Free one-on-one counseling saved Delawareans $1.5M in 2022

As Medicare Open Enrollment approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information update. From October 15 to December 7, consumers can join, switch, or drop a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan. DMAB’s free, confidential, unbiased one-on-one assistance can help residents determine if making a coverage change is the right choice. In 2022, the team completed 5,123 counseling sessions, saving beneficiaries a combined $1.5 million.

When selecting 2024 coverage, there are important changes to keep in mind. Extra Help is expanding to offer full subsidy benefits to those up to 150% of the federal poverty level, allowing more people access to $0 premiums for coverage and fixed prescription copays. Additionally, those with Medicare Part D who fall into the catastrophic phase of their benefits will no longer have to pay 5% coinsurance for covered drugs during that period of coverage. And, on July 1, 2024, CMS will institute a new cap on Part B payment amounts for new biosimilars when average sales price data is not available.

2023 Medicare changes will continue into the new plan year. As of July 1, people with Traditional Medicare who take insulin through a traditional pump pay no more than $35 a month for their supply, and deductibles do not apply. Free vaccine coverage has expanded, and as of April 1 persons with Part B have lower coinsurance for drugs whose price increased faster than the rate of inflation.

“Delaware’s Medicare Assistance Bureau provides consumers with the education and empowerment they need to find the coverage they need at a cost they can afford,” said Insurance Commissioner Trinidad Navarro, who reminded residents to be smart shoppers this enrollment season.

“Part of being a smart shopper is knowing what to ask, and where to find trustworthy answers,” shared DMAB Director Lakia Turner. “There is no shortage of marketing during Open Enrollment, and bad actors may disguise themselves by offering information about changes for 2024. Our team can help you cut through the noise by answering your questions and identifying the best plan for your needs.”
In addition to scheduled phone and virtual appointments, DMAB is offering weekly appointments at all three Department of Insurance offices from October 17 to November 30:

• Tuesdays from 9:30AM-3:00PM at 503 Carr Road, Suite 303, Wilmington DE 19809
• Wednesdays from 9:30AM-3:00PM at 28 The Circle, Suite 1, Georgetown, DE 19947
• Thursdays from 9:00AM-3:30PM at 1351 West North St., Suite 101, Dover, DE 19904

Top Tips for a Successful Medicare Open Enrollment

1. Know that enrolling in a Medicare Advantage plan means it becomes your primary coverage. Original Medicare will no longer pay for services. You will receive a new ID card from the new plan, and should store your Original Medicare card in a safe place.
2. When moving from Original Medicare to a Medicare Advantage plan, be prepared to pay both a monthly Medicare Advantage premium and a monthly Medicare Part B premium.
3. Medicare Advantage plans do not automatically give you “more money in your Social Security check every month.” To qualify, you must be eligible for the Medicare Savings Program by having an income below Medicaid limits.
4. Check that additional benefits, like dental, vision, hearing, fitness, or over-the-counter medications are actually accessible if offered. Some network providers of these services may be farther away than anticipated, including in neighboring states, so only factor them into your decision if you feel they are usable.
5. Know that premium costs aren’t the only out-of-pocket costs you may face. Medicare Advantage plans may have co-pays or cost-sharing that differ from Original Medicare.
6. Call your preferred healthcare providers and facilities to understand if your prospective plan contracts with them. You may experience additional out-of-pocket expenses, service denial, or referral requirements if providers are considered out of network.
7. Check if a prospective plan is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). HMO plans require healthcare to be completed by a provider contracted with the plan’s network, otherwise the consumer will need a referral. PPO plans have both in-network and out of network providers and facilities, with consumer costs differing based on the network. HMO and PPO plans are not Medicare Supplement Plans, and may have out-of-pocket costs each visit.
8. Check if the plan provides Prescription Drug (Part D) coverage that meets your needs.
9. Be aware that in many cases, enrollment locks a person into a plan for the full upcoming calendar year.
10. Scrutinize any contact carefully during Medicare Open Enrollment to ensure it is from a known, credible source. Commercials, cold calls, and other contact may be scams or can provide deliberately misleading information about a plan.

About the Delaware Medicare Assistance Bureau

The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more. DMAB has a Virtual Welcome to Medicare Seminar helpful for new and soon-to-be Medicare beneficiaries and those exploring enrollment changes.

The department does not manage benefits offered to state employees, pensioners, or spouses. While DMAB can counsel Medicare-eligible state plan members, questions about the state’s proposed Medicare Advantage plan or transition, they should first contact the Office of Pensions at 1 (800) 722-7300 and explore their online guide.

Medicare Advantage plans are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

Be aware of non-compliant alternative health plans

Increased competition means more options for Delawareans, employers

For the second consecutive year, Delawareans will have access to increased options on the Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today, with 57 total plans offered by four insurers. In the 2024 plan year, consumers will have the opportunity to purchase plans from Celtic Insurance Company Ambetter Health of Delaware, a carrier new to the state’s marketplace, in addition to plans from Aetna Health, AmeriHealth Caritas, and Highmark Blue Cross Blue Shield of Delaware. As recently as the 2022 plan year, consumers had only one carrier and 12 plan options to choose from.

“Improving healthcare accessibility and affordability across our state is one of my top priorities, and I’m proud that our work has led both options and enrollments to an all-time high,” said Insurance Commissioner Trinidad Navarro. “In addition, our Office of Value-Based Health Care Delivery has confirmed carrier’s filings reflect compliance with our affordability standards, including increasing spending on primary care to lower overall cost of care. We look forward continuing to make progress in this work.”

Nearly 35,000 residents purchased plans on the Delaware Marketplace during last year’s open enrollment. After Advance Premium Tax Credits, premiums averaged $197. Nearly 6,000 residents were eligible for a premium of $10 a month or less. Enrollment numbers are expected to rise as Medicaid redeterminations continue following the end of the COVID-19 Public Health Emergency. A Special Enrollment Period for Marketplace plans is available for persons no longer eligible for Medicaid.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 57 health plans and 12 dental plans are available to Delawareans for the 2024 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Be aware of non-compliant alternative health plans.

Individual Affordable Care Act (ACA) Marketplace Rates Announced

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2024 health, dental, and small group insurance plans were also announced today.

Celtic Ins. Co. Ambetter Health of Delaware’s 24 new plans range in base cost, before premium tax credits or other subsidies, from $378 to $532. Aetna Health (as a PA Corp.) will increase rates by an average of 2%, with base rate for six plans ranging from $414 to $441. AmeriHealth Caritas will decrease rates an average of 4.52%. Base rates for their six Marketplace plans will cost $300 to $416. Highmark requested a rate increase, and an average increase of 3.2% was approved after an initial increase request of 4.9%. Their 18 Marketplace plans have base costs between $274 and $654.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company.

Other ACA and ACA-Compliant Rates
Off-market individual offerings include six plans from Aetna Health (as a PA Corp.), which will increase an average of 2% in cost for the future year. AmeriHealth Caritas will decrease its plan’s rates an average of 4.52%. Highmark’s two off-market plan costs will increase an average of 3.2% after an initial request of 4.9%.

Delta Dental will increase rates by an average of 4.2% for two offered marketplace plans, and one off-market plan. Dominion Dental will decrease ACA premiums by 0.1% on their 10 plans.

Off-market small group plan options will increase for the coming plan year, with rate finalization occurring in October. Rate submissions show 62 plan options offered by six carriers: Aetna Health, Aetna Health (as a PA Corp), Aetna Life, Highmark, Optimum Choice, and United Healthcare.

About ACA Plans
All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care, telehealth, lab services, and more.

Open enrollment for 2024 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances throughout the year, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors.

Find out if you qualify for special enrollment.

Recent reports of misleading comments in response to consumer questions prompt bulletin re-issuance

The Delaware Department of Insurance has been made aware of recent misrepresentations related to the basis for premium changes in consumer-facing communications. In response, the department is reminding agents, producers, and insurers of their obligations to provide full explanations of rate changes to policyholders when asked. Additionally, the department is reissuing Universally Applicable Bulletin No. 1 relating to False or Misleading Representations Concerning How Insurance Rates Are Set in Delaware.

“In order to adjust rates in our state, insurers go through a robust regulatory process during which they have to justify their rates to our team before they are approved,” said Insurance Commissioner Trinidad Navarro. “Consumers deserve understandable and accurate explanations too. And insurers, producers, and agents are required to provide that information by law. We will continue to enforce these provisions that ensure Delawareans are treated honestly and fairly in both the rates they experience, and the explanations they are afforded.”

The Department of Insurance does not set insurance rates, instead, its role is to analyze proposed rate changes against specific, actuarily justified criteria to determine whether rates are fair for both consumers and the insurance industry alike.

18 Del. C. § 2304(2) makes it unlawful to “…[make] any assertion, representation or statement with respect to the business of insurance or with respect to any person in the conduct of the insurance business, which is untrue, deceptive or misleading.”

The bulletin reiterates that when an insured questions a premium change, the Department expects that a full explanation be provided by the company or agent. Industry professionals who offer responses to consumers that are deliberately misleading or claim the department has required the rate change shall be considered to be knowingly violating the statute.

View Universally Applicable Bulletin No. 1

More than 37,500 Delaware agents, policyholders, beneficiaries impacted

Following the receipt of additional data breach reports from insurers, including those related to the breach of the MOVEit file transfer services system used by third-party vendors, the Delaware Department of Insurance is updating this consumer alert and will be updating the online posting as information is received.

Residents who may be agents, policyholders, or beneficiaries of the following insurers should be aware that their personal data may have been compromised, and should watch for contact:

As shared during a June 26 consumer alert, the MOVEit data breach and other data security events trigger Delaware’s Insurance Data Security Act, which in addition to proactive data security measures and other requirements, mandates the following occur:

• Investigation of a cybersecurity event and correction of compromised information systems
• Detailed reporting to the Insurance Commissioner
• Notification to consumers within 60 days, except in cases where federal law or law enforcement agencies require or request modified timelines
  Consumers must be provided credit monitoring services at no cost for a period of at least one year in addition to receiving information regarding freezing one’s credit

Insurance Commissioner Trinidad Navarro encouraged consumers to protect their identities and reassured residents that the breach will be investigated thoroughly. “I take any breach of personal information very seriously, and encourage consumers affected to utilize the identity and credit protection services offered. Our Market Conduct staff, likely alongside investigators across the country, will work to investigate the situation and assess if appropriate safeguards were in place for the handling of data.”

The department worked with the General Assembly in 2019 to pass the Insurance Data Security Act and was one of the first states to implement the National Association of Insurance Commissioner’s model law. The law is an effort to fortify security measures and protect consumer data. It requires insurance companies and their vendors to follow certain data protection and breach protocols, including notification. The department may investigate violations of the Act and levy penalties accordingly.

Consumers should consider freezing their credit report due to the incident.

[Last Update: August 16, 2023 – Insurer and Producer added; Impact counts amended]

Insureds, agents, and beneficiaries should watch for notification

On June 16, PBI Research Services, a third-party vendor for Genworth Financial, disclosed a data breach that impacted the personal information of an estimated 2.5-2.7 million individuals, including about 8,000 Delaware residents. At this time, the company has indicated that the potentially compromised information may include agents, policyholders, and beneficiaries’ data including names, contact information, dates of birth, social security numbers, and policy numbers. Consumers are urged to be vigilant in protecting their data, as beneficiaries may not be aware of policies that contain their information, particularly in regard to life insurance benefits.

This event triggers Delaware’s Insurance Data Security Act, which in addition to proactive data security measures and other requirements, mandates the following now occur:

• Investigation of a cybersecurity event and correction of compromised information systems
• Detailed reporting to the Insurance Commissioner
• Notification to consumers within 60 days, except in cases where federal law or law enforcement agencies require or request modified timelines
• Consumers must be provided credit monitoring services at no cost for a period of at least one year in addition to receiving information regarding freezing one’s credit

Insurance Commissioner Trinidad Navarro encouraged consumers to protect their identities and reassured residents that the breach will be investigated thoroughly.

“I take any breach of personal information very seriously, and encourage consumers affected to utilize the identity and credit protection services offered. Our Market Conduct staff, likely alongside investigators across the country, will work to investigate the situation and assess if appropriate safeguards were in place for the handling of data.”

The department has received a relevant policyholder list, including consumers of long-term care, life insurance, and annuities lines, which investigators may use to check company compliance with the Act. Consumer service representatives may also use this information to help concerned agents, policyholders, and beneficiaries who contact the office.

This incident was a part of a significant cybersecurity attack involving the MOVEit file transfer system, with the breach likely occurring May 29-30 before a corrective action was implemented on June 2. The department has not at this time been notified of additional insurer or insured information being accessed as part of this breach.

The department worked with the General Assembly in 2019 to pass the Insurance Data Security Act and was one of the first states to implement the National Association of Insurance Commissioner’s model law. The law is an effort to fortify security measures and protect consumer data. It requires insurance companies and their vendors to follow certain data protection and breach protocols, including notification. The department may investigate violations of the Act and levy penalties accordingly.

Consumers can visit Genworth.com/MOVEit for updates and should consider freezing their credit report due to the incident.