Careful Consideration of Insurance Plans Urged During Special Enrollment Period

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


Rates To Decrease In Delaware Affordable Care Act Marketplace

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


Nov 1 – Dec 15: Open Enrollment for Delaware’s Health Insurance Marketplace

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.


Dec. 15 Is the Last Day to Sign up for 2019 Coverage on Delaware’s Health Insurance Marketplace

Picture of DHSS Secretary Kara Odom Walker
DHSS Secretary Kara Odom Walker

NEW CASTLE (Dec. 13, 2018) – Delawareans have just days left to sign up for or to change their health coverage for 2019 through the Health Insurance Marketplace. Open enrollment ends on Dec. 15, with coverage for those who enroll by that date and who pay their first premium beginning Jan. 1, 2019.

State residents can sign up for coverage at www.HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). Free, in-person assistance is available through Westside Family Healthcare at 302-472-8655 in New Castle County and 302-678-2205 in Kent and Sussex counties. 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, go to www.ChooseHealthDE.com.

As of Dec. 8, 10,378 Delawareans had signed up for 2019 coverage through the Health Insurance Marketplace, a decrease of 10 percent from a similar period last year. For 2018, 24,500 people enrolled for coverage, including more than half who signed up for or renewed their coverage in the final week of open enrollment.

“We urge Delawareans who need coverage through the Health Insurance Marketplace to take action now to enroll. The deadline will not be extended,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “As a physician, I see the difference that having access to insurance, as well as the connection to care that coverage brings.”

Consumers can go to HealthCare.gov to shop for coverage for 2019, compare plans and to enroll before midnight Saturday, Dec. 15. Individuals who need help enrolling can receive free in-person assistance from federally funded and trained specialists at several Delaware organizations, including Westside Family Healthcare, Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown.

Westside Family Healthcare is hosting drop-in enrollment sessions through Saturday. The schedule:

Bear/New Castle Health Center, 404 Fox Hunt Drive, Bear (near the Bear Post Office)

  • Thursday, Dec. 13: 4-7 p.m.
  • Friday, Dec. 14: 4-7 p.m.
  • Saturday, Dec. 15: 9 a.m.-noon

Fourth Street Wilmington Health Center, 1802 W. Fourth St., Wilmington

  •  Saturday, Dec. 15: 9 a.m.-noon

To speed up the shopping and enrollment process, Delawareans are asked to bring these documents or information with them:

  • Birth dates of those applying for coverage.
  • Social Security numbers for 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.
  • If you have previously enrolled on the Health Insurance Marketplace, bring your log-in and account information.

About 82 percent of those enrolled on Delaware’s marketplace for 2018 received tax credits to help pay their monthly premiums. For those eligible for financial assistance, the average premium after tax credits in 2018 was $122 per month. Financial help is available to individuals with an annual household income up to $48,560 and up to $100,400 for a family of four.

“Many people don’t realize that they may be eligible for tax credits to help pay their monthly premiums,” Secretary Walker said. “If you are uncertain about your eligibility based on your annual household income, it’s best to contact a local enrollment assister to help walk you through the process, and explore your options.”

For 2019, 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 – one gold plan, three silver, two bronze, one catastrophic and one platinum. The metal categories are based on how enrollees choose to split the costs of care with their insurance company. Bronze plans have low monthly premiums, but higher out-of-pocket costs when you need care; gold plans have high premiums, but lower out-of-pocket costs when you need care.

Two insurers – Delta Dental of Delaware, Inc., and Dominion Dental Services, Inc. – offer a total of 11 stand-alone dental plans, five with a low actuarial level (70 percent) and six with a high actuarial level (85 percent).

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.

After open enrollment ends Dec. 15, 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 your job, and marriage.


Almost 25,000 Sign up for 2018 Coverage on Delaware’s Health Insurance Marketplace

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.