NEW CASTLE (Dec. 14, 2020) – Delawareans have until Tuesday, Dec. 15, to sign up for or change their health coverage for 2021 through Delaware’s Health Insurance Marketplace. For those who enroll by the deadline and pay their first premium, coverage will begin Jan. 1, 2021. State residents can sign up for coverage at www.HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). Free assistance is available through Westside Family Healthcare at 302-472-8655 in New Castle County and 302-678-2205 in Kent and Sussex counties or enrollment@westsidehealth.org. State-licensed insurance agents and brokers also can help individuals enroll or re-enroll and help employers update their coverage, at no extra charge. For contact information and other details about Delaware’s Health Insurance Marketplace, go to www.ChooseHealthDE.com.

Individuals who don’t act by Dec. 15 cannot get 2021 coverage unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, birth or adoption of a child, a permanent move, marriage or divorce, or other qualifying factors.

To speed up the enrollment process, Delawareans should have the following documents or information ready:

• Birth dates of those applying for coverage.
• Social Security numbers of those applying for coverage.
• Pay stubs, W-2 forms or other information detailing your family’s income.
• Policy or member numbers for any current health insurance plans.
• Information about any health insurance that is available to you or your family through a job.
• Your log-in and account information if you have previously enrolled on the Health Insurance Marketplace.

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. Check with your health insurance company for their specific benefits and coverage policy. If you already have coverage through the Health Insurance Marketplace,

the rules in your marketplace plan for treatment of COVID-19 remain the same as for any other viral infection, but your health insurance company may have added benefits. Log in to HealthCare.gov to update your marketplace application if COVID-19 impacts your income or household. You may be able to change your plan if certain situations apply.

Rates on Delaware’s Health Insurance Marketplace have decreased more than 19 percent on average over the past two years. Monthly premiums for 2021 plans in Delaware are 1 percent lower on average than the 2020 plans. Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace. Enrollees can choose from among 12 Highmark plans for 2021 or they will be re-enrolled automatically in a plan similar to their current one.

About 86 percent of last year’s enrollees in Delaware qualified 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.

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.

For 2021, Highmark offers 12 plans for individuals and families – three gold plans, three silver, three bronze, two platinum, and one catastrophic. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – offer a collective 11 stand-alone dental plans on the marketplace, six with a low actuarial level (70 percent) and five with a high actuarial level (85 percent).

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

Through Nov. 28, 7,748 Delawareans had signed up for 2021 coverage through the marketplace, an increase of 5.7% from a similar period last year.

Last year, nearly 24,000 people signed up or renewed their coverage during open enrollment, including about 70 percent during the final three weeks. Open enrollment began Nov. 1.

“I urge Delawareans who need coverage through the Health Insurance Marketplace to take action now to enroll,” said Department of Health and Social Services (DHSS) Secretary Molly Magarik. “Go to HealthCare.gov or take advantage of our local resources to see the 2021 plans and find out if you qualify for financial assistance.”

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

Thousands of Highmark 2019 plan participants and groups to receive checks

After announcing a reduction of Delaware Health Insurance Marketplace rates for the upcoming enrollment year, Insurance Commissioner Trinidad Navarro has more good news for residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Blue Cross Blue Shield Delaware plans outside of the exchange in the individual market, and for Highmark small group policyholders, announcing more than $21.5 million in rebates for 2019 participants.

“Now, more than ever, we need to make sure that every resident and small business can afford the health insurance they need for their families and employees. These rebates, combined with the ACA health insurance rate reduction for the coming year, do just that,” said Commissioner Navarro. “This is just one of many ways we are working to reduce the cost-of-care our residents experience in the health care system.

For the first time in the history of Delaware’s individual health insurance market, more than $12.6 million will be returned to 19,273 policyholders, with the average rebate being $656. Highmark small groups, often small businesses, will receive more than $8.8 million in cumulative return. 2,779 groups will receive an average rebate of $3,198, with more than 175 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 21. 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.

These rebates are required by the Delaware Department of Insurance according to Medical Loss Ratio (MLR) measurements set by the Affordable Care Act, which are meant to ensure that insurers are spending a majority of premiums on health claims and clinical services, not taking those dollars for profit or administrative expenses. The rebate system creates balance when data shows that this ratio was off in a previous year. Not every policy will receive a rebate. MLR review for the 2020 plan year will shine a light on changes in insurance usage due to COVID-19 and will be released in 2021.

On August 31, Commissioner Navarro announced the Delaware Health Insurance Marketplace would see an average decrease in rates of 1% for individual plans. Highmark small group plans will see an average premium decrease of 3%.

Second consecutive year of reductions in health insurance rates

In a year when the nation’s attention is firmly focused on healthcare and its costs, Delaware Insurance Commissioner Trinidad Navarro has announced another reduction in rates on the Delaware Health Insurance Marketplace. Despite insurer costs related to COVID-19 testing and treatment, Commissioner Navarro negotiated an average decrease of 1% in health insurance rates. Highmark Blue Cross Blue Shield Delaware, who offers the state’s Affordable Care Act health plans, initially submitted a reduction of 0.5%. The Commissioner’s final rate announcement comes after an independent actuarial review and public comments on the insurer’s proposal.

“I am proud to announce today the second consecutive rate decrease for Delaware’s Affordable Care Act plans. Amid a global pandemic, it is more important than ever for residents to have access to affordable insurance. Given the difficult economic climate, more people are relying on the Marketplace for the coverage they need,” said Commissioner Navarro. “With this decrease, we send a strong message about the effectiveness of the ACA during its 10th anniversary year. We will continue to fight to ensure access to affordable coverage for all Delawareans.”

In 2019, after successfully applying for a 1332 reinsurance waiver, the state was able to negotiate an average rate decrease of 19% for 2020 plans. This year’s modest reduction reflects market stabilization following the implementation of reinsurance.

After the rate reductions for the 2020 plan year, enrollment spiked by 6.3% during the traditional enrollment period. As of the start of the year, nearly 24,000 Delaware residents participated in marketplace-offered plans. While the federal government has not opened enrollment in response to COVID-19, residents losing employer-sponsored health coverage due to the economic impacts of the pandemic may qualify for special enrollment outside of the traditional enrollment period.

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 news of the second consecutive rate decrease comes as the department is implementing other consumer cost-of-care protection efforts, including regulating Pharmacy Benefit Managers to control and reduce medication cost, and continuing efforts to create an Office of Value-Based Healthcare Delivery to focus on primary care affordability and availability.

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

More information on the rate review process

NEW CASTLE (Dec. 23, 2019) – With a new reinsurance program driving down the cost of monthly premiums, enrollment on Delaware’s Health Insurance Marketplace increased more than 6% during the open enrollment period that ended earlier this month.

Open enrollment began on Nov. 1 and ended Dec. 17, after the U.S. Department of Health and Human Services extended the sign-up period by two days because of technical glitches on Dec. 15, the final scheduled day to buy coverage. Through Dec. 17, a total of 23,981 Delawareans had signed up for 2020 coverage through the marketplace, an increase of 6.3% from a similar period last year, when a total of 22,562 people enrolled. Nationally, enrollment declined slightly to 8.3 million, or a drop of about 2.4% from 2018.

For those who enrolled by Dec. 17 and paid their first premium, coverage will begin Jan. 1, 2020.

“We are pleased that an increased number of Delawareans decided to buy coverage through Delaware’s Affordable Care Act health insurance marketplace,” Governor John Carney said. “Since the ACA was implemented, we have nearly cut the uninsured population in half in our state. That is another important step in moving us to a stronger and healthier Delaware.”

Under Delaware’s new reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone will be reimbursed through a $27 million fund, using a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. With the reinsurance program in place, the sole insurer on Delaware’s marketplace reduced premiums for 2020 on average by 19%. It was the first time that premiums declined since the marketplace opened for enrollment in 2013.

“I am grateful to Governor Carney, the General Assembly, the Congressional Delegation, the Department of Insurance and many other community partners in supporting the reinsurance program for our state, which drove down the cost of premiums on Delaware’s marketplace,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a practicing family physician. “As a physician, I know that having coverage makes a big difference for people because they have that critical connection to quality health care.”

For 2020, Highmark Blue Cross Blue Shield of Delaware is the only insurer on Delaware’s marketplace, offering a total of eight plans for individuals and families – two gold plans, two silver, three bronze and one platinum. The metal categories are based on how enrollees choose to split the costs of care with their insurance company. Two insurers – Delta Dental of Delaware, Inc., and Dominion Dental Services, Inc. – offer a total of 11 stand-alone dental plans, six with a low actuarial level (70 percent) and five with a high actuarial level (85 percent).

With the end of open enrollment, Delawareans can enroll in coverage only if they experience a life event that qualifies them for a special enrollment period. Among the many qualifying life events are birth or adoption of a child, a permanent move, loss of other coverage through a job, and marriage or divorce. In addition to the health insurance marketplace, some Delawareans might be eligible for coverage through Delaware’s expanded Medicaid program, which is open year-round. More than 10,000 Delawareans have received coverage under the Medicaid expansion. To be screened for eligibility or to apply for Medicaid benefits, go to Delaware ASSIST.

Dover, DE – Insurance Commissioner Trinidad Navarro officially announced the final approval of the 2019 Affordable Care Act (“ACA”) rates. Highmark Blue Cross Blue Shield of Delaware (“Highmark BCBSD”), the only insurer currently on the Marketplace, originally proposed a rate decrease of 5.8% for its 2019 individual Marketplace business. Commissioner Navarro, ultimately approved a decrease of 19%, after the implementation of a state-run reinsurance program, the first decrease ever since the Marketplace opened in 2013.

The approved decrease was a result of federal approval for the State of Delaware to implement a state-run reinsurance program as established pursuant to the 1332 State Innovation Waiver Application (“Waiver”). Under this program, individual market policies that meet certain minimum criteria, as set forth in the Waiver, will be eligible for reimbursement from a state-administered fund. The fund will be financed through a 1% assessment on the individual, small and large group market premium amounts for all health insurance carriers operating in those markets in Delaware. The assessment will take place annually and may vary depending on the federal government’s actions on the Health Insurance Industry Fee.

“I am happy to announce the first rate decrease in Delaware since the beginning of the Health Insurance Marketplace. In spite of the many efforts in Washington to dismantle the Affordable Care Act, we have been able to work with our state counterparts and stakeholders to give Delaware policyholders much-needed premium relief. I thank Secretary Walker for the work she and her team at DHSS put into seeing the Waiver across the finish line.”

Because this year’s filing may result in lower costs for many consumers, the Department urges consumers to examine their rates and reapply for coverage through the Marketplace.

Presently, approximately 23,000 Delawareans have health insurance through the Affordable Care Act and may be affected by these rates.

Please be advised that the proposed rate decrease will not apply to Delawareans on Medicare, Medicaid, or those with group or individual policies outside of the Marketplace.

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Contact: Vince Ryan

Office: (302) 674-7303

Email: vince.ryan@delaware.gov

Delaware Department of Insurance

http://www.insurance.delaware.gov

Dover Office: 302-674-7300

Consumer Services Division: 1-800-282-8611