Increased competition means more options for Delawareans, employers

For the second consecutive year, Delawareans will have access to increased options on the Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today, with 57 total plans offered by four insurers. In the 2024 plan year, consumers will have the opportunity to purchase plans from Celtic Insurance Company Ambetter Health of Delaware, a carrier new to the state’s marketplace, in addition to plans from Aetna Health, AmeriHealth Caritas, and Highmark Blue Cross Blue Shield of Delaware. As recently as the 2022 plan year, consumers had only one carrier and 12 plan options to choose from.

“Improving healthcare accessibility and affordability across our state is one of my top priorities, and I’m proud that our work has led both options and enrollments to an all-time high,” said Insurance Commissioner Trinidad Navarro. “In addition, our Office of Value-Based Health Care Delivery has confirmed carrier’s filings reflect compliance with our affordability standards, including increasing spending on primary care to lower overall cost of care. We look forward continuing to make progress in this work.”

Nearly 35,000 residents purchased plans on the Delaware Marketplace during last year’s open enrollment. After Advance Premium Tax Credits, premiums averaged $197. Nearly 6,000 residents were eligible for a premium of $10 a month or less. Enrollment numbers are expected to rise as Medicaid redeterminations continue following the end of the COVID-19 Public Health Emergency. A Special Enrollment Period for Marketplace plans is available for persons no longer eligible for Medicaid.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 57 health plans and 12 dental plans are available to Delawareans for the 2024 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Be aware of non-compliant alternative health plans.

Individual Affordable Care Act (ACA) Marketplace Rates Announced

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2024 health, dental, and small group insurance plans were also announced today.

Celtic Ins. Co. Ambetter Health of Delaware’s 24 new plans range in base cost, before premium tax credits or other subsidies, from $378 to $532. Aetna Health (as a PA Corp.) will increase rates by an average of 2%, with base rate for six plans ranging from $414 to $441. AmeriHealth Caritas will decrease rates an average of 4.52%. Base rates for their six Marketplace plans will cost $300 to $416. Highmark requested a rate increase, and an average increase of 3.2% was approved after an initial increase request of 4.9%. Their 18 Marketplace plans have base costs between $274 and $654.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company.

Other ACA and ACA-Compliant Rates
Off-market individual offerings include six plans from Aetna Health (as a PA Corp.), which will increase an average of 2% in cost for the future year. AmeriHealth Caritas will decrease its plan’s rates an average of 4.52%. Highmark’s two off-market plan costs will increase an average of 3.2% after an initial request of 4.9%.

Delta Dental will increase rates by an average of 4.2% for two offered marketplace plans, and one off-market plan. Dominion Dental will decrease ACA premiums by 0.1% on their 10 plans.

Off-market small group plan options will increase for the coming plan year, with rate finalization occurring in October. Rate submissions show 62 plan options offered by six carriers: Aetna Health, Aetna Health (as a PA Corp), Aetna Life, Highmark, Optimum Choice, and United Healthcare.

About ACA Plans
All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care, telehealth, lab services, and more.

Open enrollment for 2024 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances throughout the year, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors.

Find out if you qualify for special enrollment.

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2023 health, dental, and small group insurance plans were announced today. While premiums are rising steeply across the country, the extension of consumer-friendly subsidies through the Inflation Reduction Act, coupled with Delaware’s strong 2022 enrollment and 2023 Health Insurance Marketplace expansion, will limit consumer impact locally.

“This year, Delaware consumers have more carriers and plans to choose from than ever before, so they can find an affordable plan that meets their needs. We remain optimistic that this increased competition will lead to lower rates and higher care quality over time,” said Insurance Commissioner Trinidad Navarro. “Delawareans are facing rising costs in nearly every area of life and making difficult sacrifices to afford necessities – but let me be clear, no matter the financial cost, we cannot afford to sacrifice our health. We will continue to work to ensure that coverage is affordable and accessible to all residents.”

Two new health insurers will be joining the Marketplace for 2023. Before tax credits and subsidies, base rates for 21-year-old non-tobacco users range from $315 to $505 across 9 Aetna CVS Health plan options, and from $283 to $402 with AmeriHealth Caritas across 4 plan options. Returning ACA issuer Highmark Blue Cross Blue Shield of Delaware will be increasing rates 5.5% on average, with base rates for 17 plan options ranging from $249 to $618 including a catastrophic plan option. In the last few years, Highmark’s average rates have decreased roughly 10% despite this needed increase.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 30 plans are available to Delawareans for the 2023 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Factors Involved in Expansion, Rates

Nationally, insurers are requesting increases due to inflation, increasing costs of care, and rising drug prices. In Delaware, both state and federal legislation contributed to the long-awaited carrier expansion and final rates.

“It’s no coincidence that Delaware was able to expand the number of carrier options on the Health Insurance Marketplace in the same year that laws limiting hospital price growth to appropriate, inflation-conscious levels became enforceable,” said Commissioner Navarro. “The hospital price growth law, for the first time in our state’s history, gave insurers leverage to negotiate lower costs for consumers while still ensuring that hardworking healthcare providers receive their fair share. We’re grateful to have worked with legislators and the Primary Care Reform Collaborative to put cost containment guardrails in place to curtail rising consumer expenses, encourage carrier expansion, and ensure the effectiveness of every dollar spent.”

With little financial limitations around hospital prices, private insurance plans pay the price – on average 224% more than Medicare plans, according to RAND Corporation.

During the rate filing process, questions also remained about the expiration of American Rescue Plan Act subsidies, which the department lobbied Delaware’s congressional delegation to extend. These subsidies lowered consumer costs significantly and contributed to the state’s largest-ever ACA enrollment, a year-over-year increase of 26.8%. Had these benefits expired, healthy consumers who were influenced to acquire coverage through the enhanced discounts may have left the marketplace, shrinking the risk pool and unbalancing rates. On August 16, President Biden signed the Inflation Reduction Act into law, extending subsidies into 2025.

Aside from potential enrollment increases due to the carrier expansion, future participation growth may come from Medicaid unwinding and income eligibility reviews. National efforts are underway to ensure smooth, affordable transitions to Marketplace coverage for those eligible.

Other ACA and ACA-Compliant Rates

Delta Dental will reduce both ACA and non-marketplace rates by an average of 4%, and Dominion Dental will increase ACA premiums by 2.2%. Metropolitan Life Ins. Co.’s small group non-marketplace dental plan rates will remain at their current level.

Returning off-market small group plans from Highmark will increase an average 2.4%, Optimum Choice plans will rise by 2.7%, and United Healthcare small group rates will increase by 2.8%. Aetna Health’s small group plans will increase 7.6%, and Aetna Life rates will increase 5.1% after an initial increase request of 8.8% was reduced. Aetna Health’s 9 off-marketplace individual plan rates will remain at their current level.

About ACA Plans

All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care and telehealth, lab services, and more.

Open enrollment for 2023 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors throughout the year. Find out if you qualify for special enrollment.

Commissioner Navarro announces Health Insurance Marketplace expansion

Be aware of non-compliant alternative health plans

Consumers to have most options in history of Delaware Marketplace

After years of work to increase competition on the Delaware Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today that three health carriers intend to offer plans for the 2023 plan year – the most in the state’s history. AmeriHealth Caritas and Aetna CVS Health will join Highmark Blue Cross Blue Shield Delaware in offering coverage.

“Delaware’s Health Insurance Marketplace is more stable than ever before, with rates steadying and enrollment at an all-time high. The hard work we have put into this program is paying off, with multiple new carriers planning to offer 2023 coverage,” said Insurance Commissioner Trinidad Navarro. “I look forward to the benefits that increased competition will bring to our residents, and to continuing to improve healthcare accessibility and affordability across the state.”

From rising rates to insurer departure, the implementation of the Affordable Care Act in Delaware hasn’t always been smooth sailing. But with the state’s successful creation of a 1332 reinsurance program and federal threats of ending the critical program subsiding, rates have decreased more than 15% and remained stable, while enrollment has grown significantly.

“Today’s announcement is a testament to both the needs of Delawareans who have increasingly signed up for coverage, and to the strong regulatory environment we have built, which has helped insurers go from taking losses to being able to cover their expenses and consumers’ coverage needs.”

The announcement comes as carriers submit initial rate filings proposals pursuant to federal deadlines. These will undergo in-depth reviews by independent actuaries before the Insurance Commissioner approves and announces them later this year.

NEW CASTLE (Jan. 12, 2022) – Delawareans have until Saturday, Jan. 15, to sign up for health coverage for 2022 through Delaware’s Health Insurance Marketplace. For those who enroll by the deadline and pay their first premium, coverage will begin Feb. 1, 2022. Enhanced federal subsidies, which began earlier in 2021 under the Biden administration, will continue for 2022. The subsidies have helped to reduce consumer costs by as much as 40%.

State residents can sign up for coverage at www.HealthCare.gov or CuidadodeSalud.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). Free assistance in Delaware is available through:

• Westside Family Healthcare at 302-472-8655 in New Castle County and 302-678-2205 in Kent and Sussex counties or enrollment@westsidehealth.org.
• Quality Insights, Inc., (New Castle and Sussex counties) at 1-844-238-1189. Westside and Quality Insights each received federal funding for navigators to help people enroll for coverage.
• Certified application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown.
• State-licensed insurance agents and brokers are also available at no charge.

For additional contact information and other details about Delaware’s Health Insurance Marketplace, go to www.ChooseHealthDE.com.

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

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

Individuals who don’t act by Jan. 15 cannot get 2022 coverage unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, birth or adoption of a child, a permanent move, marriage or divorce, or other qualifying factors.

The Biden administration has made increased access to health insurance and affordability a priority by using American Rescue Plan Act funds to increase tax credits and expand subsidies further into the middle class. For instance, a family of four (both parents in their 40s) making $50,000 are eligible for a credit of roughly $16,500, compared with $14,300 previously. A majority of Delaware marketplace enrollees will be eligible for financial assistance, which can help reduce the cost of monthly premiums and/or deductibles, and lower out-of-pocket health care costs.

Federal tax credits are available for those whose household income is between 138% and 400% of the Federal Poverty Level. For 2022 coverage, that’s between $17,775 and $51,520 for an individual, or between $36,570 and $106,000 for a family of four. For coverage in 2021, about 81% of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.

For 2022, Highmark is offering 13 plans for individuals – four gold plans, three silver, three bronze, two platinum and one catastrophic. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – are offering a collective 12 stand-alone dental plans on the marketplace, seven with a low actuarial level (71.6%) and five with a high actuarial level (84.2%).

Since the start of this open enrollment on Nov. 1, 2021, more than 33,000 Delawareans have signed up for 2022 coverage on the marketplace and off the marketplace. Financial assistance is available to eligible enrollees only on the marketplace.

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 receive coverage under the Medicaid expansion each year. 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% in 2008 to 6.6% in 2019, according to the Census Bureau. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions.

NEW CASTLE (Oct. 31, 2017) – With the open enrollment period for Delaware’s Health Insurance Marketplace cut in half from 12 weeks to six weeks, Delawarean seeking coverage for 2018 are urged to sign up early  beginning Nov. 1 in order to avoid any last-minute rush before the Dec. 15 deadline. Early enrollment is also important because the federal government has announced planned maintenance shutdowns of HealthCare.gov on most Sundays during open enrollment.

The fifth open enrollment period, in which people can renew coverage or sign up for a new plan for 2018, runs from 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 fifth enrollment period with a press conference at 2 p.m. Nov. 1 at Westside Family Healthcare’s Northeast Wilmington Health Center, 908-B E. 16th St.

“Health insurance is a critical connection to quality health care,” Governor John Carney said. “Since the Affordable Care Act was signed into law, Delaware’s uninsured rate has been reduced significantly and more people are getting the health care they need. For people who don’t have access to health insurance through an employer or another form of coverage, the Health Insurance Marketplace offers them an opportunity to get covered. I urge Delawareans to shop early for a plan, meet with in-person assisters to get help understanding your options and to sign up by December 15th.”

Delaware currently has more than 27,000 people enrolled for coverage through its Health Insurance Marketplace, including 73 percent who re-enrolled for 2017 and 27 percent who were new enrollees.

Earlier this year, Aetna announced it would not sell plans on Delaware’s Health Insurance Marketplace for 2018. Enrollees with Aetna plans for 2017 must choose one of seven Highmark Blue Cross Blue Shield of Delaware plans that are available for purchase in 2018 or they will be automatically enrolled in a similar plan offered by Highmark. Enrollees who currently have coverage through Aetna Health or Aetna Life will be notified in writing as to what steps to take to obtain an alternate plan.

In October, Insurance Commissioner Trinidad Navarro announced that the Department of Insurance had approved an average rate increase of 25 percent for 2018. With the premium increase, 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 tax credits available when they buy private plans through the Health Insurance Marketplace, also known as Obamacare. The tax credits can help reduce the cost of their monthly premiums.

“With the uncertainty in Washington, many people may not realize that they can still get coverage through the Marketplace and that there’s still financial help available to help them pay for the plan they choose,” said Dr. Kara Odom Walker, secretary of the Delaware 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. It’s important that enrollees with a current Aetna plan go to HealthCare.gov or make an appointment with an assister who can help walk them through their enrollment options. 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.”

“Every American ought to have access to quality affordable health care,” said Insurance Commissioner Trinidad Navarro. “Despite the Affordable Care Act’s challenges and the uncertainty in Washington, D.C., consumers should not be discouraged. As a result of Obamacare, more Delawareans are now insured and receiving the health care not only that they need, but that they deserve. Last year Delaware continued its high participation rate on the Marketplace and achieved a 95 percent insured rate throughout the state. Open enrollment is an opportunity to build on these advancements. Because enrollment has been shortened, the Department of Insurance encourages consumers to enroll as early as possible and to consult navigators and other enrollment assisters to select the most cost-efficient plans that offer the greatest quality of services and coverage.”

Consumers can go to HealthCare.gov now to check out their options for 2018. Individuals who need help enrolling in coverage will 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 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:

• Eight-one percent of Delaware’s current Marketplace enrollees receive financial assistance to help pay their monthly premiums and/or deductibles and co-pays.
• The current average monthly premium in Delaware is $569, with an average tax credit among all enrollees of $338 per month. For the 81 percent of Delawareans who currently receive financial assistance, the average premium after tax credit is $162 per month.
• Among the more than 27,000 current enrollees, 73 percent are re-enrollees and 27 percent are new enrollees for 2017.
• Financial help is available for individuals with annual incomes up to $47,520; for a family of four the income limit is $97,200.
• More than half of all current Delaware enrollees signed up during two weeks in 2017, Dec. 11-17 and Dec. 18-24.

For 2018, Highmark Blue Cross Blue Shield of Delaware will offer a total of seven plans for individuals – one gold plan, three silver, two bronze and one catastrophic. Two insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – will offer a collective 12 stand-alone dental plans, six with a low actuarial level (70 percent) and six with a high actuarial level (85 percent).

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.

The three metal-level categories – bronze, silver and gold – 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.

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 $7,350 for an individual and $14,700 for a family.

Consumers who pick silver plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 45 percent of current enrollees qualify for cost-sharing reductions.

Penalty for going without coverage

Individuals who can afford coverage but who choose not to buy are expected to pay a penalty equal to the higher of these amounts: 2.5% of your annual household income or $695 per person ($347.50 per child under 18). For 2017, the maximum penalty will not exceed $2,085 per household. 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 U.S. representative urged uninsured Delawareans to find out what’s available for them on the Marketplace.

“I encourage everyone to use the Marketplace open enrollment period to get their free help from navigators up and down the state and review their options for coverage in 2018,” said U.S. Sen. Tom Carper. “Tax credits are available to help cover the cost of the premium, and some may find out they are eligible for Medicaid. Despite partisan politics down in Washington, the Affordable Care Act is still the law of the land, so don’t delay in getting covered.”

“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. “Whether you have insurance already or not, I encourage all Delawareans to visit HealthCare.gov 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 overall 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.”

“As families budget for 2018, the beginning of health care open enrollment marks the time to shop around, research what discounts may be available, and select coverage for the upcoming year,” said Rep. Lisa Blunt Rochester. “The health care exchanges are a valuable resource for all families in accessing quality care, and a number of Delaware families may qualify for financial assistance in meeting their insurance costs. With a shortened open enrollment period this year, I recommend all Delawareans visit ChooseHealthDE.com to get more information about what plans are available to meet their family’s needs and to find out how to take advantage of free, in-person help to navigate the health care marketplace.”

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 10 percent in 2008 to 5.7 percent in 2016, 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 a health care spending benchmark for Delaware linked to the state’s economy, we are striving to ensure that our health care system delivers quality care, produces better health outcomes, slows the growth of health care spending and enhances the experience of health care providers.”

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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.