The 2015 open enrollment is off to a pretty good start and the new market is working, federal officials insist, but for consumers and insurers, there is still a tough slough, albeit of a different sort.

In the 35 states served by the federally-operated Healthcare.gov insurance exchange, and elsewhere, health plan choices, benefits and premiums are all to the consumer’s favor in ways never before seen, according to Andy Slavitt, the former
UnitedHealth executive now serving as Health and Human Services deputy administrator, and Kevin Counihan, the former Connecticut insurance exchange director now running the federal HIX as marketplace CEO.

Three weeks after the start of 2015 open enrollment, Counihan and Slavitt discussed a new HHS analysis of the federal marketplaces option and argued that the evidence shows most low- and middle-income insurance shoppers can get a good deal.

For 2015, almost 80 percent of the individuals currently enrolled in a plan through the federal exchange can keep or get new coverage that costs $100 or less per month after tax credits, according to the report. Insurer participation in the federal exchange has increased 25 percent for the 2015-plan year, and 90 percent of individuals in the 35 states can choose between three or more issuers, up from 74 percent a year ago.

That competition is leading to lower average premiums, with rates for the second-lowest cost “benchmark” silver plans increasing on average only two percent, noted Slavitt and Counihan.

With an improved Healthcare.gov exchange website and call centers, enrollment is “much easier than last year,” explained Slavitt. “That said, we have a lot of work left to do for consumers.”

One of the big ones is education and outreach — convincing people who enrolled in a plan for 2014 to come to the exchange and shop around.

There’s a caveat to HHS’s proclamation that 80 percent of current enrollees can get coverage for $100 per month or less: that’s only across metal tiers, and most have to shop around for a new plan to keep something within a few dollars of their monthly premium. If they want want to stay in their metal level, about 65 percent of current marketplace enrollees can get coverage for $100 or less if they shop for another plan. Only 50 percent of current enrollees can get coverage for $100 or less if they do not change their plan.

“For some consumers, we think a large number of consumers, affordable premiums are going to be their number one factor,” Slavitt said.

The trouble is with insurance — health insurance, home insurance, flood insurance, car insurance, boat insurance — consumers aren’t all that likely to shop around year-to-year. “Consumers are inert with insurance in general,” said Counihan, noting that he hasn’t changed carriers for auto and home insurance in a while.

Some consumer advocates fear that individuals covered in exchange plans may be inclined to inertia, if not for the same reasons as upper-middle-class suburban homeowners — they went to the trouble of selecting a plan a year ago, they’ll be automatically renewed, which is convenient, or they want to keep access to a doctor or particular pharmaceutical drug that they went to lengths to find among numerous narrow network plans.

To take advantage of the notable 2 percent average premium increase and what HHS estimates to be $2 billion in savings, many consumers who bought benchmark plans or lower-cost plans for 2014 will have to change to avoid sizable premium increases. Only 13 percent of federal exchange rating areas have the same benchmark plan for 2015 as they did in 2014, according to an analysis by Avalere Health.

As healthcare consult and former Liberty Mutual executive Robert Laszewski observed, a number of exchange markets are seeing a scenario where “the plan that got 70 percent market share increased their rates 15 percent and the rest cut their rates or gave tiny increases.”

The most popular federal exchange plans in 2014 have increased premiums by 10 percent on average in 2015, according to Avalere. For individuals in the many rating areas seeing a change in the benchmark plan, a premium increase by 5 percent on their plans could lead to net increases of more than 30 percent after their subsidies, according to estimates by Milliman.

As Avalere outlined, a customer earning $17,500 (150 percent of the federal poverty level) who bought a 2014 plan priced under the benchmark at a cost of $18 per month could see a massive 80 percent rate hike if her $318 pre-subsidy plan increased 20 percent to $380 because her subsidy would remain the same, indexed to the cheaper benchmark plan.

Even though the individual would get a small refund a year later, that kind of rate hike can lead to frustration and make someone decide to just stop paying their premiums.

Thus, it’s crucial to engage with current enrollees and ask them to come back to update their information, Slavitt said. “Every individual is going to be touched at least three times with communications, or upwards to a dozen times.”

The consumer experience may be the fed’s main priority, but CMS and its many contractors are also sloughing away at the backend administrative system connecting the exchange with insurers.

“We continue to build out the element of the site that lets us continually automate processes,” including paying issuers on the backend,” said Slavitt, who until last June was executive vice president at UnitedHealth Group’s Optum technology subsidiary.

“Those are underway," Slavitt added. "Some functionality is expanding this year. More functionality will be delivered in 2015.”

Until, then though, exchange insurers may face a fair amount of administrative chaos related to the shopping around so many consumers may have to do to keep an affordable premium.

As Laszewski offered in a hypothetical example, a consumer, George, realizes he needs to switch plans to avoid a big hike, and “scrambles in the very few days between his getting his January premium invoice ... to sign-up for that lower cost plan and save his full subsidy.

“But then George's friend Mary tells him that the new second lowest cost Silver Plan is one of those terrible narrow network plans that restricts providers in order to be able to charge the lowest rate and suggests he sign up for a third plan that costs a little more but has his doctor in the network.

“George's first carrier will count him because it was too much bother for George to figure out whom to call to cancel his coverage –– he will just not pay the bill. But his carrier, by regulation, can't knock him off the rolls for three months –– not until April 1. George enrolled in his second choice but never bothered to pay that bill but the carrier will count him likely into February as the health plans give people plenty of time to pay their bill in what will be a very confusing situation. And, of course, George's third carrier will count him.”

As far as enrollments go, George would be one person counted three times, Laszewski concluded. “We won't have George's status cleared up until George's 2014 carrier can delete him from their rolls in April.”

This article originally appeared on Government Health IT sister site Healthcare Payer News.