different schedules. Please check here to make sure that you enroll on time.

During the ACA open enrollment period, you may:

• Add or remove dependents
• Look for a more affordable plan
• Shop for a more expensive plan that will cover your changing medical needs
• Or change other important details on your plan, like your address and phone number

Also, know that some states may extend or alter these dates if they provide state-run health plans. California residents, for instance, have Covered California, and the open enrollment period runs from November 1 through January 31.

Some consumers know they need to make changes to their health insurance plan, but they’re not sure who to contact or how to do it. If you’re not sure what sort of health insurance plan you have, let’s take a moment to sort it out.

Types of Health Insurance Available to US Residents

Americans may have group health insurance through their employer, a metal tier plan (Gold, Silver, Bronze etc.) through their state’s ACA insurance marketplace, Medicare (Medi-Cal), or Medicaid. It’s confusing, we know! Let’s take a glimpse at each type of health coverage.

What is ACA / Obamacare?

When President Obama signed the Affordable Care Act (ACA) into law in 2010, his goal was to make healthcare available for more Americans. Prior to that time, many consumers struggled to find health insurance because they had pre-existing conditions, were unemployed, or simply couldn’t afford any plans on the market.

Chances are, you have an ACA plan if you:

• Used the internet to buy health insurance through your state’s insurance marketplace
• Have a healthcare plan described as “Bronze, Silver, Gold or Platinum”
• Went to a local health insurance agent to buy a plan for yourself and your family, outside of any employment situation

One significant point of the ACA is the metal tier system. Understanding it will help you choose the right health insurance, and we’ve written about health insurance metal tiers extensively in the past.

The Metal Tier Plan for US Health Insurance

The metal tiers all reflect the same level of insurance across all providers. For example, a Bronze Plan sold by Company A is nearly identical to a Bronze Plan at Company B.

The same can be said for all Silver plans, all Gold plans and all Platinum plans. They will all offer the same coverage and deductible levels from one company to the next. The only difference is the price, so it pays to shop around.

Think of it like buying a can of Coca Cola. A can of Coke, from any place you buy it, will have the same ingredients. Some places charge more.

If you need to make changes to your ACA health insurance policy, you must do it during the annual open enrollment period. “Open enrollment 2025” starts on November 1, and depending on your state, may run through December 15, or a later date.

During open enrollment 2025, you can:

• Enroll or unenroll
• Change plan level
• Change provider
• Add or remove dependents
• Change key details of your policy, like your name or address

What is a Group Health Insurance Plan?

Group health insurance is usually offered through an employer. If you buy health insurance with a discount through your job, this is the type of insurance you have.

Federal & State Plans: Medicare, Medicaid, Medi-Cal

Medicare

Seniors aged 65 and older usually qualify for Medicare if they’ve paid into the system through payroll deductions throughout their lifetime. This is not ACA / Obamacare, and you can enroll in Medicare during a seven-month window around your 65th birthday.

Medicaid (Medi-Cal in CA)

Medicaid is a federal-state program for individuals with certain disabilities, low-income families, pregnant women, and others with unique needs. This is not part of ACA / Obamacare, and in California, it is called Medi-Cal.

Explore the table below to figure out which sort of health insurance you have, and how to reach those providers.

There are a few other types of health insurance available. Active duty service members, veterans and their families may have TRICARE. If you have TRICARE, you don’t need to enroll in Obamacare.

About Healthcare Open Enrollment 2025

Regardless of the type of health insurance you have, autumn is the time to make changes. The “health insurance year” runs concurrently for all plans. In other words, the Medicare open enrollment for 2025 runs at the same time as group insurance open enrollment, which is the same as Obamacare open enrollment.

It’s a busy time of year for health insurance agents!

When Do Children Get Their Own Health Insurance?

Currently, children can stay on their parents’ health insurance plans until they are 26. They do not even need to live with their parents to keep this coverage.

However, once you hit that milestone, you will need to find health insurance yourself. You can do that during the ACA open enrollment period, which begins November 1.

Now, let us discuss how to enroll for ACA health insurance / Obamacare if this is your first time.

How to Apply for Obamacare by Myself

If this is your first time applying for health insurance, you might feel intimidated. Fear nothing! The professionals at Einsurance are here to walk you through the process.

First, note the dates. The health insurance open enrollment period begins November 1. We suggest you make this a priority before the holidays go into full swing. We’ve seen many consumers get overwhelmed with holiday activity and forget to make their important health insurance deadlines.

Next, gather your documents. You will need:

• Your Social Security number (though not always)
• Your ID card
• A good mailing address
• Any prescriptions you take regularly (this can help you decide which plan to buy)
• And your doctor’s name if it is important that you stay with the same provider

Then, use the internet to search for “Health Insurance in [your state].” Or try our handy online quoting tool at Einsurance.com. We can match you with insurance agents offering affordable health insurance.

Buying Health Insurance: Which Metal Tier Plan Should I Choose?

As licensed insurance agents, this is a question we get a lot during the open enrollment for health insurance.

But we are all individuals, and there is no set formula that says, “buy this plan at this age.”

However, if you are young and healthy, a Bronze plan will offer the lowest monthly payments. But remember, expensive prescriptions, therapy, surgeries, and healthcare visits will cost more.

Conversely, if you’re older, have several health issues and take several expensive medications, a Gold or Platinum plan may be a better choice. These plans cost more every month, but they cover more of your needs.

You may prefer a more expensive monthly premium if you’re living with a health condition such as:

• Heart conditions
• Kidney conditions
• A history of cancer
• Respiratory disease, like mesothelioma
• Diabetes
• Dementia, Alzheimer’s, or Parkinson’s diseases

Remember to get several quotes! All Bronze plans will cover the same things, but the prices can be different from one provider to the next.

Can I Keep My Doctor if I Change Health Insurance During Open Enrollment?

This is another common question, but we cannot answer it directly.

If staying with the same doctor is important, you need to ask them which insurance they accept. Some only take Medicare, others only work with ACA / Obamacare plans. Some only work with a few select insurers in their area. It just depends on your doctor!

Luckily, this is an easy call to make. The office staff will know which insurers they accept, so give them a call.

More About State-Run Health Insurance Marketplaces

The Affordable Care Act — Obamacare — is a federal system. But every state can create their own health insurance marketplace.

According to Healthcare.gov, the following states and districts are offering websites with state-run plans:

• California
• Colorado
• Connecticut
• Washington DC
• Georgia
• Idaho
• Kentucky
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New Mexico
• New York
• Pennsylvania
• Rhode Island
• Vermont
• Virginia
• Washington (state)

Note that Georgia is offering a state marketplace for the first time for 2025. If you are a Georgia resident looking to enroll in Obamacare during this open enrollment period, you can do it online, or contact the team at Einsurance for fast, affordable healthcare quotes.

Finally, let’s explore a key point about health insurance options and the open enrollment period. We’re talking about prescription medications and formularies.

What is Formulary? Does it Matter to Me?

Earlier in this piece, we mentioned the importance of your medications when choosing a health insurance plan during the open enrollment period 2025. This is because insurers keep formularies — lists of prescriptions they will cover at X prices — and you need to know your medication is covered.

Remember that all metal tier plans are equal. They all cover some types of antibiotics, some types of pain medications, and certain other common drugs. It’s the price you’ll pay from one insurer to the next that is the main difference.

However, some prescriptions are not available in generic forms and others aren’t covered without paperwork from your doctor. It can get complicated, but in short, if you take several medications, be sure to mention these when shopping for health insurance during the ACA open enrollment period 2025.

You might discover it’s better to buy a more expensive tier (say, a Silver or Gold plan), or work with a certain insurer who covers your specific drugs.

Cyber is an expanding net-new growth area with opportunity to deliver a compelling insurance offering especially in the mid-market. Yet, the path to becoming a market-leading and profitable cyber insurer is fraught with challenges. In this article, we outline the essential strategies to develop a top-tier cyber offering, culminating in a guide to the 7 strategic cyber steps for the Chief Underwriting Officer. 

Why cyber in the mid-market has unique challenges to mitigate

The cyber risk landscape is evolving so rapidly that insurers need a robust framework to for example enable continuous data-led learning from previous claims, deliver a seamless quote and bind process, and to mitigate unintended risk aggregation. 

While the SME market will typically purchase standard cyber coverage direct and online, the mid-market consists of companies that are serviced by brokers and agents. These companies require insurers to possess both foundational and advanced capabilities to effectively address the unique challenges of cyber risk in the mid-market. The key challenges that are unique to cyber in the mid-market are as follows: 

Transparency and clarity for brokers and agents: As the mid-market is predominantly serviced by brokers and agents, it’s crucial that the insurer’s risk appetite and underwriting approach are transparent. Whether the insurer offers a dedicated cyber broker portal or utilizes existing portals for multiple lines of business, the key is to have a transparent risk appetite and to make it seamless for brokers to compare quotes and to place business. Additionally, it is imperative to turn around accurate quotes on a same-day basis. 

Need for both standard and bespoke policies: The mid-market consists of companies that purchase both standard and bespoke policies. Insurers therefore need to be able to quickly turn around changes to policy terms, changes to exclusions, or a different mix of higher deductibles or sub-limits. Some mid-market companies have sophisticated requirements on risk mitigation, prevention and incident response planning. For large mid-market customers there can be a need for in-depth exposure analysis to design the right insurance coverage.  

Significant amounts of data: Whilst no more than four data points are required from an SME customer for a standard cyber policy (name, industry, revenue, and the customer’s website), far more data points are required by mid-market customers. Some data points can be obtained through open APIs and structured data intake from brokers, but the higher complexity of the risk, the higher the likelihood is for the relevant data points to arrive in unstructured documents. 

Establishing a robust digital infrastructure for cyber insurance

Cyber insurers need foundational capabilities across distribution, quote, and bind to ensure a seamless business process. The operating model begins and ends with being focused on the customer and broker experience. Whether insurers choose to organise themselves according to the customer segment (e.g. a mid-market Center of Excellence servicing all lines of business) or according to the lines of business (e.g. a specialized one-stop-shop cyber team cutting across distribution, underwriting, and claims), it is important that this is a conscious choice made at the C-level. 

All customers, irrespective of whether they purchase cyber insurance, should quantify their cyber risk and define their key cyber risk scenarios as part of their incident response planning. If they do not, they are running an unknown and potentially significant risk through the balance sheet. Some insurers may choose to invest in risk scenario capabilities, whereas others will rely on brokers or outsource to cybersecurity experts. The capabilities required for an in-depth exposure analysis is similar to what some insurers offer in a cyber saferoom that provides a secure space for pre-incident advice and training, cyber stress-testing, cybersecurity readiness verification tools, detection and response solutions, incident response planning, notification services and embedded claims services. 

A key foundational capability for cyber is a strong digital core and master data management that is fit-for-purpose. Insurers require strategic tools like a robust digital core and fit-for-purpose master data management to perform detailed exposure analysis at the quote stage. These tools facilitate granular risk accumulation and establish a framework for measuring and understanding aggregated cyber risk exposure based on various parameters, including industry sector, underlying hardware and software, cybersecurity maturity, supply chains, jurisdiction, and company size. A detailed exposure management framework is crucial for effectively mitigating the risk of unintended risk aggregation. 

Building advanced market leading cyber capabilities

A critical component to becoming a market-leading cyber insurer is that the technology and data capabilities must be architected to work at scale and in real-time. Cyber insurance is among the most challenging sectors due to the potentially catastrophic and boundary-less nature of breaches. Cyber incidents can be continuously evolving and unpredictable, akin to oil spillages, and can critically impact businesses, societies, and essential infrastructure like hospitals, water and sewage systems, and airports. Today, the potential for insurers to face unintended risk aggregation is a clear and present threat. 

As mentioned above, significantly more data points need to be captured and modelled at the quote and bind stage for mid-market cyber policies. Additionally, at first notice of loss, there can be hundreds of relevant data points, which is far more than for example with a motor claim, where insurers typically capture 20-30 data points that are motor specific (vehicle details, purpose of use, witness details, IoT data etc.). For a cyber claim there are more than 100 data points that can be relevant for the continuous learning and refinement that feeds into exposure management, the actuarial tables, and the risk controls in the underwriting system. This in turn is what enables a market-leading insurer to remain profitable through a robust framework around risk appetite and pricing.  

As previously covered, there is a scarcity of cyber talent with deep proficiency in cybersecurity protocols and a deep understanding of the constantly evolving regulations and legislation across IT, AI, GDPR, and consumer privacy. Whilst investing in talent and continuously upskilling underwriters and claims adjusters, there are high-impact use cases in cyber insurance for AI and Gen AI solutions. We have seen AI and Gen AI save underwriters tens of hours a month and empower them to only spend their time on niche and hazardous risk areas that require deep human expertise.  

Insurers with a strong digital core can move quickly on accelerating profitable growth in cyber, but most insurers are coming to the realization of the investments needed to implement AI and Gen AI at scale. Per Accenture’s Pulse of Change research, 46% of insurance C-suite leaders say it will take more than 6 months to scale up Gen AI technologies and take advantage of the potential benefits. If applications and data are not on the cloud, and if there is not a strong security layer, then benefiting from Gen AI at scale is virtually impossible. 

The 7 strategic cyber steps for the Chief Underwriting Officer

In today’s rapidly evolving technology landscape, Chief Underwriting Officers face the critical task of steering their organizations through the complexities of cyber insurance. The following strategic steps are a roadmap for insurers to not only survive, but thrive in this challenging environment: 

1. Define your identity in cyber insurance: Decide whether you want to be a conservative insurer, a fast follower, or a market leader. This choice will guide your investments and emphasize cyber as a core part of your business. 
2. Establish your cyber brand: Determine your signature offering in cyber insurance, whether it’s leading-edge risk consulting, competitive pricing, AI-powered and streamlined processes, or a strong reputation in claims service. 
3. Opt for specialization: Choose between establishing a dedicated mid-market Center of Excellence (CoE), a cyber-specific CoE, or a hybrid operation model. 
4. Enhance responsiveness: Transform or deploy new capabilities to deliver accurate quotes within a few hours. 
5. Refine underwriting practices: Decide on the optimal number of underwriting variables for technical pricing. Reverse-engineer your processes to capture essential data at the broker submission and claim notification stages. 
6. Assess cyber exposure management: Engage external experts to evaluate your cyber exposure management helping to avoid unintended risk aggregation. 
7. Invest in talent: Focus on a talent strategy that enhances skills and integrates advanced technologies like AI and Gen AI to keep pace with the evolving cyber risk landscape. 

Measuring the path to being a cyber market leader

Designing and executing a leading framework for cyber insurance presents significant challenges. A crucial aspect involves defining success, establishing metrics for measurement, and determining the necessary actions to achieve these goals. Continuously monitoring financial and operational metrics is essential for timely adjustments, ensuring the capture of profitable growth in the cyber mid-market. For further discussion, please contact Carmina Lees and Matthew Madsen.