On Nov. 15, the two-month open enrollment period for health care policies available on the state and federal health care exchanges begins. Last year's open enrollment period was the first experienced by the exchanges, which were put together as part of the Patient Protection and Affordable Care Act – and the ride was a bumpy one.

Issues with eligibility determination, registration and even problems accessing the website due to overwhelming demand plagued the exchanges, even as eight million Americans signed up for a health insurance plan via state or federal exchanges.

Ron Goldstein, founder of CaliforniaChoice, the nation's first state-approved multicarrier health exchange, believes this year's enrollment ought to be at least a little bit smoother from an individual consumer perspective.

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"The states that have gone through their first open enrollment last year have not broken down and gone back to the federal exchange — I think the experience this year will be much better," he says. "The exchanges have got a year under their belts; they all had payment issues and issues with getting patients enrolled, but now that that's over – and there was very little activity outside of open enrollment – many of the state-run exchanges should operate with more efficiency."

However, the federal exchanges might not fare so well. "On the federal side, I think people are still going to struggle," Goldstein predicts. "It'll take at least another year on the individual side to really get that consumer experience where it needs to be, and then another year to refine it."

And from a group perspective, the 2014 enrollment experience was dismal, according to Goldstein.

Not only have the state and federal governments had more time to work the logistical kinks from the software and enrollment process, but the insurers themselves have also made some changes to the plans available for 2015.

"The plans that were priced low for 2014 probably acquired a big market share in year one, and those plans might raise their rates slightly — maybe 8 to 10 percent — because they entered the market on the lower side of things," explains Jonathan Wu, founder and chief executive officer of ValuePenguin.com. "Other plans that had higher estimates and were worried about getting a lot of sick patients are cutting their premiums so they can reach more of an equilibrium point. But across all of the carriers, rates are coming down. Subsidies are changing, and there will be more entrants into the marketplace in each of the states. It was a learning process in year one. Now that the insurers have a better idea of where things lie, over three or four years, as things play out, plans will align with one another."

Because PPACA set guidelines for benefit design, particularly in terms of preventive care and minimum coverage, it's more difficult for carriers to differentiate themselves using benefit design. Instead, what's been happening in the industry are network adjustments, which insurers use to justify their prices. 

"Carriers are trying to differentiate themselves from private and public exchanges," explains Goldstein. "They really can't tweak their benefit designs, so the thrust of the changes are all network-driven. There's really no way to justify a price difference if the benefits are the same and the networks are identical.

Goldstein adds that one big (and, unfortunately, all-too-common) wrench in the works for exchanges are the ever-changing regulations.

"It's all work in motion," he explains. "As a private exchange, we're looking forward toward the end of 2015 and crossing our fingers that the regulations won't change again. The regulation is so fluid, and that fluidity really costs people like CaliforniaChoice, the states and the federal exchanges a ton of money. You start down one direction, and you're spending money developing, and all of a sudden, there's a change. So every time a change is made, it costs people like me possibly a couple hundred thousand dollars."

From an employer perspective, Wu notes the exchanges might offer a small employer more flexibility – without even going down the SHOP rabbit hole.

"One of the things that's more problematic for businesses is that it's difficult to offer an option for all your employees," he explains, "because typically people who are younger want plans that are less comprehensive. By giving workers the option to shop for themselves on the exchange and take cash from the employer to pay their premiums, the workers are given more choices as to what they want and what kind of coverage they need."

"Even if consumers already have a plan, it's going to be a good idea for them to go out and look at the exchanges again during open enrollment," Wu says. "And there's an opportunity for brokers to remind consumers to take another look, because they might be able to get a better offer."

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