A Los Angeles furniture store worker who had never had health insurance enrolled in a plan for $75 a month that will cover both him and his son.

An unemployed accountant in Charlotte, N.C., who tried and failed to sign up last year found coverage for $11.75 a month.

A self-employed house contractor from West Palm Beach, Fla., found a health plan that will cost him nothing.

They were among more than 100,000 Americans who signed up for coverage Saturday through the Affordable Care Act’s online insurance exchanges, which launched this weekend with far fewer problems and less fanfare than last year. Many people qualified for federal subsidies that kept their monthly premiums well under $100.

“The vast majority of people coming to the site were able to get on and do what they were intending to do,” Health and Human Services Secretary Sylva Burwell said Sunday on NBC’s Meet The Press, adding that 500,000 people had signed onto the website.

By most accounts, the federal marketplace that handles enrollment for 37 states ran smoothly — a far cry from last year’s disastrous rollout that turned www.healthcare.gov into an embarrassment for President Barack Obama, spurred several staff departures and made the site virtually unusable for two months.

State exchanges that had encountered big problems last year — including Maryland, Massachusetts and Hawaii—all reported no major issues this weekend.

Still, there were some hiccups, with consumers and enrollment counselors facing sporadic delays accessing the website to set up an account and buy coverage. Some of those who bought coverage last year had trouble getting into their accounts because they had forgotten their passwords.

Meanwhile, the insurance exchanges run by 13 states and the District of Columbia functioned well — with the exception of the one in Washington state, which was shut down Saturday because it was giving out incorrect subsidy information. The site was fixed and back online Sunday morning.

To give consumers assistance, enrollment events were held across the country over the weekend, at hospitals, clinics, churches, community centers, malls, libraries – even at the Rock and Roll Hall of Fame in Cleveland.

“It was awesome,” said Joy Floyd after she got help buying a plan for $11.75 a month at the Children and Family Services Center in Charlotte, N.C. She had tried and failed to sign up for coverage last year because of website problems.

Like most enrollees, Floyd will face additional cost-sharing as a result of deductibles and co-pays when she sees doctors, gets tests or buys prescriptions.

Uncertainties Ahead

Despite this year’s far smoother opening, the enrollment process continues to face plenty of uncertainties, including the response of a confused and still uninformed public, among them 20 million uninsured who did not enroll the first year; a shorter enrollment period and premium increases that many of the 7 million people who bought coverage last year will face unless they shop around.

Recent political and legal developments also cast a shadow, including a hostile GOP taking control of Congress in January and the Supreme Court’s decision to hear a challenge to the subsidies that millions of people have relied upon to reduce the cost of their coverage.

Ricot Telcy, 37, a West Palm Beach, Fla., security guard, knew nothing about the legal challenge, but was pleased to learn he and his wife could get coverage for about $300 a month—about the same price his wife had been paying for herself.

Across town, at an event at a medical society office, Rick Pierre, 40, enrolled in about an hour in a plan that will cost him nothing in premiums because he qualifies for a large subsidy. “I’m very excited,” he said.

The Obama administration expects about 9 million people to get coverage on the exchanges before open enrollment ends Feb. 15. The marketplaces are a cornerstone of the health law because they help expand health coverage to millions of Americans who do not get health coverage at their jobs. More than eight in 10 people buying policies last year received a government subsidy to lower their premiums.

People must enroll by Dec. 15 if they want their coverage to start in January. In most states, those who bought coverage last year will be re-enrolled automatically if they do nothing by that date – a scenario that could result in higher costs since most premiums and benefits are changing.

The exchanges and the publicity around them also spurred millions of people to sign up for Medicaid, which has expanded eligibility under the health law in 27 states.

Some Wrestle With Higher Premiums, Confusion

In Philadelphia, Joseph Krakauskas, a retired 62-year-old, showed up two hours early at an enrollment event to secure a place at the front of the line. He has just found out that his current premiums were going to triple next year and he needed help finding a new plan. “This is almost like a bait and switch,” he said of the rate increase. “I can’t believe they’re getting away with this.”

Krakauskas wasn’t able to access his account through the website, however. Still, a counselor found him an HMO plan for $128 a month, higher than he was paying last year, but about half of what his old plan would cost in 2015.

Despite the government’s efforts to streamline the application, confusion and difficulty navigating the website also brought in many people, including Sarah White of Philadelphia, a mother of two.

“I have a doctoral degree,” she said. “The fact that this is so complicated for even someone with [her education] is ridiculous. But here I am trying to get help and I have hope.”

Demand for coverage was particularly high in California, where 1.2 million residents signed up for coverage last year.

By 9 a.m. Saturday, dozens had lined up for a festive enrollment event in Los Angeles sponsored by SEIU-United Healthcare Workers West. Most of the applicants came prepared – holding envelopes with pay stubs, birth certificates and Social Security cards. As each finished signing up, volunteers cheered, applauded and snapped photos.

Alejandro Irigoyen, 45, said he missed the deadline last year and didn’t want to risk doing that again. When he injured his foot recently, he paid about $500 for a doctor’s visit, X-rays and medicine. With the help of an enrollment counselor, Irigoyen signed up for a plan which will cover both him and his 23-year-old son for about $75 a month.

“I feel much more secure,” Irigoyen said.

The enrollment event took place in a heavily Latino neighborhood, and most of the counselors spoke Spanish. California exchange officials had been heavily criticized last year for not doing enough to reach out to the state’s large Latino population. Several of the families at Saturday’s event said they hadn’t previously enrolled in coverage because they have family members who are in the country illegally and feared telling the government too much.

After being reassured their information wouldn’t be given to immigration authorities, Crescencio Lorenzo, 48, a legal resident, came to the enrollment event with his daughter, Andrea, a U.S. citizen, and his wife, Susana Lorenzo, 48, who is in the country illegally. He and his daughter enrolled in Medicaid. “They told us not to worry,” about jeopardizing his wife, he said.

Weather And Glitches Are Issues In Ohio, Washington

Some enrollment events failed to draw consumers, including the “Rock Enroll” event at Cleveland’s Rock and Roll Hall of Fame. Officials blamed snow flurries. By mid-afternoon, Barb Wynveen, a navigator with the Carmella Rose Health Foundation, said she’d had no walk-ins, and all of her half-dozen scheduled appointments had been a bust.

There was more foot traffic at Northeast Ohio Neighborhood Health Services, a clinic primarily serving the poor. Counselor Khalil Ismail met with Prempal Kaur, a woman in her 50s who spoke mostly Punjabi, and her daughter, Ravinder Kaur, who translated.

“She’s a citizen. She’s a widow, a single mother,” explained Ravinda Kaur, who had traveled from Chicago to help her mother apply for insurance coverage. “And she works at the Convenient Food Mart, where she makes minimum wage.”

Before she left, Prempal Kaur was enrolled in Medicaid.

In Washington state, meanwhile, the shutdown of the website to fix a glitch led people to start filling out applications the old-fashioned way — with paper and pen.

“It’s incredibly frustrating,” said Gary Zablocki, a 51-year-old carpenter at an event at the Southcenter Mall in Tukwila, a Seattle suburb.

Joanna Richards at WCPN in Cleveland , Elana Gordon at WHYY in Philadelphia, Ann Doss Helms at The Charlotte Observer, Nick Nehamas at The Miami Herald, Lisa Stiffler and Patrick Marshall at The Seattle Times, Jordan Shapiro at the St. Louis Post-Dispatch, Wes Venteicher at The Chicago Tribune and Robert Calandra at The Philadelphia Inquirer also contributed.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

As Americans begin shopping again for health insurance under the Affordable Care Act on Saturday, they’ll be wrangling with premiums, deductibles, out-of-pocket costs and other vague and confusing insurance-speak.

Believe it or not, that’s the easy part compared to figuring out what the overall cost of health care is.

Sal Morales of Miami bought insurance in March during the ACA’s first enrollment period on healthcare.gov.

“I got my cards and it was like amazing,” Morales says, “like if I got an American Express Platinum card. That’s how I felt.”

Morales was unemployed at the time. Money was tight. And he knew he needed regular doctor visits to manage his high blood pressure. He diligently researched what he would get for the price before settling on a plan.

“Instead of me paying $560 [a month] for COBRA, I found out that I would have insurance for $145. I have a network deductible of $500,” Morales says. “My first three visits to a primary care physician, they’re zero dollars. Then it’s $5 out of my pocket.”

Morales understands his end of the health care equation, but what he sees doesn’t necessarily reflect what gets paid to doctors and hospitals for his care, says Bruce Rueben, president of the Florida Hospital Association.

Here’s how he breaks it down: “There’s one party, the hospital who provides the service. There’s a second party, the patient, who receives the service. And there’s a third party, the insurance, who pays for the service.”

That third part is where health care pricing gets really squirrelly.

Every hospital has its own “master list” of charges for different services. Those charges are different from hospital to hospital.

But insurance companies don’t pay those listed charges. The listed charges are almost fiction. Instead, each insurer negotiates for lower prices with each hospital and doctor on every plan. And insurers can have multiple plans with multiple agreements for the same hospitals or doctors.

Even if two patients have the same insurer, if their plans are different, the insurer may pay the doctor differently for the same care for each of the patients.

All of this means there are about as many pricetags for that hypertension checkup as there are insurers and providers.

“For an individual consumer I am completely sympathetic that it’s very confusing,” says Dr. Ezekiel Emanuel, who was an adviser to the president during the drafting of the health law and is now a health policy expert at the University of Pennsylvania.

“There are at least six different prices for a hospital day. And then there’s the cost of actually delivering the service, which, for most of these things, even hospitals don’t know what that is. So when you say, ‘What’s the price?’ It’s almost a meaningless question, because there [are] all these different prices.”

Those negotiated rates—the prices insurance companies really pay hospitals—are treated like trade secrets. Insurers and many hospitals don’t want their competitors to know what  the payments are

It is only on an individual basis that people can see the prices their insurer paid for their care. And it’s after the care has been delivered and only if the person is already insured.

It’s buried in a statement called an explanation of benefits. These are the letters from insurers that look like a bill but say “this is not a bill.”

Efrain Monzon helps patients interpret those explanations for Florida Blue, the largest insurance company in the state of Florida.

“We’re identifying the procedure, we’re identifying the provider, the date of service and then making sure the amount, the member responsibility has to be in there,” Monzon says.

Wedged into that statement somewhere between the billing code and the member deductible, is a column for the amount paid.

This is the secret number the insurance company and the provider have worked into their contract, says Monzon. The industry terms are usually “adjusted rate” or “negotiated rate.”

In Florida Blue’s explanation of benefits to patients, it’s called simply “amount paid.”

To get a clearer sense of what health care costs, someone would have to collect enough of those statements from patients at all different hospitals with all different insurance.

There are companies and crowdsourcing projects trying to do just that around the country. And Massachusetts has a law that says insurers have to disclose some of these prices in a way that is accessible to patients.

But so far, that’s not happening in South Florida.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Tomorrow it begins again – open enrollment for Obamacare. Two very successful state health insurance exchanges, Connecticut’s and California’s, are both intent on reaching people who avoided signing up last year – especially young Latinos and African-Americans.

“The big takeaway for us last year was that the uninsured were really pocketed in a couple of key, large cities,” says Jason Madrak, the chief marketing officer of Access Health CT, in Connecticut. In light of that, he says, the exchange has changed its ad strategy.

“We’ve dialed up some of the more locally-focused efforts while we’ve dialed down some of the broader efforts,” he says.

The uninsured people Madrak’s trying to reach tend to be young, male, urban and Hispanic or African American. They also “aren’t really consumers of traditional media,” he says.

They don’t necessarily read the big daily newspapers and they don’t watch mainstream TV, so they can be harder to reach. So Madrak is spending his media money on ads in community newspapers and on local television and radio.

Reaching potential customers is the first half of the job. The second half is figuring out what to tell them. One emphasis is on money, like in this TV ad with a barber asking his customer if he has health insurance. When the customer says, “No, I can’t afford it,” the barber says, “Now, you can, with Access Health CT, since you may qualify for help to pay for your coverage.”

Madrak says the messages of ads that appear later in the open enrollment period, as people are starting to think harder about choices, will be more specific about the cost of the insurance.

“If I say ‘affordable,’ nobody really knows what that means,” he says. “If I say, ‘I can get you a plan for 20 bucks a month with tax credits,’ that means something to somebody at that point.”

California health officials are also deploying a new and (they hope) improved campaign to woo Latinos. Last year, Covered California made a series of missteps. First, the exchange had only a handful of Spanish-speaking counselors at the call centers. And the Spanish advertising campaign was riddled with cultural oversights.

Among the worst gaffes: Some Latinos who worried that signing up would get undocumented relatives in trouble were shown a written promise from President Obama to the contrary – a note that, unfortunately, was printed on letterhead of U.S. Immigration and Customs Enforcement.

Covered California says it has learned from those mistakes. Peter Lee, the executive director, says this year, the agency is doubling down on making sure Latinos get the right messages.

“We’re actually spending more money on outreach, education, and marketing this year for a three-month period than we spent for six months last year,” he says.

The agency has hired 200 new call center counselors who speak languages other than English, Lee says. It is enlisting more trusted community organizations to allay fears about deportation. And it’s rolling out a new ad campaign tailored specifically to Latinos.

“Every person you see [in these advertisements] that is a Spanish speaker is a Latino who got coverage through Covered California this last year, and it made a difference in their lives,” says Lee.

This new video commercial shows pages of immigration documents flying into a safety vault – accompanied by verbal assurances that the application process is confidential.

But the main challenge, Lee says, is persuading Latinos to buy something they don’t believe they need or is worth the price.

“They’ve adjusted to a culture of coping,” he says. “We need to go from a culture of coping to a culture of coverage.”

Still, a woman in a recent focus group in Connecticut showed Madrak that even the best messages might not work.

“She said, ‘Listen, I saved everything that you guys sent me,’ ” Madrak says. ” ‘I have a box of postcards and letters that you sent me because it has the phone number on it and I wanted to save it.’ And we said, ‘Did you call?’ And she said, ‘No, I never called.’ And we said, ‘But you saved it all!’ And she said, ‘I know, I knew it was important; I just never got around to actually doing it.’ “

That, Madrak says, is the big, continuing challenge.

Open enrollment runs from Saturday, Nov. 15 through Feb. 15, 2015.

This story is part of a reporting partnership that includes WNPR, KQED, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Smooth sailing. The administration promises and outside experts expect that this year’s open enrollment period on the health insurance marketplaces will be markedly less glitchy and balky than last. Consumers will begin to find out if that’s true tomorrow when the marketplaces open for 2015 coverage.

But even if enrollment goes smoothly this year, consumers shouldn’t be complacent about reviewing their options online to sign up for or renew their coverage, say experts. The three-month sign-up window that closes Feb. 15 is half as long as last year’s, and if consumers want coverage to begin Jan. 1 they need to sign up much earlier than that, by Dec. 15. So if you’re planning to shop, get cracking.

As of October, there were 7.1 million people enrolled in the health insurance marketplaces, according to the Department of Health and Human Services. Earlier this week, HHS estimated that 9 to 9.9 million will be enrolled in 2015. That figure is significantly lower than the 13 million projected by the Congressional Budget Office in April.

In 2015, approximately 315 insurers will offer coverage on the health insurance marketplaces, roughly 25 percent more than this year, according to preliminary data from 44 states published by HHS in September.

But those figures don’t tell the whole story.

“There are still rural areas where there is a real dearth of plans,” says Caroline Pearson, vice president at Avalere Health, a research and consulting firm.

And more insurers doesn’t necessarily mean more plans. In Florida, for example, the number of insurers on the marketplace will increase from 11 in 2014 to 14 next year, but the number of available plans will actually decline, from 352 to 278, according to data from the Florida Office of Insurance Regulation.

But choice is a two-edged sword, according to Sabrina Corlette, project director at the Georgetown Center on Health Insurance Reforms. “Most behavioral economics studies tell us that consumers are overwhelmed by too much choice and make less than optimal decisions as a result,” says Corlette.

Premium increases in 2015 should be modest for most people, and in many cases may decline slightly.

The average premium for a 40-year-old non-smoker who makes $30,000 a year will decline by 0.2 percent next year if he buys the second lowest cost silver plan, according to an analysis by the Kaiser Family Foundation of 2015 marketplace premiums in a major city in 47 states and the District of Columbia. (KHN is an editorially independent program of the foundation.) Individual state rates for this person would deviate substantially from the average, however, from a 28.4 percent increase in Anchorage, Alaska, to a 23.7 percent decline in Jackson, Miss.

The premium tax credit available to people with incomes between 100 and 400 percent of the federal poverty level ($11,670 to $46,680 for an individual) minimizes the effect of premium increases on people’s costs. But subsidies are tied to the second-lowest-cost silver benchmark plan, and in a number of areas that plan will change in 2015. When that happens, people may face substantial premium increases unless they take the time to shop and make sure they’re still in a low-cost plan.

“You may be able to insulate yourself against a big premium increase, but you still need to go in and change plans,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

Consumers who are already enrolled in a marketplace plan and who do nothing during open enrollment this year will generally be automatically re-enrolled in their existing plan for next year with their existing premium tax credit, the federal government has said.

Consumer advocates say doing nothing could be a big mistake. Not only are benchmark plans different, if consumers have experienced changes in income or other circumstances that could affect their premium tax credit, they risk receiving the wrong amount and may have to pay back next year.

People who are already enrolled may not get the best deal if they don’t shop for a new plan, but at least they’ll have insurance. That’s not the case for the estimated 15 million uninsured people who are eligible to buy a marketplace plan. Reaching them is going to be a challenge, experts agree. They’re more likely to be younger, members of minority groups, lower income and less educated, says Anne Filipic, president of Enroll America. The organization’s Get Covered America campaign aims to get enrollment information to people in 11 states with high rates of uninsurance, among other things.

They have their work cut out for them. Nine out of 10 uninsured people said they don’t know when the open enrollment period starts, according to the Kaiser Family Foundation’s October health tracking survey. Two thirds said they knew nothing or practically nothing about the marketplaces, and more than half didn’t know that they could get financial help to pay for their coverage.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.