Enrollment in Affordable Care Act health insurance coverage sped up last week, the Trump administration said Wednesday, ahead of a Friday deadline that could catch some people by surprise.

More than one million consumers chose plans on the ACA (or Obamacare) exchanges during the week that ended Saturday in the 39 states that use Healthcare.gov. That brought the total since enrollment started Nov. 1 close to 4.7 million, including 206,000 Pennsylvanians and 139,000 New Jersey residents.

The season has been so full of uncertainty — starting with the administration cutting the enrollment period in half, to just 45 days — that enrollment predictions have been hard to come by.

They caution, however, that the one certainty is that if consumers do not act by Friday, they could be stuck for a full year. Some won't have coverage at all. People who are enrolled for 2017 coverage but have not updated their selections through the website for 2018 may find themselves automatically re-enrolled without having reviewed their options to see if something better might be available.

Last year, 2.8 million people were automatically re-enrolled after Dec. 15 but were able to go back onto the site before the final deadline six weeks later to change their plans. Because Dec. 15 is the final deadline this year, the administration has said this will not be an option except in very limited circumstances for people who qualify due to life-changing events (such as marriage or loss of a job that provided insurance).

The number of potential automatic re-enrollments is unknown, and was not included in the statistics released on Wednesday.

Antoinette Kraus, director of the Pennsylvania Health Access Network, which provides help for consumers and will continue to be available until 11:59 p.m. Friday (see details below), said that her organization had enrolled more people statewide in November alone than during last year's entire three-month open enrollment season. But she attributed that activity to consumers needing more help with enrollment due to all the conflicting information they'd heard.

Among the questions she and others are getting:

  • Is Obamacare dead? No. Republicans would like to kill it but have not succeeded.
  • Will the requirement that that most Americans have health insurance or face a tax penalty be lifted? For now, it is still the law of the land. A repeal may be included in tax reform now working its way through Congress, although Tuesday's Democratic victory in Alabama's race for the U.S. Senate could give Republicans less room to maneuver.
  • Are subsidies still available? Yes, and those whose income qualifies them may see better deals than in the past.  The Trump administration cut subsidies to insurance companies, and insurers raised rates to make up the difference. Premiums rose sharply — and that made the subsidies go up for individuals who make less than $48,000 a year and a family of four that earns less than $98,000. But people who make more than that will face much higher premiums if they seek individual policies on or off the exchange.
  • When is the final deadline to sign up? The official deadline is Friday at midnight, although Healthcare.gov is expected to continue working until 3 a.m. Eastern time (when it will be midnight on the west coast). The Obama administration sometimes extended its final deadline for people who had started enrolling when the deadline hit. But the Centers for Medicare & Medicaid Services under President Trump have not responded to questions about how they would respond to last-minute issues, including the site slowing down or crashing due to heavy use.

"Consistent with our aim to have a seamless open enrollment experience for consumers this year, the website is performing well and consumers can easily access enrollment tools to compare plans and prices," a CMS spokeswoman said in an email.

The agency released a list of 21 organizations around the country that are empowered to enroll consumers through their sites as if they were Healthcare.gov. But consumers should check to see that the site they use sells all plans that are available in their area, not just those of a single company. Consumers who don't qualify for subsidies should be especially careful to consider plans available both on and off the federal exchange, as the rate structures may differ.

Insurers such as Independence Blue Cross, which is the only company to offer individual market plans on the exchange in Southeastern Pennsylvania, can also arrange for income-qualified subsidies for their plans.

Although the administration has not indicated how it would deal with consumers who get caught up in potential glitches on Healthcare.gov, advocates suggest taking no chances.

"Consumers should print or save a screen shot as evidence they were unable to complete an application, should this happen.  This may help them to appeal their denial of coverage," said Maura Collinsgru, health program director at New Jersey Citizen Action, which posts resources and information about where consumers can find help.

Where to find last-minute enrollment help

The best, all-encompassing website is www.healthcare.gov (1-800-318-2596).

Additional help may be available from federally funded "navigators" and from the insurance companies themselves.

Be prepared with:

  • Recent income information (pay stubs, benefit letters, tax returns, etc.)
  • State-issued photo ID or driver's license (if you have one)
  • Birth dates and Social Security numbers for every household member needing coverage
  • Any immigration documents for applicants who are not a U.S. citizen
  • Information about any health insurance you have

Southeastern Pennsylvania

  • By phone (1-877-570-3642) through 11:59 p.m. Friday.
  • In person: Thursday and Friday, 9 a.m. to 9 p.m., Friends Center, 1501 Cherry St., online signups appreciated but walk-ins accepted.

Other navigator organizations statewide

Independence Blue Cross
 
(IBC plans only):
IBC is the only insurer selling individual market plans in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

  • By phone (1-888-475-6206) from 8 a.m. to 10 p.m. through Friday.
  • In person: Daily through Friday, 10 a.m. to 6 p.m.: Independence Express truck at Bala Cynwyd Shopping Center
  • In person: Daily through Friday, 8 a.m. to 5 p.m.: Independence LIVE at company headquarters, 1919 Market St., second floor.

South Jersey

  • By phone (1-877-922-2377) through 7 p.m. Friday. This is an automated line. Someone will call you back.
  • By phone (1-844-277-8219) from 8 a.m. to 10 p.m. through Thursday, till midnight Friday.
  • In person: Horizon Connect Retail Center at East Gate Square, Moorestown, from 9 a.m. to 7 p.m. Thursday and Friday.

AmeriHealth New Jersey (AmeriHealth plans only)

  • By phone (1-888-879-5331) 8 a.m. to 10 p.m. Thursday and Friday.