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

Rates reduced for second straight year; open enrollment for 2021 coverage ends Dec. 15

NEW CASTLE (Oct. 30, 2020) – Delawareans looking for health insurance will see a second straight year of reduced rates when they shop for 2021 coverage through the Health Insurance Marketplace.

The marketplace’s eighth open enrollment period starts Sunday, Nov. 1, and ends Tuesday, Dec. 15, at www.HealthCare.gov, where consumers can renew existing coverage or sign up for a new plan. Coverage for enrollees who sign up by Dec. 15 and pay their first month’s premium will take effect Jan. 1.

Individuals who don’t act by Dec. 15 cannot get 2021 coverage unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, becoming a parent, or other qualifying factors.

Monthly premiums for 2021 plans in Delaware will be 1 percent lower on average than the 2020 plans, Insurance Commissioner Trinidad Navarro announced in August. Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace. Enrollees will choose one of 12 Highmark plans or they will be re-enrolled automatically in a plan similar to their current one.

This year’s rate reduction follows last year’s average 19 percent drop, which reflected federal approval in 2019 of Delaware’s reinsurance program. The program aims to lower health insurance premiums for plans sold in the individual insurance market by partially reimbursing insurers for high-cost health care claims through a $27 million fund that uses a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. Because the insurers’ claims costs are lower, they can charge lower premiums.

Last year, nearly 24,000 people signed up for coverage through Delaware’s Health Insurance Marketplace during open enrollment. With the new reinsurance program driving down the cost of monthly premiums, enrollment increased more than 6 percent from the previous year’s open enrollment period. About 75 percent of last year’s enrollees were renewing their coverage and 25 percent 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 2021 coverage, that’s between $17,609 and $51,040 for an individual, or between $36,156 and $104,800 for a family of four. For coverage in 2020, about 86 percent of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.

“Over the past two years, health insurance rates on the Affordable Care Act (ACA) marketplace are down more than 19 percent. That’s good news for Delawareans who look to the marketplace for quality, affordable health care coverage,” said Governor John Carney. “All Delaware families need access to affordable, quality health care. That access is especially critical now as we continue to fight the spread of COVID-19 and prepare for a possible resurgence of the virus this winter. I particularly encourage small-business owners, independent contractors and individuals who don’t have access to health insurance through an employer to check out the plans available on Delaware’s marketplace.”

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 in 2021, individual consumers can’t pay more than $8,550 in out-of-pocket medical costs and families can’t pay more than $17,100.

“Catastrophic” plans are also available to some people. Catastrophic plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.

For 2021, Highmark will offer 12 plans for individuals – three gold plans, three silver, three bronze, two platinum, and one catastrophic. Two dental 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 health care plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 29 percent of current enrollees qualify for cost-sharing reductions.

All plans offer 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.

“High-quality, affordable health care greatly contributes to the health and well-being of the residents of Delaware,” said Department of Health and Social Services Secretary Molly Magarik. “This year, COVID-19 has underscored how important such coverage is for Delawareans, especially those with chronic conditions or in other vulnerable circumstances. 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’s average 1 percent decrease in premiums comes as the market has stabilized after the significant 19 percent average reduction last year, said Insurance Commissioner Trinidad Navarro. “Decreasing premiums has increased the affordability and accessibility of ACA plans. We expect to see increased enrollment again this year. Now, more than ever, it is vital that every resident can afford the insurance they need for their families.”

Assistance for Delaware enrollees

Consumers can go to HealthCare.gov or CuidadodeSalud.gov now to explore their options for 2021 coverage, and they can enroll anytime between Nov. 1 and Dec. 15. (Search “coronavirus” for how COVID-19 might impact marketplace coverage.) Quality ratings are displayed on plans on HealthCare.gov, using a five-star rating system, with five stars representing the highest quality. The rating is 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. All 12 of Delaware’s marketplace plans for 2021 are rated 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 application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown. For the third straight year, Westside is the only organization in Delaware to receive federal funding for navigators to help people enroll for coverage.

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 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 (HHS):

• Eighty-six percent of Delaware’s marketplace enrollees receive financial assistance to help pay their monthly premiums and/or deductibles and co-pays.
• The overall average monthly premium in Delaware is $668, with the average premium reduced to $192 per month after tax credit. For the 86 percent of Delawareans who receive financial assistance, the average premium after tax credit is $110 per month.
• Among the 23,981 people who signed up during last year’s open enrollment, about 75 percent were re-enrollees and 25 percent were new enrollees.
• Financial help is available for individuals with annual incomes up to $51,040; for a family of four the income limit is $104,800.
• About 70 percent of Delaware’s enrollees signed up during the final three weeks of open enrollment in 2019, Nov. 25-Dec. 1, Dec. 2-8, and Dec. 9-17 (HHS extended last year’s sign-up period by two days because of technical issues on Dec. 15, the final scheduled day to buy coverage.)
• As of 2019, there is no longer a federal tax penalty for individuals who can afford coverage but who choose not to buy it.

The 10-year-old Affordable Care Act (ACA), which created the Health Insurance Marketplace, allows states to waive certain ACA requirements in order to customize their health insurance systems while retaining the basic protections of the ACA. In August 2019, Governor Carney signed legislation codifying various ACA consumer protections into state law and ensuring that if the ACA is ever repealed or changed, its consumer protections will remain in effect in Delaware. This includes provisions such as guaranteed-issue coverage (regardless of medical history), coverage for essential health benefits, a ban on lifetime and annual benefit maximums, limits on out-of-pocket costs, and rules regarding the factors that insurers can use to set premiums.

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.

“I want to be perfectly clear: the Affordable Care Act is the law of the land, and health insurance navigators are on hand to help Delawareans enroll in an affordable health care plan that meets their families’ needs and budget starting on Nov. 1,” said U.S. Sen. Tom Carper. “Especially as our country navigates an unprecedented pandemic, it’s critical that everyone has access to affordable, quality health coverage. I encourage everyone to visit HealthCare.Gov today to enroll without delay!” “Having affordable and comprehensive health insurance is critical, especially while in the middle of a pandemic and nearing the height of flu season,” said U.S. Sen. Chris Coons. “Running through December 15, open enrollment is the time for Delawareans to review and update existing health care plans or look for completely new coverage that works best for them. I’m encouraging everyone, whether you’ve got health coverage or you don’t, to visit Delaware’s Health Insurance Marketplace to evaluate coverage options and explore financial assistance that may be available.” “In the midst of a pandemic, we’ve been starkly reminded of the importance of health insurance. That’s why I join with my colleagues and partners in telling Delawareans that November 1st marks the beginning of the open enrollment period for the Affordable Care Act,” said U.S. Rep. Lisa Blunt Rochester. “Experts and navigators will be on hand to help Delawareans select the plan that works best for them and their families and I encourage everyone to visit HealthCare.Gov to find out more and enroll.”

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. Note: As of Oct. 1, dental care is included in coverage for adult Medicaid enrollees in Delaware.

Both the Health Insurance Marketplace and the Medicaid expansion have helped to reduce Delaware’s uninsured rate, decreasing from 10 percent in 2008 to 6.6 percent 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.

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

With shortened enrollment period and fewer assisters, Delawareans urged to sign up early on HealthCare.gov to see if they’re eligible for financial help

NEW CASTLE (Oct. 30, 2018) – With the open enrollment period for Delaware’s Health Insurance Marketplace only six weeks long and fewer assisters on the ground this year to help with enrollments, Delawareans seeking coverage for 2019 are urged to sign up early 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 Sunday mornings during open enrollment.

The sixth open enrollment period, in which people can renew coverage or sign up for a new plan for 2019, 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 sixth enrollment period with a press conference at 1 p.m. Nov. 5 at Westside Family Healthcare’s Northeast Wilmington Health Center, 908-B E. 16th St. 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. In 2017, there were two federally funded organizations in Delaware, Westside and Chatman LLC.

“For Delawareans 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,” Governor John Carney said. “That access provides a critical connection to quality care in our state and to better health. The availability of insurance through the marketplace is also one of the reasons that Delaware’s uninsured rate has been reduced to 5.4 percent. I urge people to shop early for a plan on the marketplace, meet with in-person assisters to explore your options and to sign up before the Dec. 15 deadline.”

Delaware currently has about 24,500 people enrolled for coverage through its Health Insurance Marketplace, including 77 percent who re-enrolled for 2018 and 23 percent who were new enrollees.

Enrollees will choose one of eight Highmark Blue Cross Blue Shield of Delaware plans that are available for purchase in 2019 or they will be automatically re-enrolled in a plan that is similar to the one they currently have.

In August, Insurance Commissioner Trinidad Navarro announced that the Department of Insurance had approved an average rate increase of 3 percent for 2019, the lowest increase since the marketplace began in 2014. Federal tax credits are available for those whose household income is between 138 percent and 400 percent of the Federal Poverty Level. For 2018, that’s between $16,753 and $48,560 for an individual, or between $34,638 and $100,400 for a family of four. For coverage in 2018, about 82 percent of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the month premium.

“With so much uncertainty in Washington, there are many people who don’t realize that they can still get coverage through the marketplace and that there’s financial assistance available to help them pay the monthly premiums for the plan they choose,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker.

“If you need help walking through the enrollment process and understanding your options, we have in-person assisters who can help. 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 compare plans to make sure they have the best plan to meet their health needs and their budget.”

“I am pleased we were able to achieve a historically low rate increase this year,” Commissioner Navarro said. “However, with the federal government again slashing the enrollment period and providing far fewer dollars to fund critical navigator assistance this year, it is imperative that consumers be as informed about their choices and options as possible. Given the low increase and use of silver-loading for this year’s filing, I strongly encourage consumers to look at their financials, log into HealthCare.gov and look at their choices as there may be a more affordable option for them for 2019.”

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. 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, up to a maximum annual out-of-pocket cap of $7,350 for an individual and $14,700 for a family.

For 2019, Highmark Blue Cross Blue Shield of Delaware will offer a total of eight plans for individuals – one gold plan, three silver, two bronze, one catastrophic 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, five with a low actuarial level (70 percent) and six with a high actuarial level (85 percent).

Commissioner Navarro said the 2019 rates are silver-loaded, which means the highest premium increases are found on those plans because greater federal tax credits are adjusted to offset the increases and reduce the net cost of premiums to enrollees. Because of the increased federal tax credits received, silver-loading may result in reduced premiums for gold plans and low-cost or free premiums for some members who choose bronze plans, Navarro said.

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.

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

Consumers can go to HealthCare.gov now to check out their options for 2019, and can enroll at any time between Nov. 1 and Dec. 15. The federal Centers for Medicare and Medicaid Services (CMS) announced earlier this month that HealthCare.gov is scheduled to be offline for maintenance from midnight to noon each Sunday during open enrollment, except for the final Sunday, Dec. 9. CMS officials said they expect the actual downtime to be much less, citing last year when the site was offline for only a total of 21.5 hours out of a scheduled 60 hours.

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-two 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 $750, with the average premium reduced to $223 per month after tax credit.
• For the 82 percent of Delawareans who currently receive financial assistance, the average premium after tax credit is $122 per month.
• Among the more than 24,500 current enrollees, 77 percent are re-enrollees and 23 percent are new enrollees for 2018.
• Financial help is available for individuals with annual incomes up to $48,560; for a family of four the income limit is $100,400.
• About two-thirds of Delaware’s current enrollees signed up during the final two weeks in 2017, Dec 3-9 and Dec. Dec. 10-15.

No penalty for going without coverage

Starting in 2019, there no longer will be a federal tax penalty for individuals who can afford coverage, but who choose not to buy it. The penalty is still in force for 2018, and when people pay their 2018 taxes they will pay a penalty for not having health insurance that is 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 2018, the maximum penalty will not exceed $2,085 per household.

Delaware’s U.S. senators and representative urged uninsured Delawareans to find out what’s available for them on the marketplace.

“Despite constant partisan attacks and efforts to sabotage its effectiveness, the Affordable Care Act remains the law of the land because it is providing high-quality health insurance for millions of Americans,” said U.S. Sen. Tom Carper. “During open enrollment, I encourage all Delawareans to go to HealthCare.gov or meet with marketplace navigators, positioned throughout the state, for free assistance exploring your health insurance options. Don’t delay – there is no time like the present to find a health insurance plan that keeps you and your family covered, regardless of any pre-existing conditions or special health care needs.”

“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,” U.S. 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 the open enrollment period for 2019 begins, I encourage any Delawarean looking to find coverage to take advantage of HealthCare.gov to find a quality health care plan that meets each family’s needs,” said Congresswoman Lisa Blunt Rochester. “The health care exchange is a valuable resource that help Delawareans navigate the marketplace, research discounts or subsidies that may be available, and select coverage for the upcoming year. Ensuring that every family has access to health care that protects them regardless of pre-existing conditions is an essential right worth protecting. Our health care marketplace is stronger when we all get covered, so I encourage all Delawareans to take advantage of the free, in-person help available in finding the right coverage for you and your family.”

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 5.4 percent in 2017, 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 working to ensure that our health care system enhances the experience for patients, produces better health outcomes, slows the growth of health care spending and improves the experience of health care providers,” she said.