The State of the ACA Market in 2025

The 2025 Open Enrollment Period (OEP) was a significant one for the marketplace! The under-65 health insurance market had another record-breaking OEP and saw many changes that impacted agents and clients.

Adding Affordable Care Act (ACA) coverage options to your portfolio is a great way to meet client needs throughout 2025. Keep reading for an overview of the ACA insurance market in 2025 and learn why you should sell under-65 products this year.

Marketplace Enrollment Update

With affordable marketplace premiums and most people qualifying for subsidies, more people have been flocking to ACA plans. In the 2025 Open Enrollment Period (OEP), 24.2 million people enrolled in marketplace health care coverage. Just over 3.9 million were new consumers to the marketplace!

Returning Customers Automatically Re-Enrolled

To reduce coverage gaps, the marketplace automatically re-enrolls individuals who had coverage the previous year. 20.2 million of the 24.2 million total enrollments were clients that had coverage last year and returned to the marketplace.

State-Based Marketplaces Contributions

Of the total 24.2 million enrollments this year, just over seven million of those enrollments were through a state-based marketplace. This is a 43 percent increase in growth for state marketplace enrollments!

While increased outreach could be one reason for an increase in enrollments, more states are looking to this marketplace model. Georgia transitioned to a state-based marketplace last year and processed 1.5 million enrollments in their first year.

Our ACA team is adding two new states to their extensive list of states they support: North Dakota, and Wyoming! Both states operate on the federal exchange. Our team is looking forward to expanding their support; stay tuned for more!

Note: Ritter offers support in both the federal marketplace and several state marketplaces. Our ACA Sales team is active in: AL, AR, AZ, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, SC, TN, TX, UT, VA, WI, WY, and WV.

New Carriers Offering Marketplace Coverage

Three new carriers are available for ACA contracting with Ritter! Agents can add plans from Antidote Health, Medica, and Priority Health to their portfolio to support their clients under 65. Consider adding one of these carriers to your offerings today!

Note: You must register with RitterIM.com and speak with your sales specialist before using Contract Now.

Some States Experience Dramatic Enrollment in 5 Years

Increased subsidies under the Inflation Reduction Act have made marketplace coverage more affordable for many Americans. Enrollment has more than tripled since 2020 in the following six states: Georgia, Louisiana, Mississippi, Tennessee, Texas, and West Virginia.

Sources: KFF, “Marketplace Enrollment, 2014-2024” and Centers for Medicare & Medicaid Services, “Marketplace 2025 Open Enrollment Period Report: National Snapshot.”

New for 2025

The following are notable changes that will affect individuals with ACA coverage.

Federal Navigator Funding Has Been Reduced

On February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) announced that the budget for the federal navigator program would be reduced from $100 million to $10 million. CMS cited low enrollment numbers and a high cost per individual as their reasoning for reducing the budget. This is the largest budget cut to this program since its creation.

The federal navigator program was created with the formation of the ACA. Navigators are not licensed insurance agents and, therefore, cannot make specific plan recommendations for clients but can provide education and plan information. Navigators engage in outreach to underserved communities — a focus of the former Biden administration.

As a licensed agent you can make valuable connections in your community, enroll clients in a plan, and make specific recommendations.

Independent licensed agents can use this as an opportunity to add ACA products to their portfolio. As a licensed agent, you can make valuable connections in your community, enroll clients in a plan, and make specific recommendations. Now more than ever, Americans could need your help to understand their ACA health insurance options.

Recapping 2024

Here are some of the significant changes that occurred in 2024 that will impact agents going into 2025.

DACA Recipients No Longer Able to Enroll in Marketplace Coverage

Recipients of the Deferred Action for Childhood Arrivals (DACA) program in 19 states are not currently able to access marketplace coverage due to a recent lawsuit.

This group, sometimes referred to as “Dreamers,” are not eligible to enroll in ACA coverage in the following states:

• Alabama
• Arkansas
• Florida
• Idaho
• Indiana
• Iowa
• Kansas
• Kentucky
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Dakota
• Ohio
• South Carolina
• South Dakota
• Tennessee
• Texas
• Virginia

Unable to access any federally funded health care coverage, their only options remain private health insurance plans offered through an employer or purchased independently.

It is unlikely that the current administration will pass legislation to restore protections to individuals in these 19 states. The recent 2025 Marketplace Integrity and Affordability Proposed Rule mentions policy that would revert the definition of “lawfully present” status. This reverted status would not allow DACA recipients to enroll in coverage. We will continue to monitor the situation and will update as necessary.

Improved Marketplace Security for EDE & DE Platforms

In October 2024, CMS announced that agents will be required to provide Social Security numbers for all enrollments processed through Enhanced Direct Enrollment (EDE) and Direct Enrollment (DE) platforms. HealthSherpa, Ritter’s preferred EDE platform, makes this process simple for agents with their easy-to-use platform.

Since increased reports of unauthorized activity earlier last year, CMS has been trying to find a solution to reduce the number of incidents and bad actors in the marketplace. Requiring agents to provide clients’ Social Security numbers is just one way to mitigate the problem.

Rigorous Agent Review and Penalty for Unauthorized Activity

In the marketplace 2026 Final Rule, CMS expanded their authority to penalize agents that do not abide by compliance standards. CMS will review complaints of unauthorized activity and any agent that poses a threat to the integrity of the marketplace will be fined or terminated. We recommend that agents educate themselves on the marketplace requirements for agents and always abide by compliance standards to act in the best interests of their clients.

Agents should educate themselves on the marketplace requirement for agents and abide by compliance standards.

What’s Coming Later This Year

As we look forward to the rest of 2025 and Plan Year 2026, here are some of the changes we anticipate having an effect on the marketplace.

Expiring Enhanced Subsidies

The enhanced subsidies, that were established as part of the Inflation Reduction Act in 2021, are set to expire December 31, 2025. Legislation was introduced to sign the expanded subsidies into law, but nothing has been passed. If President Trump does not finalize legislation to extend the enhanced subsidies, ACA coverage may become out of reach for many individuals.

After the Inflation Reduction Act was passed, households with incomes over 400 percent of the Federal Poverty Line were eligible for subsidies. If the current subsidies expire, premium costs will increase after January 1, 2026. KFF estimates ACA premiums will go up around 75 percent. Without expanded subsidies written into the protections of the ACA, the Congressional Budget Office estimates that there will be 3.8 million more uninsured people each year.

Federal Decrease in Health Care Spending

President Trump’s Department of Government Efficiency (DOGE) is collaborating with CMS to reduce spending and maximize efficiency.

In his first term, President Trump reduced funding for outreach, which resulted in stagnated enrollment numbers. We will continue to monitor changes to the federal health care budget and will report if significant changes occur that will affect agents and clients.

Cuts to Medicaid

Congress is in current talks to make additional budget cuts to Medicaid programs. Federal budget cuts can also affect state allocations for funding. Congress has proposed capping the limit spent per enrollee, restricting or eliminating provider taxes (which fund many state Medicaid programs), or lowering the match rate. Other policies have been proposed that would require Medicaid beneficiaries to maintain employment; this could also reduce spending with lower enrollment numbers.

These changes could result in more individuals purchasing ACA coverage if Medicaid is no longer an option. Add under-65 health products to your portfolio now to be prepared.

Why Sell in 2025?

If you’re not already offering marketplace coverage to your clients that are under 65, now is an opportune time to add them to your portfolio. The ACA is a vital part of the American health care system and serves low-income citizens with an affordable health care option. Changes to Medicaid spending, increasing premiums, and more could drive more individuals to turn to the marketplace to shop for coverage. Are you ready to offer the assistance and products they’re looking for?

Note: You must register with RitterIM.com and speak with your sales specialist before using Contract Now.

At Ritter, we value your individual success and want to see your business grow. Register with Ritter today to have access to a competitive product portfolio from over 120 carriers. You’ll also have access to a knowledgeable sales team and technology to provide support along the way.