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

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

Governor John Carney published an op-ed about progress made in Delaware to get more Delawareans health insurance coverage, and reminds Delawareans the ACA health insurance marketplace enrollment period ends December 15. 

Ten years ago, before President Obama signed the Affordable Care Act into law, it was legal for insurance companies to deny Delawareans health coverage because they had diabetes or another pre-existing condition.

Across our state, more than 11 percent of Delawareans went without insurance. They skipped preventive visits to their doctors. And they accepted that a health crisis could also mean losing all their savings, or worse.

In the years since, we have made substantial progress in reducing the number of uninsured Delawareans.

With federal assistance, we have expanded our Medicaid program to provide quality health insurance coverage for Delaware families who need it the most. And more than 22,000 Delawareans have signed up for a health plan under the ACA health insurance marketplace.

Since implementation of the ACA, we have nearly cut our uninsured population in half in Delaware. And here’s some good news this year: rates on the ACA health insurance marketplace are down almost 20 percent, which we hope will encourage more Delawareans to get covered.

This is because, working with the General Assembly, we passed House Bill 193 into law, creating a reinsurance program which helped drive down the cost of coverage on the ACA marketplace.

In addition, some people will qualify for premium assistance, making the plans even more affordable.

That’s a really big deal. And as we near this year’s deadline of open enrollment on the ACA health insurance marketplace, we want to make sure even more Delawareans get covered.

For Delawareans who don’t have coverage through their employers, and for those who already have insurance through the ACA marketplace, I want to remind you and urge you to shop and compare ACA marketplace plans.

If you don’t have coverage, you need to act quickly. Enrollment on the ACA marketplace is open through December 15. Visit ChooseHealthDE.com to review your options and enroll at healthcare.gov.

If you’re not sure if can afford coverage on the marketplace, Westside Family Healthcare has health care navigators to help walk you through your options, including whether you and your family are eligible for financial assistance.

To make an appointment with a marketplace navigator, call Westside Family Healthcare at 302-472-8655 in New Castle County or 302-678-2205 in Kent and Sussex counties. Or visit ChooseHealthDE.com.

We know that we still have a lot of hard work to make health care more affordable for Delawareans and Delaware families. That’s why – working with members of the General Assembly – we created the new reinsurance program.

And that’s why we are working with health care providers on an initiative to bring transparency to health care prices and give Delaware consumers more information when they are making decision on where to get care.

Our overall goals are to reduce health care costs costs, and improve affordability and health outcomes for Delawareans across our state.

Our overall goals are to reduce health care costs and to improve affordability and health outcomes for Delawareans across our state. To do this, we need to build on the foundation of the ACA until all Delawareans are able to get the quality health care they deserve.

John Carney is the 74th Governor of the State of Delaware.

New laws codify ACA consumer protections in Delaware law and provide dental coverage for Medicaid recipients

WILMINGTON, Del. –  At Westside Family Healthcare, Governor John Carney joined members of the General Assembly and health care advocates to sign Senate Bill 35 and Senate Substitute 1 for Senate Bill 92, two pieces of legislation that will protect quality health care coverage for Delawareans and Delaware families.  

Senate Bill 35 codifies consumer protections of the Affordable Care Act in Delaware law – including protections for Delawareans with pre-existing conditions, the guaranteed availability of coverage, and permissible rating factors. Senate Substitute 1 for Senate Bill 92 will provide dental coverage for all eligible adult Medicaid recipients.

“All Delawareans and Delaware families deserve access to quality, affordable health care,” said Governor Carney. “Both of these pieces of legislation will help us deliver on that promise. Senate Bill 35 will codify in Delaware law many of the protections in the Affordable Care Act – including protections for Delawareans with pre-existing medical conditions. And adults on Medicaid will finally have access to affordable dental coverage, which we know is important to overall health. Thank you to Senator Paradee, Senator Townsend, and all members of the General Assembly for their partnership on this important issue.”

“Ensuring that Medicaid patients can access primary dental care touches on so much of what we are here to do,” said Senate Majority Whip Bryan Townsend. “It improves health care access for working families, makes our entire health care system more affordable and efficient by expanding preventative and primary care options, and upholds human dignity in a small but incredibly impactful way. I am thankful for the persistent, people-first leadership of our local health care advocates, doctors, and experts and I thank my colleagues in the House and Senate for making sure Delaware finally takes this critical step.”

“Quality, affordable health care – particularly protections for people with pre-existing conditions – should be available to every Delaware resident, not a political football to be yanked out from under them when they need it most,” said Representative Bill Bush. “By codifying key parts of the ACA, we are protecting this right for Delawareans for years to come, regardless of what happens in Washington.”

“Ensuring that Delawareans continue to receive the vital health care they need and deserve is paramount to my mission as Insurance Commissioner,” said Delaware Insurance Commissioner Trinidad Navarro. “Under this bill, Delaware guarantees that the most vulnerable consumers will continue to receive coverage. I thank Representative Bush and Senator Paradee for their commitment to protecting Delaware consumers.”

Photos from the signing ceremony can be found here.

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NEW CASTLE (Dec. 22, 2017) – Despite significant challenges to enrollment, almost 25,000 Delawareans signed up for coverage for 2018 on Delaware’s Health Insurance Marketplace. The enrollment total was about 10 percent lower than the 27,584 who signed up last year.

On Thursday, the Centers for Medicare and Medicaid Services (CMS) released Delaware’s enrollment total of 24,860 for the six-week enrollment period that ended Dec. 15. This year’s enrollment period – the fifth year for open enrollment – was half as long as it was last year. Nationally, almost 9 million people signed up for coverage in the 39 states that use HealthCare.gov for the online enrollments.

“I am pleased that so many Delawareans saw the value and the need in having health insurance coverage despite the challenges they faced this year during open enrollment,” Governor John Carney said. “Health insurance provides that critical connection to quality health care. That connection is the first step toward building a healthier Delaware.”

Earlier this year, Aetna announced it would not sell plans on Delaware’s Health Insurance Marketplace for 2018 leaving Highmark Blue Cross Blue Shield of Delaware as the only insurer on the marketplace. That meant enrollees who had coverage through Aetna Health or Aetna Life for 2017 had to choose one of seven Highmark plans that were available for purchase in 2018 or they were automatically enrolled in a similar plan offered by Highmark. In October, just before the start of open enrollment on Nov. 1, Insurance Commissioner Trinidad Navarro announced that the Department of Insurance had approved an average rate increase of 25 percent for Highmark’s plans for 2018.

“I am grateful that we were able to get out the message to Delawareans that health insurance is important to have and that financial assistance was available to help them pay for it,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “Our federal navigators, enrollment assisters and insurance agents and brokers did an outstanding job of working with people to help them understand their options, including the availability of federal financial assistance.”

During 2017, more than 81 percent of Delaware enrollees received financial assistance, including tax credits, which help to reduce the cost of monthly premiums. The percentage of Delawareans who received financial assistance for 2018 is not yet available. Financial help was available to individuals with an annual household income up to $47,520 and up to $97,200 for a family of four. CMS plans to release a full enrollment report in March.

“Despite the challenge of a much shorter enrollment period and little funding for marketing, Delaware still enrolled thousands of people who may not otherwise have been able to get covered,” said U.S. Senator Tom Carper. “I will continue my work to strengthen the health insurance marketplace and bring down the cost of healthcare for all Delawareans.”

In addition to insurance agents and brokers, Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown provided one-on-one enrollment assistance. Those assisters now will help people who have questions about using their health insurance and they also can help people who qualify for a special enrollment. Individuals who experience a life-qualifying event such as the birth or adoption of a child, marriage or divorce, moving from one state to another, or losing coverage through employment are eligible to shop for and enroll for coverage on the health insurance marketplace outside of the open enrollment period. To learn more about special enrollments, go to HealthCare.gov. 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 have received coverage under the Medicaid expansion. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

“Access to quality healthcare is the foundation for healthy communities,” said Delaware Insurance Commissioner Trinidad Navarro. “Notwithstanding the obstacles during the shortened open enrollment period, Delawareans made clear their willingness to participate in the Affordable Care Act. I commend the efforts of DHSS and the navigators who assisted consumers. I also thank the federal delegation for their efforts to try to extend the signup period.”

Under the Affordable Care Act, individuals who can afford health coverage, but who choose not to buy it are subject to paying a penalty when they file their federal tax return for the year they don’t have coverage. For 2017, the fee will be equal to the higher of these amounts: 2.5 percent of annual household income or $695 per adult, plus $347.50 for each child under 18. The maximum amount is $2,085 per household. In addition to the fee, consumers will be responsible for the total cost of any health care expenses they incur. Under the tax cut just passed by Congress and awaiting the signature of President Donald Trump, the individual mandate will be repealed beginning for the 2019 tax year.

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The Department of Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.