Pablo Martinez Monsivais / AP

When Donald Trump signed an executive order last week to reform health care by destabilizing the market for individual insurance, various thought leaders likened the measure to a wrecking ball. With Congress repeatedly deadlocked over repealing the Affordable Care Act, Trump laid out an independent plan to cut subsidies while creating cheaper policies with fewer benefits and protections.

Consumers have a lot of questions and concerns about the process of purchasing affordable health care, just in time for open enrollment. It starts on Nov. 1 in Nevada, where about 89,000 people already are covered through the Silver State Health Insurance Exchange.

“We have seen (enrollment numbers) increase each year,” said the exchange’s communications officer, Janel Davis. “We are seeing a need for these plans.”

The biggest changes to keep in mind

IF YOU ARE UNDER 30 AND HEALTHY: Anthem will still offer a catastrophic insurance plan. Davis said these plans are considered unattractive because of the high deductible.

1. There are fewer options compared with last year.

“People might expect there to be four or five options,” Davis said, explaining that Prominence Health Plan recently withdrew from the exchange and that Anthem Blue Cross Blue Shield essentially will at the end of December, citing market volatility and uncertainty about the federal framework.

Remaining providers are Health Plan of Nevada and Missouri-based Centene Corp., known here as SilverSummit.

2. The enrollment window was cut in half, closing Dec. 15.

Previously, the window was 90 days. “Having a shortened time is really concerning,” Davis said. “It’s already going through the holiday season, when people are busy enough.”

During those 45 days, the portal will stay live except for 12 hours each Sunday (excluding Dec. 10).

3. You might not get as many reminders as you’re used to.

On a national level, funding to market open enrollment and healthcare.gov was decimated this year — Davis said the budget was $100 million before a directive from the U.S. Department of Health and Human Services slashed it by 90 percent.

To counter that, the Nevada exchange is expected to spend $3.2 million on advertising and outreach, covering direct mail and email campaigns. “Despite many hurdles, the exchange is aggressively messaging our ability to help Nevada consumers navigate the confusion and connect to qualified health plans and financial assistance,” she said.

Plan to halt subsidies that cut costs for consumers

After this year, the government will cease paying carriers to lighten the load on consumers. Under the ACA, paying insurers to alleviate copays and deductibles for lower-income people is called cost-sharing reduction, but a statement released by the White House last week called it a “bailout of insurance companies through ... unlawful payments.”

About 80 percent of enrollees in the Silver State Health Insurance Exchange received some sort of subsidy, but Davis said the state anticipated this move.

“In Nevada, our Division of Insurance commissioner assumed the (cost-sharing reductions) would not be paid and therefore approved adjusted rates, allowing carriers to factor in the loss,” she said. “Consumers need to understand that when rates increase, so does the amount of financial assistance. This means the impact of rate increases will be minimal for most exchange consumers.”

Frequently asked questions

Insurance brokers can answer complicated questions about picking the best plans for individuals or families.

Chris Carothers has been in the business for 26 years, and with just 45 days to plug thousands of Nevadans into the exchange, he says anxiety is high. He plans to have brokers stationed at the Galleria at Sunset mall during open enrollment. In addition to providing information, they can act as advocates for those seeking care.

Here are some of the top questions Carothers has been hearing:

Q. What happens if people go from a preferred provider organization (PPO) to a health maintenance organization (HMO)?

Having a PPO means people can choose their preferred doctor or specialist. If they have an HMO, they have to go to a primary care physician before they can see a specialist. “The good thing about an HMO is oftentimes, people don’t even know what kind of specialist they need,” Carothers said. “In many cases, they can go to a primary care physician and just get what they need.” If people with a PPO plan were seeing a specialist and then switched to an HMO plan, they would still have to go through their primary care physician before they could go back to that specialist.

Q. What happens if someone’s plan leaves the marketplace?

The 25,000 Nevadans covered by Anthem are likely asking this. Carothers said if people had an Anthem plan and did nothing, they would be shuffled over to a new, similar plan. “But we don’t want you to do nothing,” he said. Just because a person gets matched to a similar plan, doesn’t mean all their medications, doctors or copays would be available. He advised exploring the new options and making updates when re-enrolling.

Q. What is a broker’s best advice?

When you go to a doctor, never ask if they take your insurance. “The magic words are, ‘Are you a contracted provider with my insurance?’ ” Carothers said. The subtle difference can result in a costly, and oftentimes unnecessary, medical bill.

Where to get help and more information

The state-run marketplace to purchase health insurance can be found online at nevadahealthlink.com

FOR IMMEDIATE ASSISTANCE

• Call: 855-768-5465

• Email: [email protected]

Questions can be about anything, such as technical difficulties with the website or the nuances of the rate structure.

Quick questions/comments

• Tweet @NVHealthLink using #HealthLinkHelp.

In-Person Assistance

On nevadahealthlink.com, find insurance advisers in your area trained by Nevada Health Link and certified by the Nevada Division of Insurance. Click the box at the bottom of the homepage that says “Get In-Person Assistance” and enter your ZIP code when prompted. These advisers take two forms:

NAVIGATORS

Responsible for outreach, education and to help people enroll or re-enroll in the exchange. Locally, certified navigators are:

• St. Rose Dominican Dignity Health, 2651 Paseo Verde Parkway, Suite 180, Henderson; 702-616-4904

• State of Nevada Office for Consumer Health Assistance, 555 E. Washington Ave., Suite 4800; 702-486-3587 (toll-free at 888-333-1597)

IN-PERSON ASSISTER

Responsible for outreach to underserved communities and education about such aspects of the exchange as eligibility, insurance terms and ways to purchase. Locally, certified assisters are:

• Asian Community Resource Center, 1820 E. Sahara Ave., Suite 210; 702-984-0015

• Consumer Assistance & Resource Enterprise, 3230 S. Buffalo Drive, Suite 107; 702-836-9033;

• Three Square, 4190 N. Pecos Road; 702-644-3663 (ext. 377) or 702-765-4030

• FirstMed Health and Wellness Center, 400 Shadow Lane, Suite 106, 702-731-0909; 3343 S. Eastern Ave., 702-731-0909

• Hope Christian Health Center, 4357 Corporate Center Drive, Suite 450; 702-644-4673

• Nevada Health Centers – Las Vegas, 1799 Mt. Mariah Drive; 800-787-2568.