Your Insurance News
Recent Healthcare Changes You Should Know About
As healthcare policies continue to evolve, it's important to stay informed on the latest updates. Below are the key changes affecting ACA, Medicare, and health insurance for individuals under 65. Please review the following and use the listed resources to learn more.
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Medicare
Out-of-Pocket Drug Cost Cap: Beginning in 2025, Medicare Part D will implement a cap on annual out-of-pocket prescription drug costs at $2,000. Once this limit is reached, beneficiaries won't have to pay copayments or coinsurance for covered drugs for the rest of the year. Medicare
Medicare Prescription Payment Plan: Beginning in 2025, beneficiaries have the option to spread out-of-pocket prescription drug costs over the calendar year through the Medicare Prescription Payment Plan, aiding in budgeting for medication expenses. Medicare
Insulin Cost Cap: Starting in 2025, Medicare Part D will cap the monthly cost of insulin at $35 per covered prescription. This means beneficiaries will pay no more than $35 for a one-month supply of each Part D-covered insulin product, even if they obtain a three-month supply, which would cost no more than $105. Bricklayers Union+4Medicare+4Medicare+4
Increased Part B Premiums and Deductibles: For 2025, the standard monthly premium for Medicare Part B enrollees is set at $185.00, an increase from $174.70 in 2024. The annual deductible will be $257, up from $240 in the previous year. Centers for Medicare & Medicaid Services
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Under 65 Healthcare
Short-term health insurance provides temporary coverage, typically 1 to 12 months, and is ideal for those between jobs, waiting for other coverage, or outside of Open Enrollment.
Recent Changes:
Duration Limit: New regulations (effective September 1, 2024) limit short-term plans to 4 months, including renewals. Previously, these plans could last up to 12 months.
Source: HealthInsurance.orgState Regulations: Short-term plans are regulated differently in each state, so check your state's rules.
Source: HealthInsurance.orgCoverage Gaps: Short-term plans are not ACA-compliant, meaning they may not cover essential health benefits or pre-existing conditions.
Source: UHCThings to Consider:
Short-term plans have limited coverage, and you could face higher out-of-pocket costs.
Compare options to ACA-compliant plans that offer more comprehensive coverage and may qualify for subsidies.
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Affordable Care Act (ACA)
Expiration of Enhanced Subsidies: The enhanced federal health insurance subsidies introduced during the COVID-19 pandemic are set to expire at the end of 2025. This may lead to increased premiums for many consumers unless new measures are implemented. CT Insider+1KFF+1
Marketplace Integrity and Affordability Proposed Rule: The Centers for Medicare & Medicaid Services (CMS) has proposed eliminating fixed-dollar and gross percentage-based premium payment thresholds. This change aims to enhance program integrity by ensuring enrollees contribute to their premiums, reducing the risk of improper enrollments. Centers for Medicare & Medicaid Services+1Centers for Medicare & Medicaid Services+1
Simplified ACA Reporting: New legislation signed in December 2024, including the 'Paperwork Burden Reduction Act' and the 'Employer Reporting Improvement Act,' aims to streamline ACA reporting requirements, making the process easier and less time-consuming for employers. Smith Anderson
New Updates for ACA: TBD-2026!!
New Updates for ACA: TBD-2026!!
Expiration of Enhanced Subsidies (eAPTC):
The enhanced premium tax credits that lowered costs for millions are set to expire on January 1, 2026. Without legislative action to extend them, subsidized enrollees at all income levels may see higher monthly premiums.
Centers for Medicare & Medicaid Services
End of 150% FPL Special Enrollment Period (SEP):
The monthly SEP for individuals at or below 150% of the Federal Poverty Level is expected to end once the final CMS rule is published. Going forward, consumers would need to experience a qualifying life event to enroll outside of Open Enrollment.
Centers for Medicare & Medicaid Services
$5 Monthly Premium for Passive $0 Renewals:
Starting as early as Plan Year 2026, consumers eligible for $0 premium plans may be charged $5/month if they don’t actively confirm income during renewal. Active renewals will be key to avoiding new out-of-pocket costs.
Centers for Medicare & Medicaid Services
Failure to Reconcile APTC:
The grace period for reconciling advance premium tax credits may be reduced from two years to one. Consumers who fail to file taxes and reconcile APTC on time will lose eligibility for both APTC and cost-sharing reductions.
Centers for Medicare & Medicaid Services
Shortened Open Enrollment Period:
The Open Enrollment Period may be shortened from November 1–January 15 to November 1–December 15 beginning in 2026, reducing the time agents and consumers have to review and enroll in plans.
Centers for Medicare & Medicaid Services
Pre-Enrollment SEP Verification:
Starting May 16, 2025, consumers may be required to provide documentation before enrolling during a Special Enrollment Period, adding a step that could delay or block coverage if verification is not completed.
Centers for Medicare & Medicaid Services
DMI for Income Variances:
Applicants whose self-reported income differs significantly from federal data—especially those in the Medicaid gap—could trigger a Data Matching Issue and be required to submit proof of income during enrollment.
Centers for Medicare & Medicaid Services
Other Notable Proposed Changes:
CMS is considering eliminating the automatic 60-day extension to verify income discrepancies, restricting the use of self-attested income when tax data is unavailable, and redefining “lawfully present” to exclude DACA recipients.
Centers for Medicare & Medicaid Services
Aetna CVS to Exit the ACA Marketplace in 2026:
Aetna CVS has announced it will no longer offer ACA Marketplace plans starting in 2026. Consumers currently enrolled will need to switch carriers during Open Enrollment to maintain coverage.
Aetna CVS Health