Will you have different needs in 2025?

Has your financial situation changed?

Did you qualify for a subsidy through Covered California last year? Do you expect to receive one this year?  If not, has your financial situation changed in a way that might make you eligible or adjust the amount of your subsidy from last year? Covered California offers the exact same plans at reduced prices to those who qualify.

It’s worthwhile to take a few minutes and use our subsidy calculator* to determine if you are eligible. You might be surprised. Families who earn up to 400% of the federal poverty level or more may still qualify for assistance. If you qualify, your estimated “subsidy” amount is a fixed reduction that can be applied to the premium of any plan you choose.

Did your current plan work well for you this year?

Open enrollment is the perfect time to look back at your health care experience in 2024 and reevaluate your needs for 2025. Often people think that reducing their monthly premium is the only way to save money on their healthcare costs. Contrary to popular belief, paying more on your monthly premiums may save you more money in the long run by paying less when you receive care. It’s helpful to know that typically the higher your monthly premium is, the lower your cost share will be.

• Did you spend a lot of money in premiums but rarely go to the doctor? It might make sense for you to “buy down” to a plan with lower premiums and higher cost sharing.
  
• Did you have a hard time with significant or unpredictable out of pocket expenses when you needed care? You might benefit from “buying up” to a plan with lower cost sharing.
  

Which plan will best fit your needs in 2025?

Taking a look back at last year is a great way to help select your plan for next year. If you expect your financial and health situation to be similar next year, then you can use your 2024 experience to help pick the right plan. If you expect some changes, then you will want to adjust your assumptions when selecting a plan.

Here are some suggestions…

• Log in to your member account and review if you’ve exceeded your deductible or met your out-of-pocket maximum this year.
• Review your current medical plan's benefits or look at these detailed plan comparison documents:
  • PPO plan comparison (PDF, 551 KB)
  • Trio HMO plan comparison (PDF, 952 KB)
• Identify the services you expect to need in the new year and what they may cost under different plan options.
• Download your claims from last year to see exactly how much you spent on health care and which services you utilized most often.
• If you estimate your likely health care consumption for next year, you can see if there is a plan with a cost sharing mix that hits a “sweet spot” relative to your anticipated needs.