Buying Health Insurance for 2025

Looking to buy health insurance for 2025? It’s a good idea to get up to speed on the new rules and policies that affect health insurance, and how to get or stay covered. So, here’s what you need to know.

More Financial Help Than Ever to Pay for Health Insurance

Beginning in 2024, California kicked off its first-ever state-funded enhanced Cost Sharing Reduction (CSR) program. These new subsidies eliminated deductibles for over 800,000 Californians. Those enrolled in a Silver CSR plan also saw lowered copays for prescriptions and for such things as emergency care and doctors visits. This financial help made health insurance more affordable for Californians with lower incomes. This program was expanded in 2025. All Californians who are enrolled in a Silver CSR plan will now have no deductibles and lower out-of-pocket costs.

More Dental Plans From Covered California

Covered California enrollees will have more choice among dental insurance plans with the addition of the new insurance company, Humana, which began statewide coverage in 2025. Dental plans are also available from Anthem Blue Cross, Blue Shield of California, California Dental Network, and Delta Dental of California.

Covered California enrollees under the age of 19 have dental care benefits automatically included as part of their health plan, and adults can purchase family dental coverage as an “add-on” to their health plan. While this insurance is not eligible for financial help, the family dental coverage is available to anyone who wants it, regardless of any pre-existing oral health conditions. Covered California offers both dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans. You can learn more here.

California Bans Using AI to Denying Insurance Claims

California passed a new law that bans insurance companies from using artificial intelligence (AI) to deny claims. The goal is to make sure real people, not just algorithms, decide whether to approve or reject insurance claims. AI could make mistakes or unfairly deny coverage, so this law ensures more transparency and human oversight in the process. It’s part of a bigger push to protect consumers from biased or automated decisions in healthcare, auto, and home insurance claims.

California Protects Credit Scores from Medical Debt

Californians with medical debt will no longer have to worry about unpaid medical bills showing up on their credit reports. A new law bans health care providers and debt collectors from reporting medical debt to credit agencies. The new law extends protections to credit reports used for employment and tenant screening. The goal is to protect Californians’ credit scores, making it easier for them to secure jobs, housing, and loans without being weighed down by medical bills. However, the law doesn’t cover debts from medical credit cards or specialty loans.

Limits for Health Industry Cost Increases

The state’s first cap on the health industry has been approved, limiting health care cost increases to 3% by 2029. This means that hospitals, doctors, and health insurers need to find ways to cut costs to prevent spending from exceeding the target. Between 2015 and 2020, the money Californians spent on health care went up about 5.4% each year. Increased health spending most often translates to higher out-of-pocket costs for consumers in the form of monthly premiums, deductibles, and copays. The annual spending benchmark would require health care providers to limit spending growth to 3.5% for 2025, and decrease it over five years to 3% by 2029.

California Protects & Expands Access to IVF

Having a baby via in vitro fertilization is about to become more accessible for many Californians. The new law makes the right to fertility care and in vitro fertilization (IVF) protected in the Golden State. It requires large group health plans—those covering more than 100 people—to cover the diagnosis and treatment of infertility. This includes a maximum of three egg retrievals and unlimited embryo transfers. The new law does not apply to people who get their health insurance plan from religious employers or to those enrolled in Medi-Cal. The new law also broadens the definition of infertility to include same-sex couples, bringing reproductive equity to the state’s LGBTQ+ population.

Improving Early Detection of Breast Cancer

A new law now requires mammography facilities to notify patients about the density of their breasts in an effort to improve early detection of breast cancer. Breast density may increase the risk of breast cancer and also make it harder to detect, requiring additional imaging. This affects about half of women over 40 in the United States.

Extended Notification Time for Maternity Ward Closures

Since 2012, more than 50 maternity wards have closed across California, affecting both rural and urban communities. These closures have led to longer travel times for patients and overwhelmed obstetrics departments in nearby hospitals. A new law now requires hospitals to give county governments at least 120 days’ notice before shutting down labor and delivery, along with holding a public hearing. This extended timeframe—up from the previous 90-day notice—gives public health officials and hospital systems more time to prepare for the loss of these critical services.

DACA Recipients Now Eligible for Obamacare

DACA recipients who meet all other eligibility requirements can now enroll in Obamacare (officially called the Affordable Care Act) beginning November 1, 2024. As part of the Affordable Care Act, California created Covered California, a free service that connects people with high-quality health insurance and the financial help to pay for it. Newly eligible individuals will qualify for special enrollment for 60 days. Those who enroll during November will have their coverage start on December 1, 2024. Those who enroll during December will have their coverage begin on January 1, 2025. You can still apply after the 60-day period in January during open enrollment, when coverage will begin on February 1, 2025.

California Increases Access to Behavioral Health Services

A major package of laws aim to improve mental health and substance use treatment across California. They make it easier for people to get the help they need, especially those struggling with serious mental health conditions and addiction. One of the biggest changes is expanding access to treatment facilities so more people can get care in mental health rehab centers and psychiatric health facilities. Another key law streamlines the CARE Act to help counties and courts get people into long-term stabilization programs faster. Overall, these laws are designed to get more people into treatment, improve support systems, and make mental health care more accessible across the state.

The 988 Suicide & Crisis Lifeline to Get Localized Responses

The 988 Suicide & Crisis Lifeline just got an upgrade! Now, when you call from a wireless phone, georouting will connect you to the nearest crisis center based on your real-time location, instead of your phone number’s area code. This means faster, more accurate support, so people in crisis get local help instead of being routed to a center in another state. The goal is to speed up response times and make sure callers get the right kind of assistance when they need it most.

At the same time, suicide prevention efforts are getting a boost, especially for kids, teens, and young adults in schools and juvenile justice settings. Plus, more support is going into community-based mental health programs, making it easier for people at risk of suicide to get early intervention, crisis response, and long-term care. You can learn more about covered services around mental health here.

Reduced Barriers to Mental Health, Substance Use Disorder Benefits

New rules build on the promise of the Mental Health Parity and Addiction Equity Act of 2008. The law requires health plans and insurance companies that provide mental health or substance use disorder benefits to treat these benefits equally with medical and surgical benefits. This means they can't impose stricter rules on mental health or substance use disorder coverage compared to other medical services. The new rules offer more protections against stricter limits on mental health and substance use disorder benefits compared to medical and surgical benefits. These stricter limits can include requirements such as needing approval before treatment, trying certain medications first, or rules about which providers can join a network. In simple terms, getting help for anxiety should be as straightforward as getting treatment for a hurt shoulder, and getting medication for depression should be just as easy as getting medication for high cholesterol. The final rules also prevent health insurance companies from using biased or unfair information that could make it harder to access mental health and substance use disorder care when setting limits on treatment.

Expand Mental Health & Substance Use Disorder Services into Primary Care

The Department of Health and Human Services is expanding mental health and substance use disorder services at over 400 community health centers nationwide. This initiative aims to tackle the country’s mental health and opioid crises by integrating treatment into primary care, making mental health services more accessible and reducing stigma. Patients will now be able to receive support for depression, anxiety, and addiction at their regular doctor’s office instead of needing a separate specialist. The effort includes training primary care providers, expanding services in underserved communities, and developing care models that treat physical and mental health together. Here are centers in California that received funding to expand.

Emergency Psychiatric Care Gets Expanded

A new law makes sure that anyone experiencing a psychiatric emergency—whether they came in voluntarily or were placed on an involuntary hold under the Lanterman-Petris-Short (LPS) Act—gets the care they need. It also requires Medi-Cal to cover emergency psychiatric treatment, including follow-up care after stabilization, ER visits, and facility costs. Plus, Medi-Cal managed care plans now have to reimburse providers for these services, making it easier for patients to get emergency mental health care without financial roadblocks. The goal is to expand access to care and ensure people in crisis aren’t left without support.

Medicare Enrollees Can Split Drug Costs into Monthly Payments

People with Medicare Part D now have the option to pay for their prescription drugs in smaller monthly payments instead of large upfront costs. This new Medicare Prescription Payment Plan, part of the Inflation Reduction Act, is designed to make medications more affordable and easier to budget for, especially for seniors and people with disabilities. Medicare enrollees will need to opt in to take advantage of this benefit.

New Protections for Hospital Patients on Medicare

Medicare patients who are first admitted as inpatients but later switched to outpatient status now have the right to appeal that change. The new rule introduces three types of appeals: Expedited Appeals, which can be requested while still in the hospital; Standard Appeals, for after discharge; and Retrospective Appeals, for past hospital stays going back to January 1, 2009. This change helps protect patients from unexpected coverage issues and higher out-of-pocket costs. Hospitals must also give Medicare patients a Medicare Change of Status Notice (MCSN) to inform them of their right to appeal.

New Staffing Standards for Nursing Homes

Big changes are coming for Medi-Cal nursing homes. New federal rules now require facilities to provide at least 3.48 hours of direct nursing care per resident each day, including 0.55 hours from registered nurses (RNs) and 2.45 hours from nurse aides. Plus, an RN must be on-site 24/7 to ensure better care for residents. California will also have to report how much of its Medi-Cal funding actually goes to paying caregivers, making the system more transparent.

Medi-Cal Expands Access to Culturally Relevant Health Care

Medi-Cal, California’s Medicaid program, and the Children’s Health Insurance Program (CHIP) can now cover traditional healing practices for American Indian and Alaska Native communities when provided by Indian Health Service facilities, Tribal health facilities, and urban Indian organizations. This change improves access to culturally relevant healthcare by integrating traditional healing with modern medical services and addressing health disparities in tribal communities. Covered services may include herbal medicine, spiritual healing, ceremonies, and other culturally significant treatments provided by approved Tribal healthcare providers.

Lifesaving HIV Medications and Care for Low Income Individuals

The Ryan White HIV/AIDS Program is getting more than $1.4 billion in funding to ensure that individuals with HIV who are also low-income will receive the lifesaving medication, care, and supporting services they need. The Health Resources and Services Administration of the U.S. Department of Health and Human Services provides these benefits through their AIDS Drug Assistance Program which helps pay for HIV medication, copays, coinsurance, and monthly health insurance premiums that cover HIV medication. Without this financial help, medication alone could cost individuals more than $40,000 a year. Over half of the people diagnosed with HIV in the U.S. receive services through this program every year. In 2022, 89.6 percent of Ryan White HIV/AIDS Program clients receiving medical care were virally suppressed, compared to 69.5 percent in 2010.

New Online Tool for Reporting Emergency Care Violations

It is now easier to report hospitals that violate federal emergency care laws. Center for Medicare and Medicaid Services (CMS) launched a new online tool where patients can file complaints if they’re denied emergency medical treatment, as required under the Emergency Medical Treatment and Labor Act (EMTALA). This law ensures that hospitals must screen and treat anyone in an emergency, regardless of their ability to pay. The goal is to protect patient rights and make sure hospitals follow the rules.

We’ve Got You Covered!

Just like purchasing health insurance, your needs and those of your family may change from year to year. We are here to help. Find out quickly and easily how much financial help you could get to pay for health insurance. Explore your options now to get the coverage you need — or feel free to contact us at any time.

What’s New from Previous Years

• 2024

• 2023

• 2022