Enrollment underway for marketplace health insurance

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Enrollment is underway at Delaware’s Health Insurance Marketplace.

The enrollment comes after a 19 percent drop in rates for Affordable Care Act coverage. The insurance is available for people who are not covered by an insurance plan or the state’s Medicaid system for individuals and families with lower incomes.

The seventh open enrollment period, in which people can renew coverage or sign up for a new plan for 2020, runs from Friday, Nov. 1, through Dec. 15, at www.HealthCare.gov. Coverage for enrollees who sign up by Dec. 15 and pay their first month’s premium becomes effective Jan. 1.

“The reduction in rates for 2020 offers an important incentive to compare and shop for plans on our marketplace, especially for Delawareans who own small businesses, are independent contractors or who don’t have access to health insurance through an employer,” Gov. John Carney said. “I want to thank everyone who helped create Delaware’s new reinsurance program as a critical tool to reduce rates in the individual market. It’s another way that we can connect people to quality care in our state and to better health.”

Under Delaware’s reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone will be reimbursed through a $27 million fund, using a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers.

In August – after public comment periods at the state and federal levels – the federal Centers for Medicare and Medicaid Services (CMS) approved Delaware’s application providing for a reinsurance program through 2024.

In October, Insurance Commissioner Trinidad Navarro announced that he had approved an average rate decrease of 19 percent for the only insurer on Delaware’s Marketplace – Blue Cross Blue Shield of Delaware.

Enrollees will choose one of eight Highmark Blue Cross Blue Shield of Delaware plans that are available for purchase in 2020 or they will be automatically re-enrolled in a plan that is similar to the one they currently have.

Last year, about 22,562 people enrolled for coverage though Delaware’s Health Insurance Marketplace, including about 78 percent who re-enrolled for 2019 and 22 percent who were new enrollees.

Federal tax credits are available for those whose household income is between 138 percent and 400 percent of the Federal Poverty Level.

For 2020, that’s between $17,236 and $49,960 for an individual or between $35,536 and $103,000 for a family of four.

For coverage in 2019, about 85 percent of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.

“This year, our team working with the Department of Health and Social Services, utilized the Federal 1332 Waiver to see if we could further reduce health insurance rates on the ACA Market,”

Insurance Commissioner Trinidad Navarro said.“I’m pleased that with the waiver, we were able to reduce rates by 19 percent.The initial rate filing by Highmark Blue Cross Blue Shield of Delaware indicated a rate reduction of 5 percent.Our team at the Department carefully scrutinizes all rate requests, even the ones that reduce rates, to determine if they can be reduced further.In addition, we utilize an outside actuarial firm with no ties to insurance companies to make sure the approved rate is the lowest possible rate after taking into consideration all actuarial factors.”

For 2020, Highmark Blue Cross Blue Shield of Delaware will offer a total of eight plans for individuals – two gold plan, two silver, three bronze and one platinum. Two insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – will offer a collective 11 stand-alone dental plans on the marketplace, six with a low actuarial level (70 percent) and five with a high actuarial level (85 percent).

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.

Consumers can go to HealthCare.gov or CuidadodeSalud.gov now to check out their options for 2020, and can enroll at any time between Nov. 1 and Dec. 15.

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.

According to the U.S. Department of Health and Human Services:

  • Eighty-five percent of Delaware’s current marketplace enrollees receive financial assistance to help pay their monthly premiums and/or deductibles and co-pays.
  • The overall current average monthly premium in Delaware is $842, with the average premium reduced to $202 per month after tax credit. For the 85 percent of Delawareans who currently receive financial assistance, the average premium after tax credit is $110 per month.
  • Among the more than 22,562 current enrollees, 78 percent were re-enrollees and 22 percent were new enrollees for 2019.
  • Financial help is available for individuals with annual incomes up to $49,960; for a family of four the income limit is $103,000.
  • About 75 percent of Delaware’s current enrollees signed up during the final three weeks in 2019, Nov. 25-Dec. 1, Dec. 2-8, and Dec. 9-15.
  • Beginning in 2019, there is no longer a federal tax penalty for individuals who can afford coverage, but who choose not to buy it.

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

Both the Health Insurance Marketplace and the Medicaid expansion have helped to reduce Delaware’s uninsured rate, decreasing from 10 percent in 2008 to 5.7 percent in 2018, according to a recent Census Bureau report.

That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions.

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