PITTSBURGH (KDKA) — The fourth open enrollment period under the Affordable Care Act began Tuesday.

While the administration makes a big push, it could be a tough sell for people in certain states where major health insurers have pulled out of the exchange.

Limited selection is one of the hurdles Pennsylvanians will face when buying or switching plans on healthcare.gov. Aetna and United Healthcare will not be part of the online marketplace in 2017.

People must now find coverage with either Highmark or UPMC.

“What it does is it leaves our people in western Pennsylvania exposed to a fight between health systems that would ideally be collaborating in many ways to make it easier on all of us,” said Ken Segel, the managing director of Value Capture.

Segel says the upside to fewer selections is more government subsidies, which will help bring down higher premiums.

“Of the 400,000 people who were on the marketplace last year in Pennsylvania, 78 percent got help affording the plans at an average of about $300 a month,” said Segel.

Besides money, matching is the other big thing to research ahead of time. Before signing on with a new provider, Segel says to be sure the doctors you want to see will be covered under your new network.

Shari Prichard lives in Ohio and can no longer have her Pittsburgh doctors covered.

“Some things are going to have to change because citizens can’t, I mean in the Steubenville area, the local hospital is not a trauma center,” she says. “So if you have a trauma, you’re [flown] to the Pittsburgh market. If that happens, you are looking at out-of-network deductibles.”

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Bruce Barnes likes the concept of the federal healthcare law, but says he thinks the mechanism still needs work.

“I’m not directly affected by Obamacare, but anytime you start a program it’s not going to be perfect. You’re going to have to tweak it and adjust it until it meets our purposes,” said Barnes.

“We need our leaders to put together another solution to make sure that health plans want to be serving folks that need healthcare coverage,” added Segel.

If you need to enroll, Segel says do yourself a favor and get started now.