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.

With state’s new reinsurance program in place, premiums for 2020 will be down 19%; biggest impact for those not eligible for financial help

NEW CASTLE (Oct. 31, 2019) – With the state’s new reinsurance program in place and premiums declining for the first time since Delaware’s Health Insurance Marketplace opened for enrollment in 2013, Delawareans are urged to take another look at marketplace plans during open enrollment for 2020 coverage, beginning Friday. The 19 percent drop in rates is especially significant for Delawareans who are not eligible for financial assistance on the marketplace.

The seventh open enrollment period, in which people can renew coverage or sign up for a new plan for 2020, runs from Friday, Nov. 1, through Dec. 15, at www.HealthCare.gov. Coverage for enrollees who sign up by Dec. 15 and pay their first month’s premium will be effective Jan. 1.

The state will formally mark the Health Insurance Marketplace’s seventh enrollment period with a press conference at 10 a.m. Nov. 4 at Westside Family Healthcare’s Dover Clinic, 1040 Forrest Ave. For the second straight year, Westside is the only organization in Delaware to receive federal funding for navigators to help people enroll for coverage either in person or over the phone.

“The reduction in rates for 2020 offers an important incentive to compare and shop for plans on our marketplace, especially for Delawareans who own small businesses, are independent contractors or who don’t have access to health insurance through an employer,” Governor John Carney said. “I want to thank everyone who helped create Delaware’s new reinsurance program as a critical tool to reduce rates in the individual market. It’s another way that we can connect people to quality care in our state and to better health.”

Under Delaware’s 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. The Delaware Health Care Commission will administer the program. The reinsurance program required multiple approvals at the state and federal levels. In June, Governor Carney signed enabling legislation (House Bill 193) approved by Delaware’s General Assembly that same month. In August – after public comment periods at the state and federal levels – the federal Centers for Medicare and Medicaid Services (CMS) approved Delaware’s application providing for a reinsurance program through 2024. In October, Insurance Commissioner Trinidad Navarro announced that he had approved an average rate decrease of 19 percent for the sole insurer on Delaware’s Marketplace – Blue Cross Blue Shield of Delaware. Enrollees will choose one of eight Highmark Blue Cross Blue Shield of Delaware plans that are available for purchase in 2020 or they will be automatically re-enrolled in a plan that is similar to the one they currently have.

Last year, about 22,562 people enrolled for coverage through Delaware’s Health Insurance Marketplace, including about 78 percent who re-enrolled for 2019 and 22 percent who were new enrollees.

Federal tax credits are available for those whose household income is between 138 percent and 400 percent of the Federal Poverty Level. For 2020, that’s between $17,236 and $49,960 for an individual, or between $35,536 and $103,000 for a family of four. For coverage in 2019, about 85 percent of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the month premium.

“When premiums decline in the individual market – both on and off the marketplace – that often helps to reduce health insurance costs for everyone,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker. “With premiums down 19 percent for the 2020 marketplace plans in Delaware, I urge everyone to shop for coverage on Delaware’s marketplace or to talk with their insurance agent or broker. For those who already have coverage, I encourage them to go back to HealthCare.gov or to their agent, update their information and compare plans to make sure they have the best coverage to meet their health care needs and their budget.”

“This year, our team working with the Department of Health and Social Services, utilized the Federal 1332 Waiver to see if we could further reduce health insurance rates on the ACA Market,” Commissioner Navarro said. “I’m pleased that with the waiver, we were able to reduce rates by 19 percent. The initial rate filing by Highmark Blue Cross Blue Shield of Delaware indicated a rate reduction of 5 percent. Our team at the Department carefully scrutinizes all rate requests, even the ones that reduce rates, to determine if they can be reduced further. In addition, we utilize an outside actuarial firm with no ties to insurance companies to make sure the approved rate is the lowest possible rate after taking into consideration all actuarial factors. I urge all Delawareans to log on to ChooseHealthDE.com and check the plan that best works for their situation.”

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, the maximum annual out-of-pocket cap for 2020 is $8,200 for an individual and $16,400 for a family.

For 2020, Highmark Blue Cross Blue Shield of Delaware will offer a total of eight plans for individuals – two gold plan, two silver, three bronze and one platinum. Two insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – will 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 plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 36 percent of current enrollees qualify for cost-sharing reductions.

All plans cover 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, and pediatric services.

Assistance for Delaware enrollees

Cosumers can go to HealthCare.gov or CuidadodeSalud.gov now to check out their options for 2020, and can enroll at any time between Nov. 1 and Dec. 15. The Centers for Medicare and Medicaid Services (CMS) announced earlier this month that the online application has been streamlined and that for the first time quality ratings will be displayed on plans on HealthCare.gov, using a five-star rating system, with five stars representing the highest quality. The rating will be based on medical care, member experience and plan administration. In some cases – when plans are new or have low enrollment – ratings may not be available. A rating of three stars or above means a health plan is considered average or above average. For 2020, 80 percent of plans eligible to receive a rating have at least three stars.

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, and by certified applications counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown.

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 www.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:

• Eighty-five percent of Delaware’s current marketplace enrollees receive financial assistance to help pay their monthly premiums and/or deductibles and co-pays.
• The overall current average monthly premium in Delaware is $842, with the average premium reduced to $202 per month after tax credit. For the 85 percent of Delawareans who currently receive financial assistance, the average premium after tax credit is $110 per month.
• Among the more than 22,562 current enrollees, 78 percent were re-enrollees and 22 percent were new enrollees for 2019.
• Financial help is available for individuals with annual incomes up to $49,960; for a family of four the income limit is $103,000.
• About 75 percent of Delaware’s current enrollees signed up during the final three weeks in 2019, Nov. 25-Dec. 1, Dec. 2-8, and Dec. 9-15.
• Beginning in 2019, there is no longer a federal tax penalty for individuals who can afford coverage, but who choose not to buy it.

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.

“Lower average premiums across the country and a double-digit drop in Delaware shows that we should be focused on building on the success of the ACA – not tearing it down,” U.S. Senator Tom Carper said. “By making common sense improvements, like our state has done with the reinsurance program, we can continue to provide Delaware families with access to quality, affordable health insurance which in turn can lead to better health outcomes and reduced costs. I often say, find out what works and do more of that – and the Affordable Care Act is working. Now, we must continue to build on this progress to achieve even lower costs for families across the country and protect the Affordable Care Act that insures over 20 million Americans, including more than 20,000 Delawareans, from continued partisan attacks and attempts to scrap the law entirely. This open enrollment season, I encourage Delawareans who need health insurance to look to the marketplace and get covered.”

“Open enrollment gives Delawareans the chance to explore the different health care coverage options that are available to them each year,” said U.S. Senator Chris Coons. “Even if you have already enrolled, I encourage everyone to take this opportunity and visit the Health Insurance Marketplace at HealthCare.gov. You can update your information, compare plans, and make sure you and your family are enrolled in the plan that best fits your needs. Thanks to the Affordable Care Act, open enrollment offers folks throughout the country access to affordable, comprehensive health care coverage, regardless of how old you are, where you’re from, or whether you have a pre-existing condition.”

“Despite repeated actions from the federal government to shorten the enrollment period and cut critical outreach programs that inform consumers, I’m pleased to see such a substantial drop in premiums this year,” said Congresswoman Lisa Blunt Rochester, a member of the House Energy & Commerce Committee. “With this shortened enrollment window, it’s critical that anyone who needs coverage go to HealthCare.gov to explore what options best suit them.”

Businesses with 50 employees or fewer can offer plans to their employees starting any month of the year through the Small Business Health Options Program (SHOP). Go to HealthCare.gov or call 1 (800) 706-7893 (TTY: 711).

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage though 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.

Both the Health Insurance Marketplace and the Medicaid expansion have helped to reduce Delaware’s uninsured rate, decreasing from 10 percent in 2008 to 5.7 percent in 2018, according to a recent Census Bureau report. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions. Increasing access to health care coverage is the first step toward a healthier Delaware, Secretary Walker said.

“Through our work on the health care spending and quality benchmarks for Delaware, we are adding a level of transparency to our health care system so we all can better understand where that spending is going and how those costs relate to the outcomes patients are receiving,” Secretary Walker said.

On June 20, Gov. John Carney signed enabling legislation (House Bill 193) moving Delaware a step closer to a reinsurance program beginning in 2020.

NEW CASTLE (Aug. 20, 2019) – The Department of Health and Social Services (DHSS) received approval today from the Centers for Medicare and Medicaid Services (CMS) for a 1332 State Innovation Waiver under the Affordable Care Act to create a reinsurance program beginning in 2020 as a way to reduce premiums by up to 20 percent in Delaware’s individual health insurance market.

Under Delaware’s reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone on the individual market will be reimbursed through an estimated $27 million fund. The fund will use a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. The Delaware Health Care Commission will administer the program.

Coupled with reduced rates already sought on the individual market in Delaware, the state expects a significant reduction in premiums for 2020. CMS authorized Delaware’s reinsurance program through 2024.

“We are grateful to CMS for approving Delaware’s 1332 State Innovation Waiver application that will enable us to establish a reinsurance program in our state,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “We expect that the reinsurance program will further stabilize the individual health insurance market and make premiums more affordable for Delawareans who need such coverage.”

“The number one complaint/comment we receive from consumers at the Department of Insurance is the high cost of health insurance, especially from those who are not eligible for tax credits,” Insurance Commissioner Trinidad Navarro said. “With this new waiver program, people who earn above 400 percent of the federal poverty level, small business owners, and those who are not covered by their employers will save up to 20 percent on their health insurance premiums in the individual market. My office will continue to work to seek any and all means to help make health insurance more affordable for Delawareans.”

The CMS approval was the final step in a months-long process that included a recommendation from a working group that included DHSS, the Department of Insurance, legislators and other stakeholders, enabling legislation approved by Delaware’s General Assembly in June and signed into law by Gov. John Carney, and public comment periods at the state and federal levels.

Delaware is the 11th state to receive CMS approval for a reinsurance program. A March 2019 analysis by health care consultant Avalere found state-run reinsurance programs reduce premiums by almost 20 percent on average in their first year.

In addition to reducing premiums on the marketplace, the reinsurance program will benefit anyone who buys coverage on the individual market, including people who are not eligible for coverage at their workplace, those who are too young for Medicare or make too much money to be eligible for Medicaid, young people who have aged off their parents’ plans, or those who are self-employed.

In 2019, about 21,000 people enrolled for coverage on Delaware’s Health Insurance Marketplace. Open enrollment for 2020 will begin Nov. 1 and run through Dec. 15. To learn more about the marketplace, go to ChooseHealthDE.com.

-30-

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

July 1, 2019 

Dover, DE—Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.

The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.

Commissioner Trinidad Navarro stated, “The silver loading strategy is something my staff and I gave careful consideration to last year, in anticipation that it would result in rate stabilization or possibly a decrease.  While I am happy that we will see a decrease in the proposed rate, health insurance remains unaffordable for many Delawareans who do not qualify for premium subsidies. We are committed to reviewing the proposed rate decrease with the same careful analysis that we would give any rate proposal, whether it be an increase or decrease.  I expect to announce the approved rate later this summer.”

It is important to note, that the proposed rate decrease is unrelated to Delaware’s intended submission of a 1332 Waiver to establish a reinsurance program. If the application process is successful, the actuarial consultant’s projections are correct, and the State of Delaware secures adequate funding, the waiver program may decrease rates by an additional 20%.

                                                                                           ###

The Delaware Department of Insurance protects Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.

Contact:

Vince Ryan

Sr. Advisor to the Commissioner

Vince.ryan@delaware.gov

Office: 302-674-7303