NEWS FROM THE DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES
Open Enrollment Starts Tuesday
for Delaware’s Health Insurance Marketplace
Delawareans who seek coverage through HealthCare.gov are urged
to take advantage of subsidies to offset rise in premium costs
NEW CASTLE (Oct. 31, 2016) – The fourth open enrollment period for Delaware’s Health Insurance Marketplace starts Tuesday as the state prepares to build on the progress of the last three years, in which more than 28,000 Delawareans signed up for coverage and the state’s uninsured rate dropped an estimated 35 percent.
The open enrollment period, in which people can renew current coverage or sign up for a new plan for 2017, runs from Nov. 1 through Jan. 31, 2017, at www.HealthCare.gov. Individuals must sign up by Dec. 15 for their coverage to be effective Jan. 1.
The state will formally mark the Health Insurance Marketplace’s fourth enrollment period with a press conference at 1 p.m. Nov. 10 at Westside Family Healthcare’s Bear office, 404 Fox Hunt Drive in the Fox Run Shopping Center off U.S. 40.
In the face of increased cost of premiums, Delaware is making an extra effort this enrollment season to make sure residents who do not have employer-sponsored health insurance or who are not eligible for public programs such as Medicare, Medicaid, and the Children’s Health Insurance Program are aware of the federal subsidies available when they buy private plans through the Health Insurance Marketplace, also known as Obamacare.
“Many people still don’t realize they can get financial help paying for their Marketplace coverage,” said Rita Landgraf, secretary of the state Department of Health and Social Services. “This year, more than 80 percent of Delawareans who have a Marketplace plan are receiving tax credits to lessen the costs of their premiums. I urge anyone who needs high-quality, affordable health insurance to go to HealthCare.gov to shop for a plan, and I encourage those who are already enrolled to go back to the website, update their information and pick a plan that meets their health needs and budget.”
Consumers can go to HealthCare.gov now to check out their options for 2017. Individuals who need help enrolling in coverage will again have access to free in-person assistance from federally funded and trained specialists at several Delaware organizations, including Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center and La Red Health Center.
State-licensed insurance agents and brokers are also available to help individuals re-enroll and to help employers update their coverage, at no extra charge.
According to the U.S. Department of Health and Human Services:
• Sixty-three percent of Delawareans who now have Marketplace coverage could get 2017 coverage for a monthly premium of $100 or less after tax credits, 55 percent could get coverage for $75 or less, and 45 percent could get coverage for $50 or less.
• Sixty-three percent of current Marketplace enrollees whose annual household incomes are between 100 percent and 250 percent of the federal poverty limit (from $11,880 to $29,700 for one person and from $24,300 to $60,750 for a family of four) are receiving financial assistance. Financial help is available for individuals with annual incomes up to $47,520; for a family of four the income limit is $97,200.
• The median annual income of Marketplace enrollees in Delaware is about $25,000 for one person and $51,400 for a family of four.
As in previous years, three insurers will offer Marketplace medical plans in Delaware for 2017: Highmark Blue Cross Blue Shield of Delaware, Aetna Health, and Aetna Life Insurance Company. Across the insurers, they will offer a total of 21 plans for individuals and 11 SHOP plans for small businesses. Two insurers – Delta Dental and Dominion Dental – will offer a collective 15 stand-alone dental plans, 10 for individuals and five for small businesses.
Rates in 2017 will increase an average of 32.5 percent for Highmark plans, 23.6 percent for Aetna Health and 22.8 percent for Aetna Life.
All plans cover essential health benefits such as coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.
Medical plans will be available in three metal-level categories – bronze, silver and gold – based on how enrollees choose to split the costs of care with their insurance company. Bronze plans have low monthly premiums but high costs when you need care; gold plans have high premiums but lower costs when you need care.
Tax credits are especially beneficial to consumers who pick the second-lowest cost silver plan, since the credits adjust to match any changes in premium. In a silver plan, the insurer pays about 70 percent of medical costs and the consumer pays about 30 percent, up to a maximum annual out-of-pocket cap of $6,350 for an individual and $12,700 for a family.
In Delaware in 2017, the average monthly premium for a second-lowest cost silver plan for a 27-year-old non-tobacco user will be $347 before tax credits based on eligibility are applied.
Consumers who pick silver plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance.
Penalty for going without coverage
Individuals who can afford coverage but who choose not to buy it will pay a fee equal to the higher of these amounts: 2.5% of your annual household income or $695 per person ($347.50 per child under 18). The maximum penalty will not exceed $2,085 per household or the total yearly premium for the national average price of a bronze-level plan sold through the Marketplace. In addition to the penalty, consumers will be responsible for the total cost of health expenses they incur.
Consumers can estimate their penalty using the penalty calculator available on ChooseHealthDE.com.
Delaware’s senators and congressman urged uninsured Delawareans to find out what’s available for them on the Marketplace.
“Over the last several years, I’ve had a chance to meet with Delawareans who found affordable health care and peace of mind through the Health Insurance Marketplace,” Sen. Tom Carper said. “With open enrollment about to begin, I strongly urge all uninsured individuals to go to ChooseHealthDE.com to get information about the various health insurance plans available and potential financial assistance they may qualify for to reduce their insurance costs. And because enrolling in health insurance can be overwhelming, there is free, in-person assistance available to help individuals and families. Every Delaware family deserves access to the quality health care they need, and the Marketplace is making that a reality for thousands of Delawareans for the first time.”
“Open enrollment is a great opportunity for Delaware families to shop around in the Health Insurance Marketplace and find a plan that works best for them,” Sen. Chris Coons said. “I would encourage both the uninsured and insured to visit the Marketplace and explore plans and financial assistance that may be available to them. While we have more work ahead to improve the ACA and bring down health care costs, open enrollment is an important opportunity for families to get the comprehensive health care they need, regardless of age, background, or pre-existing conditions.”
Added Congressman John Carney: “Starting Tuesday, Delawareans will have another chance to purchase quality health care coverage for themselves and their families. While we still have work to do to bring down the cost of health care, the Marketplace has made it much easier for many Delawareans to access the care they need. I encourage everyone to take advantage of open enrollment and see what their options are.”
Businesses with 50 employees or fewer can offer plans to their employees starting any month of the year through the Small Business Health Options Program (SHOP). Go to HealthCare.gov or call 1 (800) 706-7893 (TTY: 711).
In addition to the Health Insurance Marketplace, some residents might be eligible for coverage though Delaware’s expanded Medicaid program, which is open year-round. More than 10,000 Delawareans have received coverage under the Medicaid expansion. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.
Delaware’s uninsured population decreased from 83,000 in 2013 to 54,000 in 2015, according to a recent Census Bureau report. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions. Increasing access to health care coverage is the first step toward a healthier Delaware, Secretary Landgraf said. “Through the Delaware Center for Health Innovation, we are striving to ensure that our health care system delivers quality care, produces better health outcomes, reduces costs and enhances the experience of health care providers. Those goals are at the heart of the Affordable Care Act.”
For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office) or (302) 357-7498 (cell).
Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.