Décimo Año de Inscripción Abierta en el Mercado de Seguros Médicos de Delaware Comienza Nov. 1

Los residentes de Delaware encontrarán más opciones en aseguradoras y planes, y subsidios federales incrementados continuos para ayudar con la asequibilidad; la registración se extiende hasta el 15 de Enero del 2023

NEW CASTLE (1º de Noviembre, 2022) – Saliendo de un año con sin precedentes por la inscripción en el Mercado de Seguros Médicos de Delaware, los residentes de Delaware buscando cobertura para el 2023 encontrarán más opciones de aseguradoras y planes que antes visto, y seguirán encontrando subsidios federales mejorados, lo cual empezó el año anterior bajo la administración de Biden. Los subsidios han ayudado a reducir el costo del consumidor de hasta un 40%.

El décimo periodo de inscripción abierta comenzó hoy, 1º de Noviembre y termina el 15 de Enero del 2023 en www.CuidadoDeSalud.gov, donde los consumidores pueden renovar cobertura existente o inscribirse en un nuevo plan. La cobertura para miembros que se inscriban antes del 15 de Diciembre y paguen la prima del primer mes entrará en vigencia el 1º de Enero.

Los individuos que no actúen antes del 15 de Enero de 2023 no podrán obtener cobertura para 2023 al menos que califiquen para un Período de Inscripción Especial basado en circunstancias como la pérdida de cobertura médica calificada, cambio de ingresos, volverse un padre u otros factores calificantes.

Este año, los residentes de Delaware tendrán de tres aseguradoras para elegir versus solo una el año pasado y un total de 30 planes, el total más alto en los 10 años del mercado. El Comisionado de Seguros, Trinidad Navarro, anunció en Junio que dos nuevas aseguradoras, AmeriHealth Caritas (cuatro planes) y Aetna CVS Health (nueve planes), se unirían a Highmark Blue Cross Blue Shield Delaware (17 opciones de planes) para ofrecer cobertura en el mercado para 2023. En septiembre, el Comisionado Navarro anunció que las tarifas de Highmark aumentarían un 5.5% en promedio.

La estabilidad general del Mercado de Seguros Médicos de Delaware refleja la aprobación federal continua del programa de reaseguros de Delaware. El programa ha reducido las primas de seguro médico para los planes vendidos en el mercado de seguros individuales al reembolsar parcialmente a las aseguradoras los reclamos de atención médica de alto costo a través de un fondo que utiliza una combinación de fondos federales y evaluaciones recaudadas por el Departamento de Seguros de Delaware de los portadores de seguros médicos. Debido a que los costos de reclamos de las aseguradoras son más bajos, las aseguradoras pueden reducir el costo de las primas o limitar los aumentos.

Durante la inscripción abierta del año pasado, un total de 32,113 residentes de Delaware se inscribieron para la cobertura de 2022 en el Mercado de Seguros Médicos de Delaware, un aumento del 26.8% del año anterior.

“Todas las familias de Delaware necesitan acceso a atención médica de calidad asequible,” dijo el Gobernador John Carney. “Hay más planes para elegir este año, lo que ayudará a que la cobertura sea aún más asequible. Animo a todos los residentes de Delaware a mirar sus opciones, especialmente a los propietarios de pequeñas empresas, contratistas independientes y personas que no tienen acceso a un seguro médico a través de un empleador. Es importante que prioricemos nuestra salud.”

En 2021, la administración de Biden hizo que la expansión al acceso a seguro médico y la asequibilidad una prioridad a través de la Ley del Plan de Rescate Estadounidense, que aumentó los créditos fiscales y expandió los subsidios hacia la clase media. Este año, la aprobación de la Ley para la Reducción de la Inflación continuó con esos beneficios incrementados hasta 2025. Por ejemplo, una familia de cuatro (ambos padres de 40 años) que ganan $50,000 son elegibles para un crédito de aproximadamente $16,000, en comparación con los $14,300 anteriores.

Adicionalmente, el gobierno federal cambió a principios de este mes la forma en que se determina la asequibilidad de la cobertura del empleador para los miembros de la familia de un empleado, el llamado “fallo familiar.” A partir del 2023, los familiares de una persona a la que se les ofrece cobertura basada en el empleador que es “asequible” solo para el empleado y no para toda la familia, pueden ser elegibles para créditos fiscales por primera vez en el mercado. Este cambio ayudará a más consumidores a calificar para créditos fiscales y reducciones de costos compartidos a través de un plan de mercado.

Los créditos fiscales federales están disponibles para aquellos cuyos ingresos familiares se encuentran entre el 138% y el 400% del nivel federal de pobreza. Para la cobertura de 2023, eso es entre $18,754 y $54,360 para una persona, o entre $38,295 y $111,000 para una familia de cuatro. Para la cobertura en el 2022, alrededor del 89% de los afiliados en Delaware eran elegibles para créditos fiscales, lo que ayuda a reducir el costo de la prima mensual.

Los planes en el mercado se distribuyen entre categorías de nivel de metales (bronce, plata, oro, platino y catastrófico – y se basan en cómo los afiliados eligen dividir los costos de cuidado con su compañía de seguros. Los planes bronce tienen primas mensuales bajas pero altos costos cuando necesita atención; los planes dorados tienen primas altas, pero costos más bajos cuando necesita atención. En un plan plata, la aseguradora paga alrededor del 70% de los costos médicos y el consumidor paga alrededor del 30%. Los consumidores que eligen planes de atención médica plata también pueden calificar para ahorros adicionales a través de descuentos en deducibles, copagos y coaseguros. En Delaware, alrededor del 23% de los afiliados actuales califican para reducciones de costos compartidos. Para cualquier plan del mercado en 2023, los consumidores individuales no pueden pagar más de $9,100 en gastos médicos de bolsillo y las familias no pueden pagar más de $18,200.

Para 2023:

  • Highmark ofrecerá 17 planes para individuos: tres planes de platino, seis de oro, tres de plata, cuatro de bronce y uno catastrófico.
  • Aetna CVS Health ofrecerá nueve planes: dos de oro, cuatro de plata y tres de bronce.
  • AmeriHealth Caritas ofrecerá cuatro planes: uno dorado, uno plateado y dos bronce.
  • Dos aseguradoras dentales, Delta Dental of Delaware, Inc. y Dominion Dental Services, Inc. – ofrecerán un total de 13 planes dentales independientes en el mercado, siete con un nivel actuarial bajo (paga menos mensualmente, pero más cuando obtienes servicios dentales) y seis con un nivel actuarial alto (paga más mensualmente, pero menos cuando recibes atención dental).

Todos los planes ofrecen beneficios esenciales de salud, como cobertura de condiciones preexistentes, atención ambulatoria, servicios de emergencia, hospitalización, recetas medicas, servicios de salud mental y trastornos por uso de sustancias, servicios de laboratorio, servicios pediátricos, control de la natalidad y cobertura de lactancia, y vacunas de COVID-19, incluido el nuevo refuerzo bivalente. Además, la cobertura no puede cancelarse debido a un cambio en el estado de salud, incluyendo el diagnóstico o tratamiento de COVID-19.

“A medida que ingresamos al décimo año de inscripción abierta del Mercado de Seguros Médicos de Delaware, estamos agradecidos por el importante papel que desempeñan los planes del mercado para mejorar el acceso a una atención médica asequible y de alta calidad,” dijo la Secretaria del Departamento de Salud y Servicios Sociales Molly Magarik. “Y apreciamos la estabilidad que la administración Biden, nuestra delegación del congreso, el Comisionado de Seguros y que nuestro propio programa de reaseguro han aportado al mercado. Urgimos a todos a que vuelvan a mirar la asequibilidad de los planes en el Mercado de Seguros Médicos de Delaware y vean cómo la cobertura puede encajar en el presupuesto de su familia.”

“El Mercado de Seguros Médicos de Delaware es más exitoso que nunca con tasas constantes, subsidios mejorados y la inscripción en su punto más alto,” dijo el Comisionado de Seguros Trinidad Navarro. “Estoy muy orgulloso de que, de cara al 2023, los consumidores también se beneficiarán de la mayor competencia que ha visto nuestro estado, con tres aseguradoras y 30 opciones de planes para elegir”.

Asistencia para afiliados Delaware

Los consumidores pueden ir a HealthCare.gov o a CuidadodeSalud.gov ahora para explorar sus opciones para la cobertura del 2023, y se pueden inscribir en cualquier momentos desde el 1º de Noviembre hasta el 15 de Enero, 2023.

Los residentes de Delaware que necesiten ayuda inscribiéndose en cobertura tendrán acceso a asistencia en persona gratuita financiados con fondos federales por especialistas capacitados Westside Family Healthcare (en todo el estado) y Quality Insights, Inc., (condados de New Castle y Sussex) y por asesores de solicitud certificados en Henrietta Johnson Medical Center en Wilmington y La Red Health Center en Georgetown. Westside y Quality Insights recibieron cada uno más fondos federales para navegadores para ayudar a las personas a inscribirse en la cobertura.
Agentes e intermediarios de seguros con licencia estatal también están disponibles para ayudar a individuos para volver a inscribirse y ayudar a los empleadores a actualizar su cobertura, sin cargo adicional.

Para más información, visite www.ChooseHealthDE.com. Puede inscribirse en la cobertura del mercado en CuidadodeSalud.gov o llamando al 1-800-318-2596 (TTY: 1-855-889-4325).

De acuerdo con el Departamento de Salud y Servicios Humanos de EE. UU. (HHS):

  • Alrededor del 89% de los inscritos en el mercado de Delaware recibieron asistencia financiera en 2022 para ayudarlos a pagar sus primas mensuales y/o deducibles y copagos.
  • La prima mensual promedio general en Delaware es de $706, con una prima promedio reducida a $169 por mes después del crédito fiscal. Para el 89% de los residentes de Delaware que recibieron asistencia financiera, la prima promedio después del crédito fiscal es de $114 por mes.
  • Entre las 32,113 personas que se inscribieron durante la inscripción abierta del año pasado, alrededor del 78% eran reinscritos y el 22% eran nuevos inscritos.
  • Ayuda financiera está disponible para individuos con ingresos anuales de hasta $54,360; para una familia de cuatro, el límite de ingresos es de $111,000.
  • Aproximadamente el 62% de los miembros de Delaware se inscribieron durante las tres semanas anteriores al 15 de diciembre de 2021.

Apoyo de la Delegación del Congreso

Los senadores y representantes de EEUU de Delaware urgieron a los residentes de Delaware que no tienen seguro a averiguar qué hay disponible para ellos en el mercado.

“Estoy orgulloso que pudimos extender los subsidios de la Ley del Cuidado de Salud a Bajo Precio (ACA) y hacer que el seguro médico sea más asequible para los Estadounidenses hasta 2025 con la aprobación de la Ley para la Reducción de la Inflación,” dijo el Senador Americano Tom Carper. “Ahora en su décimo año, el mercado es más asequible que nunca y los residentes de Delaware tienen más opciones que antes. ¡Animo a todos a visitar CuidadodeSalud.gov o buscar ayuda gratuita con nuestros muchos navegadores de seguros de salud y obtener cobertura sin demora!”

“A medida que avanzamos al décimo año de inscripción abierta, está claro que la Ley del Cuidado de Salud a Bajo Precio ha permitido a los residentes de Delaware a acceder a un seguro de salud asequible y de calidad a través del mercado de seguros,” dijo el Senador Americano Chris Coons. “Solo en este año, mis colegas y yo pudimos extender subsidios críticos para este programa a través de la Ley para la Reducción de la Inflación para garantizar que más familias puedan pagar el seguro médico que necesitan sin tener que tirar la casa por la ventana. A partir de hoy, los residentes de Delaware tienen más opciones que nunca para protegerse a sí mismos y a sus familias, y deben visitar CuidadodeSalud.gov para inscribirse o cambiar su seguro antes del 15 de enero.”

“A raíz de la pandemia de COVID-19, el acceso a un seguro de salud asequible y de calidad nunca ha sido más importante. Es por eso por lo que voté para aprobar la Ley para la Reducción de la Inflación en agosto, que extiende los subsidios de la ACA, lo que reduce el costo de la atención médica para los residentes de Delaware inscritos en la cobertura de atención médica a través del Mercado de Seguros Médicos de Delaware,” dijo la Representante Americana Lisa Blunt Rochester. “Y este año, los residentes de Delaware tienen más opciones que nunca para encontrar un plan asequible que funcione mejor para ellos y sus familias. Me complace unirme a mis colegas—el Senador Carper y el Senador Coons—así como al Comisionado de Seguros Navarro para anunciar que hoy, 1º de Noviembre, marca el comienzo del período de inscripción abierta para que los residentes de Delaware se inscriban en la cobertura de atención médica a través del mercado. Los residentes de Delaware tienen hasta el 15 de Enero de 2023 para revisar sus planes actuales, inscribirse en un nuevo plan u obtener más información en HealthCare.gov. ¡No pierda la oportunidad de obtener cobertura!”

Además del Mercado de Seguros Médicos, algunos residentes pueden ser elegibles para la cobertura a través del programa ampliado de Medicaid de Delaware, que está abierto todo el año. Más de 10,000 residentes de Delaware reciben cobertura bajo la expansión de Medicaid cada año. Para ser evaluado o solicitar los beneficios de Medicaid, vaya a Delaware ASSIST.

Tanto el Mercado de Seguros Médicos como la expansión de Medicaid han ayudado a reducir la tasa de personas sin seguro de Delaware, decreciente del 10% en 2008 al 5.7% en 2021, según la Oficina del Censo. Esa disminución incluye a los residentes de Delaware que no pudieron obtener cobertura antes de la Ley del Cuidado de Salud a Bajo Precio debido a condiciones preexistentes.


10th Year of Open Enrollment on Delaware’s Health Insurance Marketplace Starts Nov. 1

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.


2023 Health, Dental, Small Group Insurance Rates Announced

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


Commissioner Navarro Announces Health Insurance Marketplace Expansion

Consumers to have most options in history of Delaware Marketplace

After years of work to increase competition on the Delaware Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today that three health carriers intend to offer plans for the 2023 plan year – the most in the state’s history. AmeriHealth Caritas and Aetna CVS Health will join Highmark Blue Cross Blue Shield Delaware in offering coverage.

“Delaware’s Health Insurance Marketplace is more stable than ever before, with rates steadying and enrollment at an all-time high. The hard work we have put into this program is paying off, with multiple new carriers planning to offer 2023 coverage,” said Insurance Commissioner Trinidad Navarro. “I look forward to the benefits that increased competition will bring to our residents, and to continuing to improve healthcare accessibility and affordability across the state.”

From rising rates to insurer departure, the implementation of the Affordable Care Act in Delaware hasn’t always been smooth sailing. But with the state’s successful creation of a 1332 reinsurance program and federal threats of ending the critical program subsiding, rates have decreased more than 15% and remained stable, while enrollment has grown significantly.

“Today’s announcement is a testament to both the needs of Delawareans who have increasingly signed up for coverage, and to the strong regulatory environment we have built, which has helped insurers go from taking losses to being able to cover their expenses and consumers’ coverage needs.”

The announcement comes as carriers submit initial rate filings proposals pursuant to federal deadlines. These will undergo in-depth reviews by independent actuaries before the Insurance Commissioner approves and announces them later this year.


Department of Insurance 2021 Data Shows over $21M in Consumer Savings

Successes in serving residents continue

The Delaware Department of Insurance (DOI) today published performance and productivity data for 2021. While the pandemic necessitated continued operational adjustments, staff continued to focus efforts on consumer services and saw great success. The department also released an infographic of key statistics.

“Year after year, our DOI team delivers for Delaware. In the face of many changes and challenges due to COVID-19, we continued to prioritize consumer services, and never wavered from that commitment,” said Insurance Commissioner Trinidad Navarro. “This year in review provides just a glimpse into the incredibly vast and diverse array of work our team takes on, and I look forward to continuing to make a difference every day in 2022.”

Despite minimal in-person events, services directed to individual consumers and local businesses continued to thrive in 2021. The Delaware Medicare Assistance Bureau (DMAB) held more than 5,500 free one-on-one counseling sessions with residents, ultimately saving beneficiaries a combined $521,000 – an increase of more than $230,000 compared to 2020 savings. The Consumer Services Division managed over 3,000 complaints and inquiries, recovering nearly $700,000 for consumers. In the Legal Division, 274 settled arbitration cases resulted in awards totaling more than $640,000. These services, combined with $12.3 million in ACA plan refunds and $7.4 million in workplace safety savings, amount to over $21.5 million for Delaware’s insurance consumers in 2021.

A critical focus of the department during COVID-19 continues to be ensuring health insurer compliance with state and federal rules, coverage requirements, and initiatives to reduce burdens on hospitals and those seeking care. The Market Conduct team continued investigations into insurer’s Mental Health Parity compliance, resulting in $635,000 in fines. Throughout the ACA Special Enrollment Period, more than 21,000 residents took advantage of increased subsidies and savings from the American Rescue Plan, saving an average of 53% on their monthly premiums – a savings of $1.2 million in total. To protect consumers and create a nationwide network of strong regulation, Commissioner Navarro successfully worked to create the National Improper Marketing of Health Plans Working Group within the National Association of Insurance Commissioners.

Nationally, Commissioner Navarro and the department remain engaged in numerous industry organizations. The Commissioner was recently named Vice-Chair of the National Association of Insurance Commissioners’ Market Regulation and Consumer Affairs (D) Committee, a prestigious honor, in addition to being elected to the Executive Committee of the Northeast Zone and continuing to serve as Chair of the National Anti-Fraud Task Force. Delaware continues to participate in the Special Committee on Race and Insurance, the Healthcare Fraud Prevention Partnership, the National Insurance Crime Bureau Medical Task Force, the Delaware Valley Association of International Special Investigative Units, and other committees and groups.

In 2021, the General Assembly utilized virtual procedures for session. DOI pursued 14 pieces of legislation with our partners in Legislative Hall and engaged with more than 30 insurance-related bills, including legislation to regulate the multi-billion-dollar Pharmacy Benefit Manager industry, protecting consumers of auto and homeowner’s insurance, and making progress on issues like health care access and pharmaceutical costs. The DOI also continued to work on other legislative mandates, such as the Office of Value-Based Health Care Delivery.

In Market Conduct, 16 completed insurer examinations resulted in $1.2 million in fines, and several examinations are in progress. More than 50,000 licenses were issued, and licenses total more than 200,000. Across all lines of insurance, more than 30,000 rates and forms were processed and approved.

The Bureau of Examination, Rehabilitation and Guaranty oversees the financials of 136 domestic companies that manage $680.6 billion, and more than 2,000 other companies operating in the state. They completed 62 financial examinations, and have 49 exams in progress, in addition to completing nearly 3,500 other projects including Uniform Certificate of Authority Application amendments and Security Exchange Requests.

The Fraud Bureau worked to investigate many tips and reports, and 5 criminal cases of insurance fraud were indicted in addition to the collection of nearly $9,500 in civil penalties.

Going into 2022, businesses will see the fifth consecutive decrease in Workers’ Compensation premiums, an average reduction of more than 20%. The Workplace Safety team engaged more than 1,200 companies in earning additional savings in 2021.

The Captive Division, named a finalist for International Captive Domicile of the Year, received 70 new applications and has 759 licenses in effect.

View the 2021 Infographic