It’s the season to roll up your sleeves, gather your documents, and pick a health insurance plan for 2020. For those shopping for their own plans, HealthCare.gov and the other state exchanges are open for enrollment as of November 1.

Despite the rhetoric about the implosion of the Affordable Care Act, the individual mandate going away, and other attempts to hobble the law, the marketplaces are still alive and well. And many people are eligible for subsidies to bring their costs down.

In fact, HealthCare.gov has gotten sleeker and easier to use over the years (after a famously rocky start). There are new bells and whistles to make shopping for a plan easier this year. Still, figuring out how to balance premiums, deductibles and other costs, and choose a plan that will fit your needs for the coming year is hard.

Charlene Wong knows this from experience. Even as a doctor and academic at Duke University who studies how people make health insurance choices, a few years ago, she and her husband picked the wrong plan.

“We spent several days researching plans and called around to make sure the doctors we wanted to see were in network,” she says. Then she got pregnant, and found that while her OB was in network, there was a catch.

“There was a tiered network within that health insurance plan and [my OB] was in Tier 3 of network providers,” she explains. Even though she thought she’d done everything right, she ended up having to switch doctors to keep her costs down.

So take heart — health insurance can be tricky, even for the experts. Here are a few tips to help you find the right plan.

1 – Figure out where and when you need to enroll

Depending where you live, you can either use the federal exchanges on HealthCare.gov or your state’s marketplace to shop for insurance. Twelve states and the District of Columbia run their own exchanges. The federal exchange open enrollment runs until mid-December, but you might have more time if you live in a state that runs its own marketplace.

2 – Review plan options, even if you like your current one

For people who are already enrolled in an ACA plan, Charles Gaba says it’s really important to log in and check if there’s a better value, even if you’re happy with your current plan. Gaba runs the website ACAsignups.net, where he does health care data and policy analysis, focused primarily on the Affordable Care Act.

It can be tempting to skip the whole enrollment rigmarole, especially since you’ll just get rolled into the same plan or a similar plan if you do nothing during open enrollment.

“A lot of people think that because nothing changed in their lives — like, their income is the same, the same household — nothing will change for their policy or their premiums, and that’s just not true,” Gaba says.

Every year, there can be all sorts of changes that affect the kinds of plans available and the costs of those plans. For instance, this year new insurers have entered the marketplace, and premiums have gone down in some states. It’s always worth logging in and checking to see what’s changed for you and whether it makes sense to switch things up.

3 – Compare estimated yearly costs, not just monthly premiums

It’s easy to focus on the monthly premium payment when comparing plans, but Wong at Duke says don’t forget to consider other costs as well.

“A lot of people — we know from past research — become overly focused on the monthly premium and may not pay as much attention to things like the deductible or how much the co-payments are,” Wong says.

The premium price is prominently featured when you’re looking at plans, but look at other costs too. A tool available on HealthCare.gov and some state marketplaces will calculate “estimated total yearly costs” for you. This takes into account the plan’s deductible — how much you have to pay out-of-pocket for covered services before your insurance picks up the tab — and copays, put together with how much health care you expect to use in the coming year.

Wong says that yearly cost estimate can be a really useful tool when picking a plan. “Trying to figure out that math can be a little bit tricky, especially for people who are not as familiar with health insurance.” she says.

4 – Consider how much health care you use

Picking the right insurance plan involves guesswork about how many health issues you’re likely to face in the coming year, which could affect the way costs break down. Your age is usually a useful proxy for this, but there’s always a lot of unknowns, like a surprise cancer diagnosis or a car accident.

Wong points out there are basic tradeoffs to consider. “You might want to think about, ‘Do I pay a little bit more each month in a monthly premium knowing that that would mean less out-of-pocket expenses when and if I do need more medical care?” she says. “Versus — the other way around — ‘Let me pay a lower monthly premium because I don’t really anticipate needing much care, but I know I’d have this health insurance in case something really catastrophic happens.’ “

Alongside these unknowns, leverage what you do know about your health needs. If you have a doctor you like, or if you know you’re going to take a certain prescription drug, look for a plan that covers them. HealthCare.gov allows you to add your provider and your prescription drugs as you browse plans to see whether they’re covered. Another way to find out is simply call your doctors and ask what plans they accept, says Wong.

5 – Beware too-good-to-be-true plans

If you see a good deal online, make sure you’re looking at an ACA plan, warns health policy writer and insurance broker Louise Norris. When you search for health insurance on the internet, you may stumble on short term plans that advertise much lower monthly premiums, but don’t cover the ACA’s famous ten essential benefits. These include some pretty important stuff like prenatal care and mental health treatment.

Sometimes people can find good deals on premiums in the federal and state marketplaces, Norris says, but if one plan sticks out as being too good to be true, read the fine print.

“I did see some new plans popping up in some areas for 2020 where they’ll say $0 deductible,” she says. “Then you scroll down a little bit further and you have maybe $1,000 a day copay for hospitalization.” You hope you won’t spend a lot of time in the hospital, but if you do, that kind of cost could really add up.

Norris points out a new tool this year to help sort out good plans from bad — a star rating, similar to what consumers are used to on Yelp or Amazon (hearkening back to Obama’s original vision). The star ratings are based on information insurers submitted regarding cost, combined with enrollee feedback.

“Star ratings are one of those at-a-glance things where you can kind of see, “OK, how do other customers feel about this plan?’ ” Norris says. Not all plans have them since some are new, she says, but for plans that do, the stars “give you some some red flags if maybe there are some concerns.”

6 – Get free help from the pros

The Trump administration slashed federal funding for advertising open enrollment and the navigator program, but those programs do still exist: There are still people across the country trained and ready to sign people up — for free.

“My best piece of advice for people — particularly those who are less familiar with insurance, is to see if you can get some help,” Wong says. You can call for help, but she recommends trying to meet in person with “a health insurance navigator or a certified application counselor,” she says. “Importantly, these are folks who are impartial to which health insurance plan may be best for you.”

Katie Turner is one of those trained navigators — she’s been signing people up for seven years, and works with the Family Health Care Foundation in the Tampa Bay, Fla., area. Leading up to open enrollment, she’s been busy calling consumers from past years, letting them know that this is the time.

She advises people to assemble all the necessary documents, such as Social Security cards, immigration documentation, tax returns, before going into a meeting with a navigator.

Most of all, she says, don’t miss your chance to sign up for coverage if you need it.

“There is a lot of confusion out there,” Turner says. Many people are confused about what a legal challenge to the law means for the marketplaces (nothing for now), when open enrollment is, and more. “All we can do,” Turner says, “is continue to be here and provide the resources that we’ve been providing for the last seven years to help people enroll in coverage.”

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Fern Brown, 81, sat in the rear of a tent on the windswept fairgrounds of the historic Gold Rush town of Auburn, Calif., this week, drawing deep breaths through the mouthpiece of a nebulizer plugged into a power strip atop a plastic folding table.

Afflicted for years with asthma and chronic obstructive pulmonary disease, Brown uses the nebulizer twice a day to avoid flare-ups that can be life-threatening. It turns her medicine into a fine mist that she can inhale.

Her machine runs on electricity, and when Pacific Gas & Electric Co. shuts off the power in the region amid wildfire scares, as it did earlier this week, Brown must scramble to find a place where she can administer her treatment.

She knows the makeshift “resource center” she visited on Tuesday afternoon, one of several set up by PG&E, is not a viable long-term fix ? especially now that this month’s power outages and the uncertainty that comes with them seem likely to be a more frequent feature of California’s fall fire season.

“I could rent a generator. Or can you rent to own?” Brown asked. “They’re expensive. But that’s probably what I’ll do. We just want to be ready for the next time.”

“That is the real travesty of this PG&E plan,” said Sandy Jay, a nurse practitioner at Santa Rosa Memorial Hospital in Sonoma County, about 130 miles southwest of Auburn. “As the dominoes fall, it’s the poor and the disabled who are the most affected by this.”

Jay supervises a program that for 20 years has sent teams of workers throughout the Santa Rosa area to bring medicine and treatment to those whose conditions prevent them from leaving home or keep them bedbound.

Without power, though, almost all of those patients need help immediately, she said. Air-pumped mattresses, used to prevent chronic bedsores, begin to deflate. Ventilators and nebulizers cease to function. Electric wheelchairs don’t respond. And many of the affected people are reachable only by landline telephones, which aren’t all reliable when the power’s out.

“It’s just kind of unconscionable,” Jay said.

Hardened by experience of shut-offs imposed by their utility company, many residents of this region ? and others up and down the state ? have concluded they must prepare for future power cuts.

PG&E confirmed that notion in an emailed statement, saying all its customers should “have an emergency plan to be prepared for any extended outages due to extreme weather or natural disasters.” Extended outages, even planned ones, can mean up to a week without electricity, Californians in some areas have been dismayed to discover.

PG&E’s statement referred customers to the utility’s website page on wildfire safety, adding that local county emergency offices may also offer help.

The PG&E outages that have affected some 1.8 million Californians in the past few weeks, amid nerve-wracking warnings of wind and fire, have only affirmed the company’s message.

For those with home medical needs, the quest for a durable fix has taken on real urgency.

Steve Bast, who lives in a rural section of Auburn in the Sierra foothills, has Type 2 diabetes, and his insulin needs to be refrigerated. Bast has been forced to deal with previous outages, both weather-related and PG&E-driven, some lasting several days.

Now, he said, he keeps ice packs in his freezer and puts them on the insulin containers as soon as his power goes down. He then stores the medication inside a soft cooler that zips closed and goes back in the refrigerator for as long as the unit remains cold.

Bast also uses a CPAP machine for his sleep apnea, and it must be plugged in, so he said his next move is to buy a small, personal generator. He notes however, that he would still need to find an open gas station for fuel to keep the generator running during an outage. Gas stations rely on electricity to run their pumps.

Then there’s the cost: A personal generator sells for between $400 and $1,000, meaning it could be out of reach for people of limited means.

PG&E’s temporary resource centers, of the type Fern Brown visited, are small, tented areas where up to 100 people at a time can power up devices of all kinds and get free bags of ice, cases of water and snacks. The centers are set up when an area is plunged into a utility-ordered shut-off, and they close once power is fully restored to that area.

But such centers cannot solve the bigger problems. During the last power shut-off a few weeks ago, Debrah Vitali went to check on her neighbor, 88-year-old Joan Casper. She and Casper have become close friends in their neighborhood in Santa Rosa, and Vitali knows that Casper wears an emergency calling device around her neck, which she can use to alert medics if she needs help.

The device is tied to Casper’s landline, but what neither woman realized was that the landline operates through her internet connection. When the power went out, so did the internet — and with it Joan’s ability to summon help.

“I couldn’t believe it,” Vitali said. “So we’ve just agreed as a group of neighbors to take turns checking on her, because she’d have no way to let anyone know she was in trouble.”

California’s Health and Human Services Agency this week established an ongoing, nonemergency hotline (833-284-3473) to help residents find health services in their communities during any power shut-off.

Gov. Gavin Newsom, meanwhile, has announced a $75 million fund that state and local government leaders can tap to help purchase generators and other backup energy sources that would keep local emergency services going in their communities.

For people whose medical treatment begins at home, however, the solutions also need to begin there.

At the PG&E center in Auburn, Fern Brown completed her 30-minute treatment before speaking. She said that her asthma and COPD have become worse over the past couple of years and that skipping a nebulizer session is not an option.

Brown and her sister, Lavina Suehead, who cares for Brown, drove a half-hour from their home in the remote town of Foresthill to reach the resource center at Auburn’s Gold Country Fairgrounds. They said they would be seeking another solution, both for Tuesday night’s treatment and beyond.

“We’ll have to do something,” Brown said. “We’re out of power a lot.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.

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