Delawareans will find more choice in insurers and plans, and continuing enhanced federal subsidies to help with affordability; enrollment runs through Jan. 15, 2023

NEW CASTLE (Nov. 1, 2022) – Coming off a record-breaking year for enrollment on Delaware’s Health Insurance Marketplace, Delawareans seeking coverage for 2023 will find more choice in insurers and plans than ever before, and continue to find enhanced federal subsidies, which began last year under the Biden administration. The subsidies have helped to reduce consumer costs by as much as 40%.

The marketplace’s 10th open enrollment period started today, Nov. 1, and ends Jan. 15, 2023, at www.HealthCare.gov, where consumers can renew existing coverage or sign up for a new plan. Coverage for enrollees who sign up by Dec. 15 and pay their first month’s premium will be effective Jan. 1.

Individuals who don’t act by Jan. 15, 2023, cannot get coverage for 2023 unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, becoming a parent, or other qualifying factors.

This year, Delawareans will have three insurers to choose from vs. only one last year, and a total of 30 plans, the highest total in the 10 years of the marketplace. Insurance Commissioner Trinidad Navarro announced in June that two new insurers – AmeriHealth Caritas (four plans) and Aetna CVS Health (nine plans) – would join Highmark Blue Cross Blue Shield Delaware (17 plan options) in offering coverage on the marketplace for 2023.

In September, Commissioner Navarro announced that Highmark’s rates would increase 5.5% on average. The overall stability of Delaware’s Health Insurance Marketplace reflects continued federal approval of Delaware’s reinsurance program. The program has lowered health insurance premiums for plans sold in the individual insurance market by partially reimbursing insurers for high-cost health care claims through a fund that uses a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. Because the insurers’ claims costs are lower, the insurers can reduce the cost of premiums or limit increases.

During last year’s open enrollment, a total of 32,113 Delawareans enrolled for 2022 coverage on Delaware’s Health Insurance Marketplace, an increase of 26.8% over the previous year.

“All Delaware families need access to affordable, quality health care,” said Governor John Carney. “There are more plans to choose from this year, which will help to make coverage even more affordable. I encourage all Delawareans to look through your options, especially small-business owners, independent contractors and individuals who don’t have access to health insurance through an employer. It’s important we prioritize our health.”

In 2021, the Biden administration made expanding access to health insurance and affordability a priority through the American Rescue Plan Act, which increased tax credits and expanded subsidies into the middle class. This year, the passage of the Inflation Reduction Act continued those enhanced benefits through 2025. For instance, a family of four (both parents in their 40s) making $50,000 are eligible for a credit of roughly $16,000, compared with $14,300 previously.

In addition, the federal government earlier this month changed the way that the affordability of employer coverage is determined for members of an employee’s family, the so-called “family glitch.” Starting in 2023, family members of a person who is offered employer-based coverage that is “affordable” for the employee only and not the whole family, may be eligible for tax credits on the marketplace for the first time. This change will help more consumers qualify for tax credits and cost-sharing reductions through a marketplace plan.

Federal tax credits are available for those whose household income is between 138% and 400% of the Federal Poverty Level. For 2023 coverage, that’s between $18,754 and $54,360 for an individual, or between $38,295 and $111,000 for a family of four. For coverage in 2022, about 89% of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.

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. 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. In a silver plan, the insurer pays about 70% of medical costs and the consumer pays about 30%. Consumers who pick silver health care plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 23% of current enrollees qualified for cost-sharing reductions. For any marketplace plan in 2023, individual consumers can’t pay more than $9,100 in out-of-pocket medical costs and families can’t pay more than $18,200.

For 2023:

• Highmark will offer 17 plans for individuals – three platinum plans, six gold, three silver, four bronze and one catastrophic.
• Aetna CVS Health will offer nine plans – two gold, four silver and three bronze.
• AmeriHealth Caritas will offer four plans – one gold, one silver and two bronze.
• Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – will offer a collective 13 stand-alone dental plans on the marketplace, seven with a low actuarial level (pay less monthly, but more when you get dental services) and six with a high actuarial level (pay more monthly, but less when you get dental care).

All plans offer 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, pediatric services, birth control and breastfeeding coverage, and COVID-19 vaccines, including the new bivalent booster. In addition, coverage cannot be terminated due to a change in health status, including diagnosis or treatment of COVID-19.

“As we enter the 10th year of open enrollment on Delaware’s Health Insurance Marketplace, we are grateful for the important role that marketplace plans are playing in improving access to high-quality and affordable health care,” said Department of Health and Social Services Secretary Molly Magarik. “And we appreciate the stability that the Biden administration, our congressional delegation, the Insurance Commissioner and our own reinsurance program have all brought to the marketplace. I urge everyone to take another look at the affordability of the plans on Delaware’s Health Insurance Marketplace and look at how the coverage can fit into your family’s budget.”

“Delaware’s Health Insurance Marketplace is more successful than ever before with steady rates, enhanced subsidies, and enrollment at an all-time high,” said Insurance Commissioner Trinidad Navarro. “I am so proud that going into 2023, consumers will also benefit from the most competition our state has seen, with three insurers and 30 plan options to choose from.”

Assistance for Delaware enrollees

Consumers can go to HealthCare.gov or CuidadodeSalud.gov now to explore their options for 2023 coverage, and they can enroll anytime between Nov. 1 and Jan. 15, 2023.

Delawareans who need help enrolling in coverage will have access to free in-person assistance from federally funded and trained specialists at Westside Family Healthcare (statewide) and Quality Insights, Inc., (New Castle and Sussex counties) and by certified application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown. Westside and Quality Insights each received increased federal funding for navigators to help people enroll for coverage.

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.

For more information, go to www.ChooseHealthDE.com. You can enroll in marketplace coverage at HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325).

According to the U.S. Department of Health and Human Services (HHS):

• About 89% of Delaware’s marketplace enrollees received financial assistance in 2022 to help pay their monthly premiums and/or deductibles and co-pays.
• The overall average monthly premium in Delaware is $706, with the average premium reduced to $169 per month after tax credit. For the 89% of Delawareans who received financial assistance, the average premium after tax credit is $114 per month.
• Among the 32,113 people who signed up during last year’s open enrollment, about 78% were re-enrollees and 22% were new enrollees.
• Financial help is available for individuals with annual incomes up to $54,360; for a family of four the income limit is $111,000.
• About 62% of Delaware’s enrollees signed up during the three weeks before Dec. 15, 2021.

Support from Congressional Delegation

Delaware’s U.S. senators and representative urged uninsured Delawareans to find out what’s available for them on the marketplace.

“I am proud that we were able to extend Affordable Care Act (ACA) subsidies and make health insurance more affordable for Americans through 2025 with the passage of the Inflation Reduction Act,” said U.S. Sen. Tom Carper. “Now in its 10th year, the marketplace is more affordable than ever, and Delawareans have more options than before. I encourage everyone to visit HealthCare.gov or seek free help from our many health insurance navigators and get covered without delay!”

“As we go into the 10th year of open enrollment, it’s clear that the Affordable Care Act has enabled Delawareans to access quality, affordable health insurance through the insurance marketplace,” said U.S. Sen. Chris Coons. “Just this year, my colleagues and I were able to extend critical subsidies for this program through the Inflation Reduction Act to ensure that more families can pay for the health insurance they need without breaking the bank. Starting today, Delawareans have more options than ever before to protect themselves and their families, and they should visit HealthCare.gov to sign up for or change their insurance before January 15.”

“In the wake of the COVID-19 pandemic, access to quality, affordable health insurance has never been more important. That’s why I voted to pass the Inflation Reduction Act in August which extends ACA subsidies, reducing the cost of health care for Delawareans enrolled in health care coverage through Delaware’s Health Insurance Marketplace,” said U.S. Rep. Lisa Blunt Rochester. “And this year, Delawareans have more options than ever before to find an affordable plan that works best for them and their families. I’m glad to join my colleagues – Senator Carper and Senator Coons – as well as Insurance Commissioner Navarro to announce that today, November 1st, marks the beginning of the open enrollment period for Delawareans to sign up for health care coverage through the marketplace. Delawareans have until January 15, 2023, to review their current plans, enroll in a new plan, or get more information at HealthCare.gov. Don’t miss the chance to get covered!”

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage through Delaware’s expanded Medicaid program, which is open year-round. More than 10,000 Delawareans receive coverage under the Medicaid expansion each year. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

Both the Health Insurance Marketplace and the Medicaid expansion have helped to reduce Delaware’s uninsured rate, decreasing from 10% in 2008 to 5.7% in 2021, according to the Census Bureau. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions.

Double-digit drop will be effective December 1

Insurance Commissioner Trinidad Navarro announced today that workers’ compensation insurance rates will decrease for the sixth year in a row, effective December 1, 2022. Both the voluntary market and the residual market will see rate decreases in the double digits.

“Lowering worker’s compensations costs time and time again helps our local businesses, who have faced several years of uncertainty and economic difficulty due to the pandemic,” said Insurance Commissioner Trinidad Navarro. “It also helps us to attract new companies and jobs to our state. While costs continue to decrease, companies are keeping their eye on the ball by reducing risk through programs like our Workplace Safety initiative.”

This year’s decrease in worker’s compensation insurance rates is expected to be coupled with the reversal of voluntary and residual market trends – the residual market is expected to see a greater rate decrease. Residual insurers provide ‘last resort’ coverage for companies unable to obtain or afford coverage in the traditional market. Generally, rates in the residual market do not decrease more than the voluntary market, as the clientele tends to be businesses with higher risk or claims history. The reduction seen in the residual market is an indicator that these policies are being used less frequently, as companies can better afford the traditional, voluntary market.

Workers’ compensation insurance provides coverage when an employee is hurt on the job and can provide medical coverage as well as payments for lost wages if a person is unable to work due to their injury. Lower premiums don’t change the amount of compensation an injured employee receives.

Final rates are expected to be announced in early November, following a review of the Delaware Compensation Rating Bureau (DCRB) filing by independent actuaries, and a public hearing with DCRB and the State’s Ratepayer Advocate. Actual savings will vary by policy.

These lower rates are just one component of several Department efforts to help businesses financially. More than 1,200 employers are saving even more money on their workers’ compensation premiums by participating in the department’s Workplace Safety Program, saving approximately $7.4 million last year. Eligible businesses can earn up to a 19% discount on their insurance by successfully undergoing annual safety inspections and complying with recommendations. Importantly, employees may also benefit directly from employer-based safety goals – for example, a workplace may offer bonuses if there are no injuries in a given timeframe and pass on the savings to workers.

Businesses eligible for the Workplace Safety Program are notified each year seven months prior to their renewal date. Organizations interested in participating can access questionnaires online and contact safety@delaware.gov to begin the process. For the first time in 20 years, the Department will update the Inspection Fee Schedule for program participants. Businesses will be notified accordingly. Only benefits can be gained by participating, failure to qualify cannot be the basis for premium increases or sanctions imposed by other safety officials.

Update as of November 2, 2022: Following a review of the Delaware Compensation Rating Bureau (DCRB) filing by independent actuaries and a public hearing with DCRB and the State’s Ratepayer Advocate, the final Workers’ Comp rates have been approved.
Residual Market: Average decrease of 19.72%
Voluntary Market: Average decrease of 14.76%

View the DCRB website

Free one-on-one counseling saved consumers more than a half million dollars in 2021

As the October 15 to December 7 Medicare Open Enrollment quickly approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information announcement.

During Medicare Open Enrollment, 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 2021, DMAB provided more than 5,500 counseling sessions, saving beneficiaries a combined $521,000.

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 Medicare Advantage plan or transition should first contact the Office of Pensions at 1 (800) 722-7300 and explore their online guide. Medicare Advantage plans themselves are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

“Our Medicare Assistance Bureau is an important resource for residents. Many Delawareans face confusion when it comes to Medicare Advantage plans, and as Open Enrollment approaches, they will begin to see an influx of television commercials and be targeted by a lot of other enrollment marketing,” said Insurance Commissioner Trinidad Navarro.

DMAB Director Lakia Turner agreed. “Many beneficiaries enroll in plans based on marketing, without fully assessing the plan’s total costs or asking key questions about their coverage, and ultimately that means they then experience unexpected issues. We work hard to inform consumers on the front-end to help ensure they get the right plan from the start.” Commissioner Navarro and Director Turner recently shared enrollment advice on Delmarva Life.

Ten 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.

Be aware of non-compliant alternative health plans

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2023 health, dental, and small group insurance plans were announced today. While premiums are rising steeply across the country, the extension of consumer-friendly subsidies through the Inflation Reduction Act, coupled with Delaware’s strong 2022 enrollment and 2023 Health Insurance Marketplace expansion, will limit consumer impact locally.

“This year, Delaware consumers have more carriers and plans to choose from than ever before, so they can find an affordable plan that meets their needs. We remain optimistic that this increased competition will lead to lower rates and higher care quality over time,” said Insurance Commissioner Trinidad Navarro. “Delawareans are facing rising costs in nearly every area of life and making difficult sacrifices to afford necessities – but let me be clear, no matter the financial cost, we cannot afford to sacrifice our health. We will continue to work to ensure that coverage is affordable and accessible to all residents.”

Two new health insurers will be joining the Marketplace for 2023. Before tax credits and subsidies, base rates for 21-year-old non-tobacco users range from $315 to $505 across 9 Aetna CVS Health plan options, and from $283 to $402 with AmeriHealth Caritas across 4 plan options. Returning ACA issuer Highmark Blue Cross Blue Shield of Delaware will be increasing rates 5.5% on average, with base rates for 17 plan options ranging from $249 to $618 including a catastrophic plan option. In the last few years, Highmark’s average rates have decreased roughly 10% despite this needed increase.

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.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 30 plans are available to Delawareans for the 2023 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Factors Involved in Expansion, Rates

Nationally, insurers are requesting increases due to inflation, increasing costs of care, and rising drug prices. In Delaware, both state and federal legislation contributed to the long-awaited carrier expansion and final rates.

“It’s no coincidence that Delaware was able to expand the number of carrier options on the Health Insurance Marketplace in the same year that laws limiting hospital price growth to appropriate, inflation-conscious levels became enforceable,” said Commissioner Navarro. “The hospital price growth law, for the first time in our state’s history, gave insurers leverage to negotiate lower costs for consumers while still ensuring that hardworking healthcare providers receive their fair share. We’re grateful to have worked with legislators and the Primary Care Reform Collaborative to put cost containment guardrails in place to curtail rising consumer expenses, encourage carrier expansion, and ensure the effectiveness of every dollar spent.”

With little financial limitations around hospital prices, private insurance plans pay the price – on average 224% more than Medicare plans, according to RAND Corporation.

During the rate filing process, questions also remained about the expiration of American Rescue Plan Act subsidies, which the department lobbied Delaware’s congressional delegation to extend. These subsidies lowered consumer costs significantly and contributed to the state’s largest-ever ACA enrollment, a year-over-year increase of 26.8%. Had these benefits expired, healthy consumers who were influenced to acquire coverage through the enhanced discounts may have left the marketplace, shrinking the risk pool and unbalancing rates. On August 16, President Biden signed the Inflation Reduction Act into law, extending subsidies into 2025.

Aside from potential enrollment increases due to the carrier expansion, future participation growth may come from Medicaid unwinding and income eligibility reviews. National efforts are underway to ensure smooth, affordable transitions to Marketplace coverage for those eligible.

Other ACA and ACA-Compliant Rates

Delta Dental will reduce both ACA and non-marketplace rates by an average of 4%, and Dominion Dental will increase ACA premiums by 2.2%. Metropolitan Life Ins. Co.’s small group non-marketplace dental plan rates will remain at their current level.

Returning off-market small group plans from Highmark will increase an average 2.4%, Optimum Choice plans will rise by 2.7%, and United Healthcare small group rates will increase by 2.8%. Aetna Health’s small group plans will increase 7.6%, and Aetna Life rates will increase 5.1% after an initial increase request of 8.8% was reduced. Aetna Health’s 9 off-marketplace individual plan rates will remain at their current level.

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 and telehealth, lab services, and more.

Open enrollment for 2023 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors throughout the year. Find out if you qualify for special enrollment.

Commissioner Navarro announces Health Insurance Marketplace expansion

Be aware of non-compliant alternative health plans

The Delaware Department of Insurance today announced that industry veteran Stephen Taylor has joined the department as the incoming Director of its world-renowned Captive Bureau. Taylor will succeed Steve Kinion, who transitions out of the role on September 30.

“Stephen Taylor’s extensive experience as an innovative yet meticulous insurance regulator stood out amongst contract applicants for our Captive Director position, and we are happy to welcome him to the department,” said Insurance Commissioner Trinidad Navarro. “This role is certainly not without its challenges, but Taylor’s adeptness at engaging in both federal and nonfederal policy matters will serve our state well in the years to come.”

Stephen Taylor served as Insurance Commissioner of the District of Columbia from 2015 to 2020. In that role, he instituted a number of innovative insurance regulation reforms and prioritized initiatives that aimed to empower residents and increase economic inclusion. Taylor has held numerous prominent leadership roles in the National Association of Insurance Commissioners. He most recently served as Director of Policy and Assistant General Counsel to the Surety and Fidelity Association of America, and has nearly 30 years of insurance regulation, legislative, and legal experience.

“I look forward to working with the Commissioner and the talented Captive team to continue providing a best-in-class captive program for the risk management community and bringing important economic opportunities to the State of Delaware,” said Stephen Taylor.

Captive insurance companies, which are owned by the entities that they insure, are usually formed by businesses that wish to better manage the cost and administration of their insurance coverage. Delaware is the world’s fifth largest and the third largest U.S. captive domicile. It is one of four domiciles in the world recognized by the International Center for Captive Insurance Education as ICCIE Trained. To learn more, visit captive.delaware.gov.