Obamacare's unsubsidized customers face higher prices and doctor changes

Residents in every U.S. county are expected to have at least one insurer to buy coverage from on Obamacare's exchange when open enrollment starts in November, but several difficult decisions lie ahead for customers, particularly those who will not receive any help paying for their premiums.

Those customers are facing significantly higher costs for their policies, and those whose current insurer isn't providing coverage for 2018, whether subsidized or not, likely will have to change doctors and hospitals to make sure they aren't slammed with high out-of-pocket medical expenses.

Solutions to those troubles will be explored by Congress when lawmakers return to the Capitol in September, but already federal data show that 2.7 million of those who will buy coverage on the exchange are facing the prospect of being able to select a plan from only one insurer for next year. Many of the insurers that filled "empty counties," meaning those where insurers initially said they wouldn't sell plans, significantly increased premiums from what customers are paying this year.

Insurers have requested double-digit increases in some states, though the rates still need to be approved by insurance commissioners. The situation could change quickly: A Congressional Budget Office analysis projected that rates would be roughly 20 percent higher if insurers don't receive cost-sharing reduction payments, funds that the Trump administration has not said it would continue and which are mired in both a political and legal battle.

Insurers alternatively could decide not to sell plans in certain counties, causing more people to face the prospect of having only one company to choose coverage from, or none at all.