REGIONAL – And here we are in the fourth full year of the Affordable Care Act, of which so much has been said, often by people with very little real information. The act was passed in 2010, and one key point of intended reform was to promote price competition via health insurance exchanges. This allows consumers to actually know and understand what they're buying, which very few people did pre-ACA. Now, benefits are normally comprehensive and comprehensible, not hidden behind stultifying, sometimes bogus language.

A second key point was to halt the decline in the percentage of the American population who had any health coverage at all. Under the ACA, about 20 million people have gained coverage. Under the pre-ACA situation, people who were self-employed, or worked in very small businesses, were fairly harshly discriminated against. The new law has ended that.

There are still people in America who are not covered by the ACA. They include between 8 and 10 million illegal immigrants, as well as young, healthy people who have chosen, so far, to opt out. Then there are citizens in states that opted out of Medicaid expansion for political reasons. We should note that illegal immigrants, who do not pay for health care, are still eligible for emergency services under the 1986 EMTAL Act, under which health care providers may not turn away anyone seeking emergency care.

But... say you DO have insurance. The most important thing to note right now is that if you had "marketplace" (i.e. the Obamacare individual plan) health insurance in 2014, your coverage ceased on December 31. For your new coverage, whether you stayed with your old plan or go for a new one, the open enrollment period is ongoing right now and continues until February 15. That's the deadline, unless you qualify for a Special Enrollment Period, which is activated by something like a marriage, or birth of a child or loss of employer-provided health coverage.

For many people with employer-provided healthcare plans, no matter the size of one's payment, one must also be filing paperwork now on whether you're continuing or changing whatever plan you're with.

In our region the list of companies offering individual plans is starting to look pretty strong. Ulster County has seven, Sullivan has six and Orange County, nine. Some companies are in the market in all three, such as Empire Blue Cross Blue Shield and Health Republic.

You can change your health plan right up to February 15 and your coverage will begin on March 1. If you were automatically enrolled in your old plan, you're covered from January 1, and will be until your new plan takes effect.

As before, your choices in plans come in four bands, marked by cost and degree of care — Platinum, Gold, Silver and Bronze. Also, as before, In Person Assistors or "navigators" can be contacted to help with enrollments and guide you through the process. All the necessary information can be found at the nystateofhealth.ny.gov website.

Bronze plans will cover about 60 percent of your health care costs, leaving you to pay for the rest. Silver would handle 70 percent, Gold 80 percent and Platinum 90 percent.

If you meet the income requirements you can qualify for government subsidy to pay for your health insurance. When you shop for a health plan on the insurance provider websites you will find a calculator to assist in calculating your subsidy. Generally speaking, most people are pleasantly surprised by the final figure, achieved via subsidy, through the health care exchanges.

It has been noted that the market for health insurance in New York and California has become much more competitive since 2012. In New York State there were some dramatic changes in market share during 2013. Before the ACA, Wellpoint had 28 percent of the market for individuals. That shrank to 18 percent of the Exchange market. Even more dramatic was the collapse of United Health's share from 20 percent pre-ACA to just 2 percent of the Exchange market, mostly due to higher prices.

Meanwhile, new entrants to the market, Health Republic with 16 percent, Fidelis Care with 14 percent and MetroPlus Health with 11 percent, have sprung to life with vigor. So did MVP, which had just 2 percent of the individual market before and rose to 10 percent.

Chalk it all up to market dynamism, exactly what the ACA promised, and what the opaque, stodgy, pre-ACA market lacked.

Final note, choosing to do without health insurance will also get more expensive this year, rising to either $325 per adult, $162.50 per child or 2 percent of your income, whichever is higher.

Just remember: February 15 is coming on fast!