Health-care counselors help clients navigate the second round of open enrollment for the Affordable Care Act in Manassas, Va.

Nancy Sobin knows her way around paperwork. She started her own business three years ago, helping small business owners and elderly clients manage their finances. That's when she turned to the Obamacare exchanges for health coverage.

"I was fortunate enough, because I was just starting my business, to get a subsidy … and it was pretty good insurance" for about $300 a month, said the owner of Professional Paperwork Services in Lawrenceville, New Jersey.

But as her business improved, her insurance options changed last year.

"I didn't get the subsidy anymore, because my business went well," Sobin explained. So, she switched plans to "the least expensive one I could get — and it was $750 a month."

With the Nov. 1 start of 2019 open enrollment on the Affordable Care Act exchanges, the New Jersey native says it looks like she may have to change coverage again.

"My same plan looks like it's going to be about $150 more per month" in 2019, or $900, she said.

Yet, she may find savings if she switches plans again. President Donald Trump's administration says on average prices for 2019 are 1.5 percent lower than they were last year on the federal health exchange, healthcare.gov.

After years of regulatory uncertainty which led to double-digit price hikes on exchange plans, health insurers are starting to turn a profit on the ACA exchanges. For 2019, there are more carriers getting back into the market and offering new plan options.

"Our view is (that) the marketplace for the individual exchange business is more competitive in 2019 than it has been ... there's more competitors entering the space," said Cigna CEO David Cordani on the company's earnings conference call Thursday.

Cigna is expanding its exchange footprint to a seventh state for 2019, returning to the Arizona market and saying that it is on track to make a profit on its ACA plans this year.

Six-year-old start-up Oscar Health is also expanding into Arizona, and will be offering plans in Michigan and Florida for the first time, bringing its exchange footprint to nine states.

"This is a special open enrollment for us. We feel great about going into more markets," said Oscar CEO Mario Schlosser. "We increasingly are in the markets that have found stability."

A big reason for more stability in the exchange open enrollment was the pause this year in the GOP's legislative push to repeal Obamacare. Still, one big change could prove disruptive during this fall's open enrollment period, which runs through Dec. 15 on the federal exchange.

The Trump administration extended the length of cheaper, short-term plans with fewer benefits to provide up to 12 months of coverage. Some analysts predict those cheaper plans could attract healthier members.

Online insurance brokerage eHealth boosted its staffing this fall to help consumers navigate all of the new alternatives. CEO Scott Flanders says for those who receive subsidies, Obamacare remains the best option. But for those who earn too much to qualify for tax credits, the new plans could be a viable alternative.

"UnitedHealth is coming with some really innovative products for the individual short-term market ... so there's just a lot more choice," Flanders said. "Now, the negative to that is there's more complexity."

He says that will make it even more important for people to shop and compare their options this year. Short-term plans are cheaper because many come with coverage limits and can deny coverage for pre-existing conditions.

Sobin says it's important to do your homework. She's glad she did after considering a short-term plan that claimed her doctors would be covered in-network.

"I called my doctors, and they said they don't take those plans," she said. "It would have been a good savings, but I don't really trust that it would have covered anything."

Another factor that could be disruptive in 2019 is the repeal of the ACA individual mandate penalty. Americans won't have to pay a fine for being uninsured, as a result of the GOP tax plan.

It could lead to even lower enrollment for younger people, but insurers say they're confident people will still sign up.

"Members in this market have started to become educated to the point where they realize it isn't just about premiums, it's about the service you get," said Schlosser.

Polls show health-care affordability remains a top campaign issue for most Americans.

Flanders says it may be good for the health insurance market if Democrats take the House and the Republicans keep control of the Senate after the midterm elections Tuesday.

"I don't think it's realistic to expect major legislative change heading into 2019 … so we think we'll have a more stable environment over the next two years," he explained, "and predictability is good for the private sector, because then they can make plans."

— Follow Bertha Coombs on Twitter: @coombscnbc

