NEWS FROM THE DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Open Enrollment Starts Tuesday
for Delaware’s Health Insurance Marketplace
Delawareans who seek coverage through HealthCare.gov are urged
to take advantage of subsidies to offset rise in premium costs

NEW CASTLE (Oct. 31, 2016) – The fourth open enrollment period for Delaware’s Health Insurance Marketplace starts Tuesday as the state prepares to build on the progress of the last three years, in which more than 28,000 Delawareans signed up for coverage and the state’s uninsured rate dropped an estimated 35 percent.

The open enrollment period, in which people can renew current coverage or sign up for a new plan for 2017, runs from Nov. 1 through Jan. 31, 2017, at www.HealthCare.gov. Individuals must sign up by Dec. 15 for their coverage to be effective Jan. 1.

The state will formally mark the Health Insurance Marketplace’s fourth enrollment period with a press conference at 1 p.m. Nov. 10 at Westside Family Healthcare’s Bear office, 404 Fox Hunt Drive in the Fox Run Shopping Center off U.S. 40.

In the face of increased cost of premiums, Delaware is making an extra effort this enrollment season to make sure residents who do not have employer-sponsored health insurance or who are not eligible for public programs such as Medicare, Medicaid, and the Children’s Health Insurance Program are aware of the federal subsidies available when they buy private plans through the Health Insurance Marketplace, also known as Obamacare.

“Many people still don’t realize they can get financial help paying for their Marketplace coverage,” said Rita Landgraf, secretary of the state Department of Health and Social Services. “This year, more than 80 percent of Delawareans who have a Marketplace plan are receiving tax credits to lessen the costs of their premiums. I urge anyone who needs high-quality, affordable health insurance to go to HealthCare.gov to shop for a plan, and I encourage those who are already enrolled to go back to the website, update their information and pick a plan that meets their health needs and budget.”

Consumers can go to HealthCare.gov now to check out their options for 2017. Individuals who need help enrolling in coverage will again have access to free in-person assistance from federally funded and trained specialists at several Delaware organizations, including Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center and La Red Health Center.

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 http://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:

• Sixty-three percent of Delawareans who now have Marketplace coverage could get 2017 coverage for a monthly premium of $100 or less after tax credits, 55 percent could get coverage for $75 or less, and 45 percent could get coverage for $50 or less.

• Sixty-three percent of current Marketplace enrollees whose annual household incomes are between 100 percent and 250 percent of the federal poverty limit (from $11,880 to $29,700 for one person and from $24,300 to $60,750 for a family of four) are receiving financial assistance. Financial help is available for individuals with annual incomes up to $47,520; for a family of four the income limit is $97,200.

• The median annual income of Marketplace enrollees in Delaware is about $25,000 for one person and $51,400 for a family of four.

As in previous years, three insurers will offer Marketplace medical plans in Delaware for 2017: Highmark Blue Cross Blue Shield of Delaware, Aetna Health, and Aetna Life Insurance Company. Across the insurers, they will offer a total of 21 plans for individuals and 11 SHOP plans for small businesses. Two insurers – Delta Dental and Dominion Dental – will offer a collective 15 stand-alone dental plans, 10 for individuals and five for small businesses.

Rates in 2017 will increase an average of 32.5 percent for Highmark plans, 23.6 percent for Aetna Health and 22.8 percent for Aetna Life.

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.

Medical plans will be available in three metal-level categories – bronze, silver and gold – 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.

Tax credits are especially beneficial to consumers who pick the second-lowest cost silver plan, since the credits adjust to match any changes in premium. In a silver plan, the insurer pays about 70 percent of medical costs and the consumer pays about 30 percent, up to a maximum annual out-of-pocket cap of $6,350 for an individual and $12,700 for a family.

In Delaware in 2017, the average monthly premium for a second-lowest cost silver plan for a 27-year-old non-tobacco user will be $347 before tax credits based on eligibility are applied.

Consumers who pick silver plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance.

Penalty for going without coverage

Individuals who can afford coverage but who choose not to buy it will pay a fee equal to the higher of these amounts: 2.5% of your annual household income or $695 per person ($347.50 per child under 18). The maximum penalty will not exceed $2,085 per household or the total yearly premium for the national average price of a bronze-level plan sold through the Marketplace. In addition to the penalty, consumers will be responsible for the total cost of health expenses they incur.

Consumers can estimate their penalty using the penalty calculator available on ChooseHealthDE.com.

Delaware’s senators and congressman urged uninsured Delawareans to find out what’s available for them on the Marketplace.

“Over the last several years, I’ve had a chance to meet with Delawareans who found affordable health care and peace of mind through the Health Insurance Marketplace,” Sen. Tom Carper said. “With open enrollment about to begin, I strongly urge all uninsured individuals to go to ChooseHealthDE.com to get information about the various health insurance plans available and potential financial assistance they may qualify for to reduce their insurance costs. And because enrolling in health insurance can be overwhelming, there is free, in-person assistance available to help individuals and families. Every Delaware family deserves access to the quality health care they need, and the Marketplace is making that a reality for thousands of Delawareans for the first time.”

“Open enrollment is a great opportunity for Delaware families to shop around in the Health Insurance Marketplace and find a plan that works best for them,” Sen. Chris Coons said. “I would encourage both the uninsured and insured to visit the Marketplace and explore plans and financial assistance that may be available to them. While we have more work ahead to improve the ACA and bring down health care costs, open enrollment is an important opportunity for families to get the comprehensive health care they need, regardless of age, background, or pre-existing conditions.”

Added Congressman John Carney: “Starting Tuesday, Delawareans will have another chance to purchase quality health care coverage for themselves and their families. While we still have work to do to bring down the cost of health care, the Marketplace has made it much easier for many Delawareans to access the care they need. I encourage everyone to take advantage of open enrollment and see what their options are.”

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.

Delaware’s uninsured population decreased from 83,000 in 2013 to 54,000 in 2015, 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 Landgraf said. “Through the Delaware Center for Health Innovation, we are striving to ensure that our health care system delivers quality care, produces better health outcomes, reduces costs and enhances the experience of health care providers. Those goals are at the heart of the Affordable Care Act.”

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For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office) or (302) 357-7498 (cell).

Delaware 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.

Commissioner Stewart Urges People without Coverage to Enroll Now

​Dover, DE – The open enrollment period for obtaining health insurance through Delaware’s Health Insurance Marketplace ends on January 31. If you want health insurance coverage to begin on February 1, you’ll need to enroll in a plan by January 15. If you enroll in a plan between January 16 and January 31, your health insurance will not take effect until March 1, 2016.

Insurance Commissioner Karen Weldin Stewart reminds Delawareans who think they can’t afford health insurance that eight out of ten people who enrolled in Delaware received help paying for their insurance. Find out if you qualify for financial assistance now by going to www.healthcare.gov.

If you don’t have health insurance coverage in 2016 you’ll risk having to pay a federal fee at tax time. You’ll pay a penalty of either 2.5% of your income, or $695 per adult ($347.50 per child) — whichever is higher. You pay the fee when you file your federal tax return for the year you don’t have coverage.

After January 31, 2016, you can’t buy a health insurance plan for the rest of 2016 unless you have a specific life change — like having a baby, getting married, or losing other health coverage — that qualifies you for a Special Enrollment Period.

Are you ready to enroll? Consumers can find more details about the various plans and their related premiums and deductibles, as well as any potential premium subsidies they may be eligible for, at www.healthcare.gov. If you need additional help choosing a plan, there are free and local assistance available across the state to help answer your questions. They can also assist you with the enrollment process – find their contact information at www.choosehealthde.com.

Commissioner Stewart also reminds you that scam artists are active as enrollment deadlines approach, so be cautious if you purchase a health plan through a site other than www.choosehealthde.com or www.healthcare.gov. Other websites may offer plans that don’t contain the coverage benefits available through the Affordable Care Act.

Don’t forget, small businesses can apply for SHOP coverage for their employees any time, all year. Go to https://www.healthcare.gov/small-businesses/employers/

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Dover, DE – Complications within health insurance marketplaces have created challenges for some new enrollees who have not yet received proof of their insurance coverage. As a result, some consumers are unsure if their medical treatments are covered. If you recently purchased a plan, but still haven’t received proof of insurance from your insurance company, the National Association of Insurance Commissioners (NAIC) and the Delaware Department of Insurance have some tips for confirming coverage.

Since open enrollment began on October 1, insurance companies have encountered multiple problems that have prevented the companies from being able to enter new members into their systems. Some companies received incomplete or incorrect information from the insurance marketplaces. Other companies were overwhelmed with the number of applications they received and were unable to process them by the time the new plans went into effect. This delay in providing proof of coverage has many consumers worrying if they really have insurance and wondering what to do next.

Contact the Company
The first thing you should do is contact your insurance company to verify that you do have insurance coverage. Insurance Commissioner Karen Weldin Stewart stated, “The insurance company will be able to verify if you are indeed enrolled in a plan or not. Some people signed up for a plan but never paid the premium so be sure to discuss your payment. And, of course, ask your insurance company for proof of coverage, such as an insurance card or identification numbers. Many insurance companies have a website, which, after setting up your account, will allow you to print a temporary ID card.”

When you speak to your insurance company, take detailed notes of the conversation. Include the date and time that the conversation took place, and the name of the representative. Hold on to copies of any written communication you received from your insurance company such as emails or letters as you may need these materials later. You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage that is retroactively effective to January 1, 2014. Find out your insurer’s deadline and keep any records that can serve as proof of payment.

If you have yet to purchase coverage but are planning on buying insurance through the federal Health Insurance Marketplace, www.healthcare.gov, print out any paperwork or confirmations that you receive during the enrollment process. If you do not have a printer save digital copies of forms or take “screenshots” of any confirmation numbers or account numbers. It never hurts to e-mail those digital forms to yourself so you can access them from anywhere or in case something happens to your computer.

Payment Options
You may need to get a prescription filled or see your doctor before you receive your insurance card. Your provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If verification of coverage cannot be obtained, you still have options. One option is to pay for expenses out of pocket. Once your insurance coverage is established, your insurance company should reimburse you to the extent that the service or medication is covered under your policy. You may also be able to work with your doctor’s office, hospital or pharmacy to delay payment or set up a payment plan until they can verify that you’re insured. Keep your receipts and any bank statements that show that you’ve paid for the services. It can sometimes be easier to track purchases made with a debit or credit card as opposed to cash.

More Information
If you have questions about your health insurance options visit www.delawareinsurance.gov for more info and links. You can also visit Delaware’s Health Insurance Marketplace, www.choosehealthde.com. Individuals have until March 31, 2014 to enroll in a health insurance plan in order to meet the Affordable Care Act’s “individual mandate” without incurring a penalty, or fee, from the IRS. For more info about penalties and subsidies please visit www.healthcare.gov.

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Contact: Marla Blunt-Carter
(302) 577-5259
Marla.Blunt-Carter@delaware.gov

Delaware Department of Insurance: “Protecting Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.”

Dover, Del.- Delaware libraries throughout the state are offering information sessions and one-on-one enrollment assistance on Delaware’s Health Insurance Marketplace. These presentations have been available for the public since the beginning of November.

Certified Marketplace Guides will give presentations at the libraries for Delaware residents interested in enrolling in low-cost health insurance made possible by the Affordable Care Act.

Four community organizations, Brandywine Women’s Health Associates, Christiana Care, Delmarva Foundation for Medical Care, Inc. and Westside Family Healthcare are under contract to provide one-on-one guidance through certified Marketplace Guides to residents about the new marketplace, which will help give the 90,000 uninsured Delawareans greater access to affordable health care.

There are more than 70 guides throughout Delaware who have been undergoing rigorous state and federal training, a proctored exam, and state and federal background checks to be certified to handle sensitive personal information.

Enrollment in the marketplace opened October 1, 2013, and runs through March 31, 2014.  Insurance coverage begins as early as January 1, 2014, for those who enroll by Dec. 15, 2013.

For more information on Delaware’s Health Insurance Marketplace go to www.ChooseHealthDE.com. For information on the Affordable Care Act, as well as dates, times, and locations of sessions, may be found on the Delaware Libraries ACA guide at http://guides.lib.de.us/ACA

For more information on Delaware Libraries go to www.delawarelibraries.org.

Contact: Beth-Ann Ryan at (302) 257-3002 or beth-ann.ryan@delaware.gov, Delaware Division of Libraries, Deputy Director.

The Department of Health and Social Services and the Department of Insurance have reached contract agreement with four community organizations to provide one-on-one guidance to Delawareans about the new health insurance marketplace.

The organizations will hire marketplace guides to help individuals learn more about health insurance, and how to be screened and enrolled for insurance through Delaware’s marketplace, also known as the exchange. Enrollment on the marketplace, part of the implementation of the Affordable Care Act, will begin Oct. 1, with insurance coverage beginning Jan. 1, 2014.

The four community organizations, announced today at the Delaware Health Care Commission meeting, are:

Brandywine Women’s Health Associates
Christiana Care
Delmarva Foundation
Westside Family Healthcare

“The marketplace guides are all coming from trusted community organizations that regularly interact with people who are in need of affordable health insurance,” said Rita Landgraf, Secretary of the Department of Health and Social Services. “For some people, the process of enrolling for health insurance can be intimidating. The marketplace guides will walk people through the documents they will need and the process they will use to compare health insurance plans to find the one that is right for their families.”

“This is another important step forward in Delaware’s state-federal partnership health insurance marketplace,” Insurance Commissioner Karen Weldin Stewart said. “The marketplace guides hired by these four organizations will be trained to provide unbiased consumer support services to prospective enrollees. To be certain that you are speaking with a trusted marketplace guide, they will carry cards that identify them as members of their respective organizations and as state-certified marketplace guides.”

The health insurance marketplace is a one-stop shop that will provide online access to quality, affordable private insurance choices for consumers and small businesses. Some individuals will be eligible for tax credits to help pay for their health insurance. Delaware expects to serve as many as 35,000 individuals through the marketplace. About 90,000 Delawareans are currently uninsured.

In the state-federal partnership marketplace, Delaware retains controls of plan management, including state requirements for qualified health plans. The state also controls consumer assistance and outreach, including the marketplace guides. Public decisions and discussions about the marketplace are done at the monthly Delaware Health Care Commission meetings in Dover.

Delaware received a $4.06 million federal establishment grant to contract with community organizations for the hiring of marketplace guides.

For more information about Delaware’s health insurance marketplace, contact Marla Blunt-Carter (DOI) or Jill Fredel (DHSS).

To learn more about how the health insurance marketplace may work for your family, go to www.healthcare.gov/marketplace.

For background on the development of Delaware’s health insurance marketplace, go to http://dhss.delaware.gov/dhss/dhcc/ or http://www.delawareinsurance.gov/.