Highmark plan participants and groups to receive checks

Insurance Commissioner Trinidad Navarro announced today that Highmark Blue Cross Blue Shield Delaware will issue rebates totaling over $12.3 million to some Delawareans. Residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Delaware plans outside of the marketplace, and Highmark small group policyholders may receive rebates as a result of the Medical Loss Ratio (MLR) calculation.

MLR measures an insurer’s spending on medical expenses to confirm that at least 80 percent of premiums are being used for policyholders’ healthcare and prescription needs. It is an accountability measure included in the Affordable Care Act (ACA) that holds insurers to a strict standard and requires refunds if the threshold is not met. Insurers are not permitted to retain funds above this value for any reason, including to lower premiums for future years, as the policyholders effected may change. MLR is calculated on a three-year average – 2018, 2019, and 2020 were used in this assessment.

“Requiring insurers to meet the MLR ratio is one of the most critical tools the ACA gave us to protect consumers. These guardrails ensure residents and small businesses get the care they pay for, or get their money back – and they’re more important now than ever before,” explained Commissioner Navarro, who pointed to policyholders’ decreased and delayed use of healthcare throughout the pandemic as something likely to necessitate future rebates. “With decreased utilization of health services in 2020 and 2021 factoring into MLR for the next four years, and expected increases of utilization factoring into rates for 2022, this is yet another reminder that COVID will impact all aspects of healthcare, including insurance, for much of the foreseeable future.”

20,857 individual policyholders will receive rebates totaling over $8.4 million, with the average rebate being $405. This will be the second time in state history that rebates will be distributed to the participants of the individual market, with more than $12.6 million being sent to over 19,000 residents last year.

Highmark small groups, often small businesses, will receive nearly $3.9 million in cumulative return. 2,573 groups will receive an average rebate of $1,514, with 20 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years, or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September and checks for both individual policyholders and small groups will be sent the week of September 15. Not every policyholder will receive a rebate. Those in the individual market with rebate questions can contact Highmark at 800-544-6679. Small group employers with rebate questions can contact their insurance producer, or Highmark at 800-241-5704.

Expanded federal subsidies keep consumer costs low; SEP sees success

After two consecutive years of rate decreases, Highmark Blue Cross Blue Shield of Delaware, who offers the state’s Affordable Care Act (ACA) health plans, will increase base rates an average of 3% for the 2022 plan year. The announcement comes after extensive, in-depth independent actuarial reviews and a public comment period on the insurer’s initial proposal of a 4% increase. While insurers are increasing rates across the country, federal subsidies from the Biden-Harris Administration have cut consumer costs by 40% and will continue to be applied in the 2022 plan year. Residents are still expected to see savings despite the modest increase in the base rate.

The 2022 rate announcement comes after the end of the Biden-Harris Administration’s Special Enrollment Period (SEP), which gave residents the ability to enroll in 2021 ACA plans between February 15 and August 15. More than 5,377 Delawareans signed up for coverage during the SEP. Taking into account the 5% participation increase seen in last fall’s open enrollment, an estimated 30,000 Delawareans are now covered by 2021 plans. 23% of new and returning Delaware participants are enrolled in a plan costing $10 or less per month due to the American Rescue Plan.

“Stability in the individual health insurance market is so critical as we continue to battle COVID-19 and healthcare shortages. Rates remain more than 15% lower than they were just a few years ago, and with the American Rescue Plan, they’re more affordable than ever before,” said Insurance Commissioner Trinidad Navarro. “Coupled with the safety net of the SEP, the past year has been positive for insurance access.”

Delaware SEP enrollment February 15 through July 31 was more than double the same period last year, which saw higher-than-usual circumstantial enrollment due to COVID, and is nearly triple the typical enrollment for this time of year. Final numbers are expected in the coming weeks. The SEP’s success has led to proposals at the federal level for permanent open enrollment expansion as well as monthly enrollment opportunities.

Expansion of access and increased affordability remains a priority at the federal level, as American Rescue Plan funds increased tax credits and expanded subsidies farther into the middle class. Premium assistance will continue through 2022, and majority of Delaware marketplace enrollees will be eligible for these discounts that can reduce their monthly premiums.

Nationally, insurers are requesting premium increases as policy use is expected to rise with more residents scheduling postponed elective procedures and visits. The rise of prescription costs continues to be a factor in premium planning.

All ACA 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. ACA rates do not vary based on vaccination or COVID-19 status.

Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace for 2022, offering 12 plans for individuals and families. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – offer stand-alone dental plans on the marketplace.

Open enrollment for the Marketplace takes place between November 1 and December 15 each year. However, residents may qualify to enroll or change plans based on special circumstances, such as a loss of qualifying health coverage, change of income, becoming a parent, and several other qualifying factors. Find out if you qualify for special enrollment.

The rate change does not apply to Medicare, Medicaid, or those with group or individual policies outside of the Marketplace.

More information on the rate review process

Consumers should be wary of non-marketplace plans that offer limited benefits

Insurance Commissioner Trinidad Navarro is joining commissioners across the country in cautioning residents who may be considering purchasing an insurance plan that does not adequately meet their needs or comply with Affordable Care Act (ACA) benefit requirements. The Special Enrollment Period, which started February 15, is a great time to review and enroll in insurance plans offered on the Marketplace. However, non-compliant off-marketplace plans may be heavily advertised during this period, and may appear attractive despite often being more expensive and far less comprehensive.

One health insurance alternative that is being marketed quite a lot is short-term limited benefit health insurance. This not a recommended form of coverage, and these plans do not provide coverage for pre-existing medical conditions – anything that a person has been diagnosed with or sought treatment for within the past five or more years. Limited benefit plans only cover a set number of doctor visits for a limited dollar amount and may have very high deductibles and copay requirements. These plans do not qualify for or replace a major medical, ACA-approved health insurance policy, and policies are only effective for three months and are not renewable.

Other products contain similar flaws that could put the consumer at risk of significant medical bills, including lack of coverage critical needs. Coverage for prescriptions, pre-existing conditions, surgery and outpatient procedures, hospital and emergency visits, maternity and pediatric care, and mental and behavioral healthcare could all be excluded from these plans. Non-insurance products, such as health care sharing ministries, are not regulated, and as such are not required to cover a person’s needed care. Trade association plans and other limited plans can offer low-quality coverage that does not meet ACA standards and may not meet a consumer’s needs. None of these plans offer the financial subsidies and tax credits of ACA plans, which about 86 percent of Delaware enrollees are eligible for.

Delaware consumers can ask themselves questions to better recognize problematic plans:

• Is the policy underwritten by a reputable insurer?
• Does this policy cover pre-existing medical conditions?
• Are plan details, such as coverage for maternity care, available in writing?
• Is the plan found on an official Marketplace website, like HealthCare.gov or ChooseHealthDE.com?
• Can a person enroll without any auxiliary payment, such as an enrollment fee, subscription, or membership fee?

If the answer to any of these questions is no, the plan may not be legitimate, and the consumer should reconsider the policy. Even if these red flags are not found, residents should scrutinize plan content, and, if working with an agent or broker, verify their license with the department.

While the Delaware Department of Insurance has not seen significant increases in fraudulent contact or limited benefit plan sales, the pandemic has emboldened bad actors who aim to capitalize upon unusual circumstances, including the Special Enrollment Period.

The Special Enrollment Period was authorized by President Biden and will allow Marketplace enrollment through May 15 on HealthCare.gov. Individuals who are uninsured, regardless of the reason for their lack of insurance, can enroll during this period. Existing Marketplace participants have the option to move to another plan. Local coverage navigators are available to direct consumers to appropriate plans, visit the Choose Health DE website to get connected to a local navigator, or call (800) 318-2596.

More information about the Special Enrollment Period

NEW CASTLE (Feb. 9, 2021) –Delawareans looking for affordable health insurance will have an additional opportunity to sign up for coverage – including tax credits for eligible enrollees that help to reduce monthly premiums significantly – from Feb. 15 to May 15 on HealthCare.gov, the federal online Health Insurance Marketplace created by the Affordable Care Act (ACA).

In light of the exceptional challenges and uncertainty caused by the coronavirus pandemic, President Joe Biden signed an executive order Jan. 28 that created a three-month special enrollment period (SEP) to give Americans greater access to health insurance, including those who lost their job or their coverage as part of the fallout from the pandemic.

“Access to affordable health care remains a critical need for all Delawareans as we continue to fight the spread of the coronavirus. I am grateful to President Biden for giving state residents this additional opportunity to get the coverage they need,” said Delaware Gov. John Carney. “I encourage everyone to spread the word about the benefits of enrolling in coverage through HealthCare.gov during this three-month sign-up period.”

“This special enrollment period provides a great opportunity for Delawareans who are looking for high-quality, affordable health insurance, especially those impacted by the pandemic,” said DHSS Secretary Molly Magarik. “Despite the success of the Health Insurance Marketplace since it opened eight years ago, many state residents still lack insurance, and some might remain unaware that they can access comprehensive care – and, in many cases, get financial help to afford it – through HealthCare.gov.”

The marketplace’s annual open enrollment period for 2021 coverage ended Dec. 15, and since then individuals could get coverage only if they experienced a life event that qualified them to apply for a special enrollment period. The new three-month enrollment period is open to all eligible applicants who want to apply for coverage or change their existing coverage for any reason; applicants won’t be required to provide documentation of a qualifying event (e.g., loss of a job or birth of a child).

Individuals currently covered under a marketplace plan will be able to change to any plan available in Delaware without being restricted to the same level of coverage as their current plan. Current enrollees will need to go through their existing application and make any necessary changes then submit their application in order to receive an updated eligibility result.

Eligible individuals who enroll under the special enrollment period will have 30 days after they submit their application to choose a plan. Note that even after the special enrollment period ends May 15, individuals who experience qualifying life-changing events will be eligible to enroll for marketplace coverage. (It is also worth noting that proof of insurance is not required to receive the COVID-19 vaccine, once your group becomes eligible.)

Delaware is one of 36 states that use HealthCare.gov for eligible residents to sign up for coverage. More than 25,000 Delawareans signed up for 2021 coverage during the recent open enrollment period.

The special enrollment period is available to all marketplace-eligible individuals who are submitting a new application or updating an existing application. You can enroll in marketplace coverage at www.HealthCare.gov or www.CuidadodeSalud.gov or by calling 1 (800) 318-2596 (TTY: 1 855 889-4325).

Applicants will need to provide the following when applying for coverage:

• Full names, Social Security numbers, and birth dates of all those applying for coverage
• Legal documents for all eligible immigrants who are applying for coverage (i.e. Visa, Green Card, etc.)
• Paystubs, W-2 forms, or other information about your family’s income
• Information about any health coverage from a job that’s available to you or your family
  For more information, go to www.ChooseHealthDE.com.

About 6.6 percent of Delawareans remain uninsured, according to the 2020 America’s Health Rankings. That’s down significantly from the nearly 10 percent who lacked insurance in 2010 before the ACA and the Health Insurance Marketplace existed.

“For nearly a year, we have hoped that the Health Insurance Marketplace would allow for greater enrollment opportunities in response to the pandemic and economic conditions. President Biden has made it happen,” said Insurance Commissioner Trinidad Navarro. “This Special Enrollment Period will help ensure Delaware residents have access to comprehensive health insurance that protects pre-existing conditions. And, because we’ve reduced rates by more than 19% over the past two years, these plans are more affordable for residents.”

Support from Congressional delegation

Delaware’s U.S. senators and representative urged uninsured or underinsured Delawareans, especially those who may have lost their jobs because of the pandemic, to find out what’s available for them on the marketplace during the three-month enrollment period.

“President Biden understands that it is critical for Americans to be able to access the care and coverage they need during an unprecedented pandemic. That’s why he’s beginning a new open enrollment period so that Delawareans, and families across this country, have another chance to enroll in a health insurance plan and get covered this year,” said U.S. Sen. Tom Carper, who helped pen the Affordable Care Act that created the marketplaces. “Don’t leave your family’s well-being to chance. Enroll in an affordable, high-quality health insurance plan today that meets your needs and your budget.”

“I commend the Biden administration for reopening the federal online Health Insurance Marketplace, which will allow Delawareans, particularly those impacted by COVID-19, another opportunity to sign up for the health insurance coverage that best meets their needs,” said U.S. Sen. Chris Coons. “Ensuring that Delawareans have access to quality, affordable health care is critical, even more so during a pandemic. I urge all Delawareans who need health coverage to assess their options during this three-month special enrollment period.”

“As we continue to face the COVID-19 pandemic, and Americans are in need of affordable and accessible care, it is crucial that comprehensive health coverage is available to all those that need it,” said U.S. Rep. Lisa Blunt Rochester. “A special enrollment period is critical for allowing Delawareans in need of health insurance to sign up. I’m grateful to President Biden for reopening the Health Insurance Marketplace and ensuring that everyone who needs coverage has access.”

What’s covered

All plans on the marketplace offer essential health benefits such as coverage of pre-existing medical conditions, outpatient care (including telehealth services), emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.

Marketplace plans can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19. The rules in marketplace plans for treatment of COVID-19 are the same as for any other viral infection; enrollees are encouraged to check their particular plan for complete information about benefits.

Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace for 2021. Highmark offers 12 plans for individuals and families. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – offer a collective 11 stand-alone dental plans on the marketplace.

Affordability

About 86 percent of marketplace enrollees in Delaware in 2020 were eligible for federal tax credits, which help reduce the cost of the monthly premium.

Tax credits are available for those whose household income is between 138 percent and 400 percent of the Federal Poverty Level. For 2021 coverage, that’s between $17,609 and $51,040 for an individual, or between $36,156 and $104,800 for a family of four.

According to the most recent figures from the U.S. Department of Health and Human Services, the overall average monthly premium in Delaware in 2020 was $668, with the average premium reduced to $192 per month after tax credit. For the 86 percent of Delawareans who received financial assistance, the average premium after tax credit was $110 per month.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold and platinum – 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 percent of medical costs and the consumer pays about 30 percent. For any marketplace plan in 2021, individual consumers can’t pay more than $8,550 in out-of-pocket medical costs and families can’t pay more than $17,100.

“Catastrophic” plans are also available to some people. Catastrophic plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.

Consumers who pick silver health care plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 29 percent of current enrollees qualify for cost-sharing reductions.

Where to find help

Delawareans who want help enrolling in coverage will have access to free assistance from trained specialists at Westside Family Healthcare. Virtual and phone appointments are encouraged; in-person appointments are limited and must be made in advance. Because of the pandemic, walk-ins are not permitted. Assistance is available in any language and for all Delaware residents. Call 302-472-8655 in New Castle County, 302-678-2205 in Kent/Sussex counties or email enrollment@westsidehealth.org.

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. See a list at ChooseHealthDE.com.

Medicaid

President Biden’s executive order also called for states to reexamine policies, such as work requirements, that restrict access to coverage through Medicaid, which pays medical bills for eligible low-income families and others whose income is insufficient to meet the cost of necessary medical services. This part of the president’s order does not affect Delaware, which under the ACA expanded access to Medicaid starting in 2014. More than 10,000 Delawareans have received coverage under the state’s Medicaid expansion. To be screened for eligibility or to apply for Medicaid benefits year-round, go to Delaware ASSIST.

Joins ten Insurance Commissioners in providing short- and long-term recommendations to the incoming administration

A group of the nation’s state insurance commissioners joined together in a pledge to work with President-elect Joe Biden by providing health policy recommendations to the incoming administration.

The commissioners share President-elect Biden’s vision that no American should have to go without health care coverage. They believe comprehensive and progressive health care is essential to addressing urgent public health priorities, such as the COVID-19 and opioid crises, addressing racial disparities in the health care system, and ensuring enforcement of mental health parity.

“President-elect Biden knows the healthcare needs of Delaware residents first-hand. So many of the healthcare challenges we face are being felt across the country, and I am proud to join Insurance Commissioners from coast to coast in recommending short and long-term policy solutions,” said Delaware Insurance Commissioner Trinidad Navarro.

A letter sent by the group of commissioners detailed six immediate or critical policy recommendations and six longer-term recommendations for the Biden administration to consider.

Immediate policy recommendations

• Ensure immediate access to the federal marketplace, Healthcare.gov, through a special enrollment period.
• Provide immediate relief from Affordable Care Act (ACA) subsidy clawbacks created by COVID-19 uncertainty.
• Provide clarity on COVID-19 testing coverage requirements, especially in regard to tests that are ordered as part of state-based contact tracing efforts.
• Partner with states in actively focusing on programs and practices that address the needs of historically marginalized communities.
• Address problematic elements of the recently proposed Notice of Benefit and Payment Parameters (NBPP) for Plan Year 2022.
• Allow flexibility for states aiming to pursue progressive policy aims by empowering them to apply for ACA innovation waivers beyond reinsurance.

Longer-term policy priorities

• Reverse policies, such as the weakening of non-discrimination protections and the public charge rule, that undermine the ACA and deny health care coverage to many people.
• Encourage both people and small businesses to enroll in ACA programs, and stop encouraging enrollment in insurance plans that do not provide the ACA’s most critical consumer protections.
• Improve income counting rules to allow consumers greater flexibility.
• Extend premium tax credits to Deferred Action for Childhood Arrivals (DACA) recipients so that legally present noncitizens have access to health care coverage.
• Modernize Department of Labor oversight of the Employee Retirement Income Security Act to ensure all health insurance coverage is held to similar standards.
• Consider a national reinsurance program to stabilize health insurance markets and improve affordability of health insurance coverage.

Enacting these policy recommendations will provide immediate relief to many Americans affected by the COVID-19 crisis, provide states with flexibility to strengthen health insurance markets, remove discriminatory barriers to health coverage, protect the coverage needs of Americans with pre-existing conditions, and ensure comprehensive health insurance access is available to all Americans.

The following state insurance commissioners developed these recommendations and are committed to working with the Biden administration on its national health care plan:
Commissioner Ricardo Lara, California
Commissioner Michael Conway, Colorado
Commissioner Trinidad Navarro, Delaware
Commissioner Colin M. Hayashida, Hawaii
Director Anita G. Fox, Michigan
Temporary Commissioner Grace Arnold, Minnesota
Commissioner Andrew R. Stolfi, Oregon
Commissioner Jessica K. Altman, Pennsylvania
Health Insurance Commissioner Marie Ganim, Rhode Island
Commissioner Mike Kreidler, Washington
Commissioner Mark Afable, Wisconsin

View the Commissioners’ Letter