Posted in Healthcare
Written by Misa Bailey, Healthcare Program Manager at SC Appleseed
Blog Summary: There are four changes to the ACA Marketplace happening on August 25, 2025, two permanent, and two temporary through the end of 2026. The changes include the need to pay past premiums to start a new policy, less time to handle income issues that come up, additional requirements for proof of income to insurers, and the end of a special enrollment period for low-income populations. Those who qualify for ACA coverage but have not applied should do so before August 25th to get affordable insurance through the end of 2025.
NEWS: A federal judge injunction has put a hold on some of the rule changes in this blog. We have left a note indicating which rules were on pause. We will update if anything changes.
Major changes are coming to the ACA as a result of recent new rules and laws. The new changes shorten enrollment timelines, end many automatic renewal protections, and remove financial protections. All these changes risk loss of coverage and higher costs for consumers.
Many changes begin as early as August 25, 2025, while others start between late 2025 all the way into 2028. The biggest change will come during this coming enrollment season starting November 25. Financial assistance from the last administration that tremendously lowered the cost of plans in the ACA marketplace will be ending unless Congress takes action between now and November. That means the cost of plans will rise significantly, making insurance unaffordable for many. We will be discussing this change in another blog, but if you have been able to gain ACA marketplace insurance due to this financial assistance, expect major changes to your costs this coming enrollment season.
In this blog, we will be discussing the August 25 changes to the ACA marketplace that you need to know.
What is the Affordable Care Act (ACA) Marketplace?
The Affordable Care Act (ACA) Marketplace (Healthcare.gov) provides health insurance to more than 600,000 South Carolinians who otherwise would not have health insurance, including Healthy Connections (SC Medicaid), Medicare, or coverage from their employer. The new laws and agency changes will impact eligibility and enrollment.
Note: ACA is where you go to apply for the Affordable Care Act Healthcare. This is not for Medicaid or Medicare. If you want to apply for Medicaid or Medicare, you need to go medicare.gov or SC DHHS’ Healthy Connections page for Medicaid.
Breaking Down the Changes Effective August 25, 2025
(Permanent Changes)
These changes are changes to the federal rules through the ACA Marketplace Integrity and Affordability. Some of these changes are permanent, while others are temporary and set to sunset (or expire) December 31, 2026.
Past Due Premiums Must Now Be Paid to Start a New Policy
NEWS: This rule change is on hold due to a Federal Judge injunction. We will update if this policy goes into effect later.
What This Means: Right now, the ACA marketplace allows people to continue their coverage in the new year even if they owe past due premium payments. This rule change ends this. This means insurance companies can make you pay your past due balance, plus the new premium, before your new plan can start. Insurance companies can now refuse a new policy if there are past due premiums.
What You Need to Do: If you have past-due premiums and want to renew your ACA marketplace coverage, plan to pay your balance before open enrollment starts November 1, 2025 to make sure you stay covered.
If you need to borrow money to pay past premiums, please consult with a consumer advisor to not borrow money you do not have the ability to repay.
Note: It may be possible to switch insurers to avoid paying premiums, but it will depend on the available insurers and if they are willing to allow that.
Click for Further Details Explaining the Change
Currently: Health insurance companies are barred from forcing consumers to pay past-due premiums as a condition to enroll in an ACA plan from that insurer in the future.
Change: Allows ACA marketplace insurer to add the past-due premiums to the amount the applicant must pay to start the new policy/coverage. This is allowed if there is nothing in state law to prohibit this. There are no limits on the lookback period. If the applicant doesn’t pay the past-due premium, the insurer will be allowed to refuse to start the new policy.
Less Time to Handle Income Issues with Insurers
What This Means: People applying for ACA marketplace coverage will have less time to provide proof of their income if asked. Going forward, you will only have 90 days to get this information approved. You do not get your benefit until this information proves you are eligible. This change will especially impact people with seasonal, variable, or self-employment income, increasing the risk of losing coverage.
FYI: Signed statements are acceptable form of proof of income.
What You Need to Know: If an income verification issue comes up during the application process, resolve it as quickly as possible. Failure to get this information could mean having to wait until next year for coverage.
Click for Further Details Explaining the Change
Currently: ACA marketplaces were required to grant applicants an automatic 60-day extension to the 90- day period to resolve income inconsistencies.
Change: The final rule permanently removes the current automatic 60-day extension applicants are given to provide requested income documentation. ACA marketplaces may only grant extensions to the 90- day period to resolve income inconsistencies if requested, and on a case-by-case basis.
Temporary Changes Effective August 25, 2025
The following changes are temporary changes to the ACA marketplace. These go into effect August 25 and end on 12/31/26. What happens to these changes after 2026 is not yet known.
Additional Documents Required in Proving your Income
NEWS: This rule change is on hold due to a Federal Judge injunction. We will update if this policy goes into effect later.
What This Means: You will no longer be able to self-verify your income if it is much different from your last tax return. You can still use your last tax return if your income hasn’t changed much. If there is a big difference you will need proof: pay stubs, a written statement from your employer, or some other written proof that shows your income.
What You Need to Know: If you know your income is going to be much different from your last tax year, be prepared to have some alternative ways to prove your income. It is important to give the most accurate amount. This helps you get the health plan that’s right for you.
Click for Further Details Explaining the Change
Currently: a) Marketplaces were required to accept an applicant’s self-attestation (your own statement of income without any additional proof) of income if no tax data were available. b) Marketplaces were required to accept an applicant’s self-attestation of income if the amount was higher than the amount shown in federal databases.
Change: Self-attestation will no longer be allowed if income data conflicts with prior tax filings by more than 10% – currently the threshold is 50%. a) People will be required to submit income verification if there is no tax data available. b) People will be required to submit income verification if they attest to income that would make them eligible for Premium Tax Credit (PTC), but federal databases show income that would make them eligible for PTC.
Pause of the Low-Income Special Enrollment Period
What This Means: The Special Enrollment Period (SEP) helps low-income consumers (up to $22,590 for one person or $46,800 for a family of four) who find themselves uninsured apply for ACA coverage even if it is outside of open enrollment. This will no longer be available on August 25,2025, and now consumers will have to wait until the open enrollment to get insurance if they have extremely low income.
Note: The Special Enrollment Period will still be available for any person who experiences a unique life event. This includes situations like losing health coverage due to moving, getting married, having a baby, or adopting a child.
What You Need to Know: If your income falls in this range and need health insurance now, apply by the end of August 24. You may qualify for Premium Tax Credits to help lower the cost of your insurance through the ACA Marketplace and stay covered until the end of 2025. You will have to enroll once again during open enrollment to see if you qualify for any plans for 2026.
Click for Further Details Explaining the Change
Currently: The Low-income Special Enrollment Period (SEP) allowed enrollees with income at or below 150 percent of FPL to enroll in an ACA marketplace plan, or switch plans, at any time during the year, with no prior coverage requirement.
Change: This program will end August 25th.
This program will start again on January 1, 2027., but applicants will no longer receive Premium Tax Credits (PTC) to lower the cost for this insurance. This will make the insurance too expensive for applicants.
Thanks for reading. If you have questions, please feel free to email us at [email protected]. Stay tuned for more information on the ACA and healthcare changes ahead in our future blogs.
