If Oct. 1 isn’t marked on your calendar, do it now. It promises to be one of the biggest milestones in U.S. health care reform.

That’s when open enrollment begins for the new health insurance marketplaces created by the Affordable Care Act. The marketplaces, often referred to as state insurance exchanges, will let individuals and small businesses shop online for health insurance from a variety of private carriers.

Different levels of coverage—nicknamed platinum, gold, silver and bronze—will be available. But all of the plans will have to provide support for hospitalization, prescription medication and other essential services. People with preexisting conditions can’t be denied service.

And small businesses will be part of a larger risk pool, which could help them receive better pricing. Temporary tax credits will be available, on a sliding scale, for companies with fewer than 25 workers whose average pay is less than $50,000 per year.

“A lot of the small business owners are happy because they realize this is going to level the playing field with larger businesses,” said Stephene Moore, the Region 7 director for Health and Human Services.

Yet many other business owners are eyeing the law cautiously, or with deep reservations. There are still some unknowns about the marketplaces and exactly how much the plans will cost. And it’s not clear yet when the general public will learn how much coverage costs in the marketplaces operated by the federal government. (Some states that will run their own exchanges have started to release their plan information.)

When Gallup surveyed small business owners in April, 55 percent of respondents said they expect to pay more for insurance as a result of health care reform.

About 48 percent said they believe the Affordable Care Act will hurt their business. The second-biggest group—39 percent—don’t expect any change. Only 9 percent believe the law will benefit them.

“The ACA will have a big impact on insurance prices, we believe,” said Dan Murray, the Kansas state director for the National Federation of Independent Business. “It will not help to stop the growth of health insurance. It’s probably going to contribute to the increasing cost.”

The Ground Rules

There are actually going to be two different marketplaces in each state: one for individuals and one for small businesses with fewer than 50 employees. That program has been dubbed the Small Business Health Options Program, or SHOP. Small business owners will be able to choose how much they contribute to employees’ coverage.

Eventually, employers will be able to let workers pick from multiple plans from multiple companies. Earlier this spring, though, the federal government announced that this option won’t be available until 2015 in the marketplaces it operates.

Nobody will be forced to use the marketplaces. It will still be acceptable to buy insurance through a private broker.

If your company employs fewer than 50 full-time workers or full-time equivalents, you won’t be required to provide health insurance at all. And the federal government has decided to delay for one year the “employer mandate” that would require companies with 50 employees or more to offer coverage or pay a penalty. (Read more about that decision here.)

Weighing the Costs and Benefits

Will the marketplaces help or hurt small businesses? A lot of that will depend on your particular situation, said Karen Pollitz, a senior fellow with the Henry J. Kaiser Family Foundation.

Historically, insurers have been allowed to charge small businesses more based on the health experiences of their employees, Pollitz said. If an employee suffered a heart attack or experienced a premature birth, for example, their employer could expect rates to rise—dramatically, in some cases.

At the end of the year, though, insurers won’t be able to consider that when they set rates. Instead, they’ll use a methodology called modified community ratings for companies with fewer than 50 employees, said Ron Rowe, Blue KC’s department vice president of small group and consumer market products. Those ratings will factor in general age groups and a few other considerations—but not prior claims or utilization.

Companies with an older workforce or one that has filed some expensive claims could see their premiums decrease.

“Small businesses that have mostly young and healthy employees who never make claims?” Pollitz said. “They’re going to move more toward the average.”

In other words, they need to be prepared for a jump in their health care costs, at least for 2014.

The upside, Pollitz said, is that prices shouldn’t be quite as volatile in future years. One of the major frustrations for business owners is that they never knew exactly how much their coverage was going to cost from year to year. Under the Affordable Care Act, the rise in premiums should more or less reflect increases for the entire health care industry.

And the online marketplaces should make it easier for customers to shop for plans.

“They’ll all display information about health plans in uniform ways that’ll make it easier to compare across different plans and see what the differences are,” Pollitz said.

Having a centralized, transparent marketplace—one where users can easily compare options—can be a good thing for consumers, the NFIB’s Murray said. Just ask anybody who has ever used Travelocity or Expedia.

But requiring that plans include certain benefits limits insurers’ ability to control their prices and limits their ability to respond to the market, he said.

“We’re concerned with anything we see taken over by the state or federal government,” Murray said.

Will Businesses Do Business with the Marketplaces?

Will small businesses use the new marketplaces? A lot of local companies say they plan to avoid them, at least in 2014, Rowe said. Part of that’s because SHOP won’t offer the multiple-plan option in most states. And many entrepreneurs want to see how everything shakes out before they commit.

“Most small employers are really in a wait-and-see mode,” said Rowe, who expects the marketplaces for individuals to be very active this fall.

There’s evidence that some small businesses will continue to stick to the private market, regardless. In Massachusetts, which passed health care reform in 2006, a lot of small businesses have continued to buy coverage through agents and brokers, Pollitz said. Some owners might prefer to work with agents because of long-standing relationships, customer service—or just because that’s how they have always done it.

And while the federal government is offering tax credits to help some small employers provide health insurance, those tax credits will go away in a few years. (The subsidies for individuals, however, are not scheduled to sunset.)

Is it possible that some small business owners will simply throw up their hands and end their employee health plans? There have been a few high-profile cases in the national media, but that doesn’t appear to be the case in Kansas City for now.

Employee health insurance is one of the first things that potential hires ask about, said Eric Kesselring, vice president at Axcet HR Solutions. To compete with bigger firms, most companies realize they have to have a health plan.

“If they’ve been providing health benefits, they’re not thinking about scrapping those plans and going to the exchanges when they’re available,” Kesselring said.

The Decision That’s Best for You

The marketplaces’ enrollment window will stay open through March 2014, Moore said. In future years, that timeframe will shrink, but officials wanted to provide extra time early in the process.

Some people might need that. Health and Human Services has worked to publicize the Affordable Care Act’s ins and outs, but there is still a lot of misinformation in the community, she said. That’s why the federal government is planning a major public information campaign in September.

Officials are spending the summer testing their toll-free support hotlines and relaunching HHS’s healthcare.gov, which has published a wealth of information about health care reform. In fact, to get ready, Moore recommends that small business owners review a checklist offered at www.tinyurl.com/7tipsforsmallbiz.

Ultimately, business owners need to review their own situation, talk to their advisers and make the decision that works best for them and their team.

“There’s a big analysis that needs to be done by each employer with their own specific case,” said Rowe.

The Struggle to Provide Health Care

Fewer U.S. workers get health insurance through work than they did a decade ago.

The number of nonelderly Americans with employer-sponsored insurance declined from 69.7 percent in 1999-2000 to 59.5 percent in 2010-11, the Robert Wood Johnson Foundation noted in a study released this spring. (Missouri and Kansas saw drops of 12.4 and 9.9 percent, respectively.)

It’s been even tougher for the smallest companies. Between 2002 and 2008, the number of companies with three to nine employees offering employee coverage dropped from 58 to 49 percent, according to a report from the President’s Council of Economic Advisers.

The high cost of care appears to be a major driver. The average annual premium for single coverage went from $2,490 in 1999-2000 to $5,081 in 2010-11. And family plans shot up 125 percent during the same period, from $6,415 to $14,447, the Robert Wood Johnson Foundation reported.

Who’s Running the Marketplaces?

That depends on where you live. In 26 states, including Kansas and Missouri, the federal government will operate the marketplaces because the state government either wasn’t able or wasn’t willing to create their own. Iowa, Illinois and five other states will run their marketplaces in partnership with the feds. The other states will operate their own on their own.