Written by Brittany Zephier, Navigator Project Manager
Open enrollment is almost here, and with it comes another opportunity to help those who are uninsured or need coverage take the first step to apply. This is also the time to encourage those who are new to the Marketplace or already have coverage to log in, update their information, and actively re-enroll through healthcare.gov. Open enrollment runs from November 1, 2025, through January 15, 2026.
This year brings several important changes that make early action and clear communication important.
What’s New This Year:
- End of the year-round special enrollment period (SEP) for lower-income households. Individuals under 150% of the federal poverty level who once could enroll anytime must now act during Open Enrollment unless they qualify for another life event.
- Tighter documentation and verification timelines. Applicants must submit proof of income or eligibility sooner, with fewer grace periods to resolve data issues.
- Pre-enrollment verification for life events. People qualifying for coverage due to job loss, marriage, or other life changes must submit documentation before their plan can start.
- Anticipated expiration of enhanced Marketplace subsidies. The enhanced premium tax credits are set to expire at the end of 2025, which could increase costs for many consumers in 2026 if they are not extended by Congress.
These changes may create confusion or delay if individuals wait too long, but early outreach, proactive referrals, and strong messaging will help people stay covered.
Why Does Open Enrollment Matter?
Open enrollment period is the one time each year to secure or renew affordable coverage. Marketplace coverage provides a vital safety net for those who don’t have access to affordable employer insurance, have recently lost or been denied Medicaid, or aren’t eligible for Medicaid or sliding-fee programs. It also supports individuals and families during transitions—changes in work, income, or life circumstances—when coverage is most needed. Your connection, trust, and relationships with patients and clients can be the difference between someone staying uninsured or getting the coverage they deserve.
How You Can Help:
- Health centers have certified application counselors or Navigators that can help individuals enroll in health coverage. Find a health center near you.
- In South Dakota, refer clients directly to GetCoveredSouthDakota.org to connect with a navigator for free, confidential, and unbiased help or schedule an appointment.
- In North Dakota, Navigators can be reached at 1-800-233-1737 or NDNavigators@MinotStateu.edu.
- DIY option: Direct individuals in both states to HealthCare.gov to compare plans and apply on their own.
- Promote the 2025 Open Enrollment Toolkit. Use the shareable flyers, graphics, and talking points available for North Dakota and South Dakota.
- Visit the Partner Support Page. Download referral flyers, “How to Refer” guides, and outreach templates at communityhealthcare.net/get-covered-sd/partners-support/.
- Encourage document readiness. Have clients gather pay stubs, IDs, or household details early to prevent delays during verification.
Key Dates (South Dakota & North Dakota):
- Dec 15, 2025: Deadline for Jan 1 coverage
- Jan 15, 2026: Final deadline for Feb 1 coverage
Sign up for the Get Covered South Dakota Newsletter to stay up-to-date on open enrollment, eligibility guidelines, policy changes, training opportunities, and more!
