Just over 43,400 Louisiana residents have signed up for health care coverage next year under the Affordable Care Act, nearly a quarter of last year’s total so far, with experts saying many are either dragging their feet, confused by changes or shopping around to avoid increased costs.

“They (consumers) are waiting until the last minute. They’re being worked, it’s just not happening (enrollment) as quick as people think it’s going to,” said B. Ronnell Nolan, president and chief executive officer of Baton Rouge-based Health Agents for America. “Or people just can’t afford it.

The enrollment figure in federal Health Insurance Marketplace plans is as of Nov. 28. Consumers have until Dec. 15 to enroll if they want their coverage to begin on Jan. 1. Consumers who had a plan in 2015 and don’t pick another by Dec. 15 will be automatically re-enrolled, according to the U.S. Department of Health and Human Services.

Open enrollment ends Jan. 31, but consumers who wait until then to enroll won’t have coverage start until March 1.

A year ago, 186,277 Louisiana residents either picked plans or were automatically re-enrolled in health plans under the Affordable Care Act, often referred to as “Obamacare.”

Nolan said the low first-month enrollment numbers appear to be the result of a combination of factors. The premiums for individual coverage are expected to increase an average of 6.4 percent to 29.5 percent in Louisiana. Despite that, HHS says 82 percent of Louisiana enrollees can find a plan for $75 or less a month after tax credits.

However, a number of consumers have complained their premiums have doubled, while their out-of-pocket costs have also jumped. Those kinds of increases weren’t supposed to happen under the Affordable Care Act, which ties consumers’ share of the premium to their household income. Nolan said while federal financial assistance helps consumers pick up the slack, there is a lot of slack to pick up for 2016 coverage.

Brian Burton, state director of Southwest Louisiana Area Health Education Center, said it’s difficult to compare current enrollment figures to last year’s.

In 2014, open enrollment began Nov. 15 and ended Feb. 15, he said. The president also extended the enrollment period for people who began the enrollment process but didn’t complete it.

Burton said there has been a lot of confusion about how much consumers will see their premiums increase.

Part of the problem is that when insurers sent out renewal notices, the letters showed the increase in premiums but didn’t include changes in the level of federal assistance, he said. Sometimes the renewal notices were for different plans because the insurers had stopped offering the coverage consumers purchased a year ago.

A renewal notice may show the consumer’s premiums increase by $150 a month, but that number is based on the subsidies for 2015, Burton said. So the consumer may actually be responsible for $50.

The center is one of the two nonprofits the federal government is paying to help educate Louisiana consumers about the Health Insurance Marketplace.

Burton expects the 2016 enrollment total will equal the 2015 numbers by Jan. 31. A lot of people wanted to wait until after Thanksgiving to enroll, he said. Others put off paying for coverage as long as possible since coverage doesn’t begin until Jan. 1, even if the consumer pays now. “Every day we see a bigger and bigger pickup of people looking to get it all done,” Burton said.

Many of those consumers are people who didn’t enroll in 2014 or 2015, Burton said. It’s difficult to pinpoint a single cause for the new enrollees, Burton said. Higher penalties for forgoing coverage — the higher of $695 for adults or 2.5 percent of their income — are one possibility. Meanwhile, Nolan said many consumers may not have enrolled because they expect to be automatically re-enrolled in the same plans.

That may not be the best idea, Nolan said. She advised consumers to review their plans to get the best deal. Health and Human Services Secretary Sylvia Burwell has advised consumers to shop.

For 2016, shopping would allow 75 percent of returning HealthCare.gov consumers in Louisiana to save an average of $788 in premiums before tax credits for a plan in the same level of coverage.

Follow Ted Griggs on Twitter, @tedgriggsbr.