The law forbids insurance companies from turning away clients and also limits how much more they can charge someone because of age. They can vary premiums based on whether a person is a smoker, and on geography, but that’s about it. So instead, many will limit where customers can get care.

“Narrower networks are less expensive,” Jost says. “It really gives the plans more bargaining power. They can say ’if you can give us a discount , we’ll give you patients.'”

People will squeal, but studies show that the care is just as good for most people using a narrow network of doctors and hospitals as those who have more choice, Jost says. But Corlette, of Georgetown’s Health Policy Institute, says it’s a question that remains to be answered, especially in states with few insurers.

Corlette predicts renewed focus on whether insurance coverage is working as intended or as expected. “Insurance is supposed to provide financial security and peace of mind. Are these new plans providing that?” she asks. “And, people who haven’t had insurance before may get a surprise hit from things like deductibles, in-network vs. out-of-network, pre-authorization, coinsurance and co-payments.”