Health exchanges are hitting the market next year as required under the Patient Protection and Affordable Care Act has many wondering how they are going to change the health insurance world.

That is, if they are even aware of the changes coming down the line. According to a survey by CVS Caremark, 78% of people that are eligible for new coverage have not heard of a health exchange.

“There’s so much involved and so many layers to this health0care reform it’s not a big surprise people don’t understand what’s going on and how it will impact them,” says Carrie McLean, senior manager, customer  service and  retention at eHealthInsurance. “Health and Human Services is giving people the impression that buying health insurance in 2014 will be like buying a book on Amazon. But it’s not like buying Harry Potter. It’s a very personal decision.”

McLean says her website fields thousands of health insurance related calls every day from new and existing customers, and many of them focus on how reform impacts their care and coverage.

Here’s a look at the top four questions eHealthInsurance customers have when it comes to understanding the president’s health-care reform.

Question No. 1: Why am I being declined for health insurance?

One of the big aspects of health-care reform is that no insurer will be able to decline a person because they have a preexisting condition. But that rule doesn’t go into effect until Jan. 1, 2014.

Many people wrongly correlate the reelection of President Obama with every aspect of health-care reform becoming active, says McLean. Patients needing coverage should start shopping for their plan on Oct. 1 during the open enrollment period. “Open enrollment is the one chance to get your individual or family plan. If you don’t enroll during that time you can’t get insurance unless there is a qualifying event such as divorce or loss of employer coverage."

Question No. 2: How much will new health insurance plans going to cost?  

The cost of health care reform continues to be a major issue. Although many Americans will pay more for health insurance if they aren’t eligible for subsidies, McLean says exactly much more won’t be known until this summer when insurers start publishing their plan rates.

According to McLean, those who make less than $45,000 as an individual or $92,000 as a family will qualify for government discounts.

Question No. 3: I have a preexisting condition, will I pay more?

According to McLean, instead of rates being based on preexisting conditions, insurers will base them on a customer’s location, age and smoking habits.

“Somebody older cannot pay more than 3X the price of someone younger.” Currently, an older person can pay 5X-10X more than someone who is younger and healthier, she adds.

Question No. 4: What will happen to my existing plan?

Insurance plans are going to change for many people in 2014 unless they have a plan that is grandfathered in, in which case it will stay largely the same. A

McLean says those with a plan purchased prior to March 23, 2010 aren’t likely to see many changes. “The best thing is to check with your carrier or employer. Grandfathered plans will be subject to some of the affordable care act rules but not subject to all of them.”