James Marx, left, helps Jeff Leskosek, right, and Sheri Leskosek sign up for health insurance in a mobile BlueCross BlueShield bus at the Northgate Mall parking lot Friday, Dec. 11, 2015, in Chattanooga, Tenn. Tuesday marks the deadline to sign up for insurance coverage which would begin on Jan. 1st.
polls here 3435Jeff Leskosek isn't happy with the health insurance coverage he is getting, but he and his wife, Sheri, were very pleased with the service at the BlueCross BlueShield of Tennessee mobile health care sign-up trailer, parked in the Northgate Mall parking lot.

"It's efficient," Sheri Leskosek said after spending about 30 minutes Friday with BlueCross BlueShield counselor James Marx, who also manages the outreach trailer.

"It would have taken us longer had we used the computer," her husband added, "because I'm not very computer savvy."

Jeff Leskosek is retired. The couple lost their health insurance a year ago when Sheri left her job as a pharmacy technician at CVS. They signed up with the Community Health Alliance, but the consumer cooperative announced in November that it was closing. It said it had lost too much money and received a much smaller reimbursement than expected from the federal government for selling health plans under the Affordable Care Act.

With BlueCross BlueShield, Jeff Leskosek said, they will be "getting less coverage and paying more. But we had to get something."

The Leskoseks are among a record number of Tennesseans who have signed up on the ACA health insurance exchange ahead of the Tuesday deadline.

Marx said the BCBS trailer has been at Northgate about two weeks.

"It's been pretty steady. And Monday and Tuesday will be crazy," he said.

Some 88,007 Tennesseans had signed up as of Dec. 5, compared to 87,137 who signed up through Dec. 15 last year, according to the federal Centers for Medicare and Medicaid Services. In a conference call with reporters Wednesday, federal health insurance officials said they expect a big surge over the next few days.

"Last year, we saw more than half of enrollees sign up during the final two weeks before the deadline," said Jonathan Gold, press secretary for U.S. Health and Human Services.

A top official at BlueCross BlueShield said her company is pleased with results so far and believes it will again be the top insurer in the state for individuals on the exchange.

"I do believe we will be the market share leader," said Carla Raynor, vice president of strategic marketing for BCBS.

BlueCross BlueShield had about 70 percent of the Tennessee market last year.

The health insurance exchanges were set up as part of the Affordable Care Act, also known as Obamacare. Those without employer-sponsored health insurance can shop for a variety of policies offered by several insurers in every state.

In Tennessee, BlueCross BlueShield is competing with Cigna and Humana, each of which had about 5 percent of the market last year, and UnitedHealthcare, a major player nationally which only entered the Tennessee market this year. The Community Health Alliance, which is closing its doors at the end of the year, had about 20 percent of last year's market in Tennessee.

Raynor said her BCBS is focusing its efforts more on retaining customers from last year.

"One thing we've noticed is that once they have locked into a plan and gotten familiar with how it works, and have gotten used to its doctors, they don't want to change," she said.

For consumers, deciding which plan is best and then figuring out if they qualify for federal subsidies can be a daunting task, Raynor said. BlueCross BlueShield also has focused on providing one-to-one counseling for anyone considering its policies.

"Selecting a plan is deceiving," she said. "You need to look for a doctor, if you have a doctor you prefer, and you need to know what medicines you are taking and where you get them."

The application form for the tax subsidies is also complicated, Raynor said, so "a lot of people want to go in, hand you their information and ask questions, and have the agent take over the application process."

Plan labels reflect benefits and cost, with platinum offering the richest coverage and bronze the lowest.

Raynor said almost 70 percent of the plans consumers are choosing are at the silver level. A few returning customers are moving down to the bronze level, but not a significant number, she said. About 10 percent of consumers are choosing the more expensive gold and platinum plans, typically people with severe medical problems who know their medical bills will exceed their deductibles.

The Tuesday deadline is for those who want their insurance to start by Jan. 1.

Overall, consumers have until Jan. 31 to choose a health insurance plan.

The penalty this year for not having health insurance, either from the exchange or from an employer, goes up to $695 for individuals or $2,085 for a family, or 2.5 percent of income, whichever is higher.

In the Wednesday conference call Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, said he believed consumers were paying more attention to the details of their plan this year, such as which doctors were in their network and what drugs it covered, rather than just choosing the plan with the lowest monthly premium.

He noted that the website now has several tools allowing consumers to check on what services hospitals and doctors in their area offer.

Contact reporter Steve Johnson at, 423-757-6673, on Twitter @stevejohnsonTFP, or on Facebook, stevejohnsonTFP.