Open Enrollment Starts Tuesday for Delaware’s Health Insurance Marketplace

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.


Delaware Joins Suit to Block Health Insurance Merger Of Aetna and Humana

Combination Would Significantly Reduce Competition In Delaware Medicare Advantage Market

Delaware’s Attorney General will join the U.S. Department of Justice and eight other attorneys general in opposing the merger of health insurance companies Aetna and Humana – the third and fifth largest health insurance companies in the country – arguing that the combination would reduce competition in Delaware and drive up prices.

Both Aetna and Humana sell Medicare Advantage plans in New Castle and Kent counties, which are offered as an alternative to traditional Medicare and a merger would result in high market share by the combined entity in those two counties.

“This proposed merger would very significantly reduce competition for health insurance through Medicare Advantage plans in the counties that contain three-quarters of our state’s population,” Attorney General Matt Denn said. “At a time when health care costs are already a concern, this would move Delaware in the wrong direction.”

The complaint by the USDOJ and the attorneys general of eight states and the District of Columbia filed in U.S. District Court for the District of Columbia explains, “Today, Aetna and Humana compete across the country to sell Medicare Advantage plans, a market-based alternative to traditional Medicare. This competition benefits Americans who can least afford health insurance. It benefits seniors, who visit doctors and hospitals more than twice as much as the average person and have less income than the average American household.”

The challenge to the Aetna-Humana merger also is based on reduced competition between Aetna and Humana nationally in offering health coverage on state health care exchanges, but Humana does not currently participate in the exchange in Delaware. USDOJ and a number of states also filed a challenge to the proposed merger of health insurance companies Anthem and Cigna. Anthem does not operate in Delaware.

A release from USDOJ announcing the federal-state action, including a link to the filed complaint, can be found HERE.


General Assembly Passes Important Health Care Pricing Transparency Legislation

Dover, DESenate Bill 238, which establishes the Delaware Health Care Claims Database within the Delaware Health Information Network, passed the Senate unanimously on June 9th, and passed the House unanimously earlier this evening.

“Today, the General Assembly passed legislation that represents a critical step in Delaware’s health care innovation efforts,” Governor Markell said. “I greatly appreciate the leadership of Senator Bethany Hall-Long and Representative Melanie George Smith in sponsoring this important health care transparency legislation, which has been in progress for several years. I also would like to thank the Delaware Center for Health Innovation and all of the health care community stakeholders who worked with us on this consensus legislation.”

“This legislation creates much-needed transparency around health care costs, and moves Delaware toward a more efficient health care delivery system that emphasizes quality care and places a greater value on patient outcomes,” Sen. Bethany Hall-Long said.

“The creation of a Health Care Claims Database will be an important asset to State policy-makers and other stakeholders who are working on public policy solutions to rising health care prices without sacrificing the quality and availability of care to Delawareans,” said Rep. Melanie George Smith, who has confronted rising health care costs in her role as Co-Chair of the General Assembly’s Joint Finance Committee.

Governor Markell discussed the need for a health care claims database in his 2012 State of the State Address, where he noted that “[a] next step to leverage technology is to create a claims and cost database. Business leaders have come to understand the key to improving performance is harnessing the capacity of information technology to aggregate and analyze data. This database will allow us to figure out why some providers get better results and why some providers create more costs without better results to show for it. We will be in a position to reward what works and change what doesn’t.”

The Health Care Claims Database will be administered under the authority of the DHIN’s board of directors, whose membership reflects a cross-section of stakeholders from the health care industry, state government, and members of the public and health care consumers. The DHIN currently holds clinical data from all of Delaware’s major hospitals and providers, and this legislation allows the DHIN to also maintain pricing data. The legislation requires that the information be maintained in a secure, encrypted setting in compliance with all federal and state health care privacy and data security laws.


Governor and Legislators Propose Expansion of Needle and Syringe Exchange Program

Part of continuing efforts to address addiction epidemic

Dover, DE – Today, Governor Markell announced his support for legislation that would authorize the Division of Public Health (DPH) to expand the Syringe Exchange Program (SEP) statewide to help reduce the sharing of potentially infected needles and support the state’s larger efforts to address opioid addiction and HIV transmission. This enabling legislation would allow the program to go statewide should federal funding become available.

“Heroin abuse continues to affect communities across our state, and needle exchange programs can help those struggling with addiction to avoid getting other diseases as we connect them to treatment for their addiction,” said Governor Markell. “A statewide expansion of Delaware’s needle exchange program will protect IV drug users from infections such as HIV, hepatitis and other bloodborne diseases. In doing so, we also protect the families and partners of these individuals, keep our streets and neighborhoods free of needle litter, and hopefully get more people into treatment for their addiction.”

“While our ultimate goal must continue to be securing addiction treatment for the Delawareans who need it most, we must do whatever we can to ensure that IV drug users are not putting themselves or the public at further risk by using contaminated needles,” said Senate Majority Whip Margaret Rose Henry. “Like drug use, diseases like HIV and hepatitis disproportionally impact low-income and minority populations and we have a moral responsibility to take these sorts of prudent measures to stop the spread of these devastating diseases.”

“During the past decade, we have seen the needle exchange program have a positive impact in the City of Wilmington by reducing the spread of HIV infections and other diseases that can be transmitted through a used needle. It also has helped connect people to various services and resources to reduce drug use,” said Rep. Helene Keeley, who sponsored the original needle exchange bill in 2006. “However, intravenous drug use is not just a problem in Wilmington; it’s a concern throughout our state. Expanding this successful program throughout Delaware will hopefully have the same benefits up and down the state that it has had in the city, reducing the spread of diseases and connecting people to the services they need to combat drug use.”

“We have long been supporters of needle exchange programs because they work in preventing the spread of HIV/AIDS,” said Peter Houle, executive director of the Delaware HIV Consortium, one of the state’s largest providers of services to people with HIV/AIDS. “We helped form the coalition that pushed through Delaware’s first effort at needle exchange. We support expansion of the program to serve all three counties in Delaware effectively. Since the recent surge in the use of heroin began, we have been hoping for expansion of the clean needle exchange program – it’s just good public health policy that will save lives.”

The Delaware SEP was established in 2007, initially as a pilot program in Wilmington. With this legislation, the program will no longer be limited to Wilmington and will be permitted to operate in areas of need throughout the state. While New Castle County and the City of Wilmington have significant numbers of people living with HIV resulting from IV drug use, the issue, along with the larger addiction epidemic, exists statewide.

Under the law, injection drug users can be provided with referrals to appropriate treatment and access to a 1-for-1 exchange where participants will receive one sterile needle and syringe unit in exchange for each used needle. The program is also designed to maintain maximum security of exchange sites and equipment, including security measure that will allow for:
• Identification of Program needles;
• Full accounting of the number of needles distributed;
• The number of needles in storage;
• Safe disposal of returned needles;
• And any other measures that may be required to control the use and dispersal of sterile needles and syringes.

In addition, the program educates participants about the dangers of contracting HIV or hepatitis through needle-sharing practices, and provides HIV and other communicable disease testing when and where available and appropriate. All participants can access counseling and treatment services, as well as follow-up to any of those services, to ensure participants can receive the most comprehensive treatment possible.

SEP has proven to be an effective way of reducing the use of potentially contaminated needles:

• Since June of 2015, 2,532 participants have been enrolled in the program and more than 353,000 potentially contaminated syringes have been safely disposed of and kept off of Wilmington streets.
• Currently, the program exchanges approximately 80,000 potentially contaminated syringes each year.
• The program promotes substance usage treatment and has successfully enrolled 894 clients in treatment programs.
• The number of Delawareans diagnosed with HIV attributable to intravenous drug use has dropped significantly, from 38 cases in 2005 to three cases in 2015.
• The program is a national model for cooperation between needle exchange services and law enforcement, and has been publicly endorsed by a number of medical associations and community organizations:
o American Medical Association
o American Public Health Association
o National Academy of Sciences
o American Nurses Association
o U.S. Conference of Mayors
o American Bar Association

IV drug use is a one of the primary paths to acquiring HIV. In Delaware, 43 percent of those currently living with HIV/AIDS and 50 percent of all HIV/AIDS cases are directly or indirectly related to needle sharing. This legislation could reduce the health risks for intravenous drug users and also protect their wives, husbands and partners.


Open Enrollment Starts Sunday for State’s Health Insurance Marketplace

Delawareans have 3 months to sign up for 2016 coverage to avoid penalty

WILMINGTON – Delaware will launch the third open enrollment period of its Health Insurance Marketplace on Sunday, ready to build on the success of the first two seasons in which more than 23,000 Delawareans enrolled in private health plans and activated their coverage.

Department of Health and Social Services Secretary Rita Landgraf joined County Executive Tom Gordon and Paul Reynolds from the Department of Insurance to preview the launch during an event Thursday at Absalom Jones Community Center.

Open enrollment for health coverage in 2016 runs from Nov. 1 through Jan. 31 on HealthCare.gov. Individuals must sign up by Dec. 15 for coverage to be effective Jan. 1. Policies for all current enrollees expire Dec. 31.

Individuals enrolled this year can renew their current plan or enroll in a different plan for 2016. While insurance companies will automatically renew many consumers’ coverage, individuals who bought a marketplace plan are encouraged to go to HealthCare.gov to update their household income and other personal information, review their current coverage, and check out the new plans among the 29 individual plans offered for 2016.

Secretary Landgraf said she is eagerly anticipating the start of the third enrollment season. “Beginning Nov. 1, more Delawareans who previously were denied coverage because of a disability or other pre-existing condition, or who thought health insurance was beyond their monthly budgets, will have the chance to join thousands of their neighbors who are enjoying the peace of mind and possibility of improved health that come with being covered.” She said one common misconception that people have is that tax credits won’t apply to them. Tax credits, which help to lower the monthly premium, are available for individuals making up to about $46,000 a year and for families of four with an annual household income of up to about $95,000.

Giving Delawareans access to health care is just a first step, Landgraf said. “Delivering quality care, producing better health outcomes, and reducing health care costs have always been at the heart of the Affordable Care Act. With the start of open enrollment we will take the next step toward a healthier Delaware.”

The Health Insurance Marketplace in Delaware for 2016 will include:

  • More choice: Individuals who are enrolling for the first time or re-enrolling will have more plans to choose from: 29 plans vs. 25 in 2015. Highmark Blue Cross Blue Shield, Aetna Health, and Aetna Life Insurance administer the plans. A dozen dental plans will also be available.
  • Health benefits that include coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.
  • Rate changes: Individual-plan premiums will increase an average 22.4 percent for Highmark plans and less than 17 percent for Aetna.
  • Small business employers: Owners will have 15 SHOP (Small Business Health Options Program) plans to choose from for 2016 vs. 16 in 2015. Premiums will decrease 0.5 percent to 1 percent for Aetna plans and increase 12.7 percent for Highmark plans. Small business owners can enroll in SHOP at any time.
  • Federal tax credits that in 2015 helped to lower the cost of coverage for 84 percent of Delawareans who enrolled. Their average monthly tax credit was $260.
  • A new and improved ChooseHealthDE.com, Delaware’s official source of information about the Health Insurance Marketplace and connection to HealthCare.gov, the federal enrollment site. The new site, launched today, has a cleaner look and improved navigation. A penalty calculator will again allow visitors to see how much they could pay for going uninsured.
  • A higher penalty for going uninsured. Those who are not exempt and do not buy insurance for 2016 will pay $695 per adult (plus $347.50 for each child younger than 18 not covered) or 2.5 percent of their household income, whichever is higher.
  • Free in-person enrollment 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 also are available to assist individuals and employers with their enrollments. Go to www.ChooseHealthDE.com for details.
  • A faster, smoother and safer enrollment process on Healthcare.gov that includes new features such as a calculator that estimates total costs – deductible, co-pays, cost-sharing — based on the plan and a consumer’s expected medical needs; a simplified re-enrollment process; and a “privacy manager” that gives users more control over the information they choose to share.

About eight out of 10 current enrollees will be able to buy a 2016 plan with premiums less than $100 dollars a month after tax credits, and about seven out of 10 will have a plan available for less than $75 a month, according to the U.S. Department of Health and Human Services.

Those attending Thursday’s kickoff heard from Nancy Lemus, a 35-year-old woman from New Castle who has struggled to get health care for her and her son, Christopher, 10, who has cerebral palsy and dystonia, a movement disorder that causes debilitating spasms. Lemus, who works part-time jobs as a waitress and a nursing aide, said she is eager to explore her health insurance options through the marketplace.

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 in a statement. “With open enrollment now underway, 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.”

Sen. Chris Coons reminded Delawareans to enroll as soon as possible. “It’s an important process and a right that all Americans have access to comprehensive health insurance that fits their needs, regardless of age, background, or pre-existing conditions.”

Added Congressman John Carney: “Next week begins another opportunity for Delawareans to get quality health care coverage that works for themselves and their families. While we still have a lot to do to improve on the quality and cost of health care, the marketplace is an important step that provides thousands with access to care. I encourage Delawareans to look at their options.”

Insurance Commissioner Karen Weldin Stewart said she is excited about the start of another open enrollment period. “I intend to keep working with my partners to make sure comprehensive health care is affordable for all Delawareans.”

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 9,000 individuals have received coverage under the Medicaid expansion. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

For more information, go to www.ChooseHealthDE.com or call 1 (800) 318-2596, TTY: 1 (855) 889-4325. You can enroll in marketplace coverage directly at www.HealthCare.gov or through an agent or broker, always with no charge to the individual.

NOTE TO MEDIA: Photos from Thursday’s Delaware Health Insurance Marketplace Kickoff Event will be available for download beginning Thursday afternoon at DHSS’ flickr page.

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

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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.