Open Enrollment Now Underway on DE Health Insurance Marketplace
Open enrollment on Delaware’s Health Insurance Marketplace is underway. The 10th open enrollment began Tuesday morning – and will end on January 15, 2023 at http://www.healthcare.gov/. DHSS officials say Delawareans will find more choice in insurers and plans along with enhanced federal subsidies that could bring consumer costs down by as much as 40%. You can renew your existing coverage or sign up for a new plan – coverage for enrollees who sign up by December 15 and pay their first month’s premium will be effective January 1st.
Additional information from the DHSS Press Release:
Individuals who don’t act by Jan. 15, 2023, cannot get coverage for 2023 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.
This year, Delawareans will have three insurers to choose from vs. only one last year, and a total of 30 plans, the highest total in the 10 years of the marketplace. Insurance Commissioner Trinidad Navarro announced in June that two new insurers – AmeriHealth Caritas (four plans) and Aetna CVS Health (nine plans) – would join Highmark Blue Cross Blue Shield Delaware (17 plan options) in offering coverage on the marketplace for 2023. In September, Commissioner Navarro announced that Highmark’s rates would increase 5.5% on average.
The overall stability of Delaware’s Health Insurance Marketplace reflects continued federal approval of Delaware’s reinsurance program. The program has lowered health insurance premiums for plans sold in the individual insurance market by partially reimbursing insurers for high-cost health care claims through a 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, the insurers can reduce the cost of premiums or limit increases.
During last year’s open enrollment, a total of 32,113 Delawareans enrolled for 2022 coverage on Delaware’s Health Insurance Marketplace, an increase of 26.8% over the previous year.
In 2021, the Biden administration made expanding access to health insurance and affordability a priority through the American Rescue Plan Act, which increased tax credits and expanded subsidies into the middle class. This year, the passage of the Inflation Reduction Act continued those enhanced benefits through 2025. For instance, a family of four (both parents in their 40s) making $50,000 are eligible for a credit of roughly $16,000, compared with $14,300 previously.
In addition, the federal government earlier this month changed the way that the affordability of employer coverage is determined for members of an employee’s family, the so-called “family glitch.” Starting in 2023, family members of a person who is offered employer-based coverage that is “affordable” for the employee only and not the whole family, may be eligible for tax credits on the marketplace for the first time. This change will help more consumers qualify for tax credits and cost-sharing reductions through a marketplace plan.
Federal tax credits are available for those whose household income is between 138% and 400% of the Federal Poverty Level. For 2023 coverage, that’s between $18,754 and $54,360 for an individual, or between $38,295 and $111,000 for a family of four. For coverage in 2022, about 89% of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.
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% of medical costs and the consumer pays about 30%. Consumers who pick silver health care plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 23% of current enrollees qualified for cost-sharing reductions. For any marketplace plan in 2023, individual consumers can’t pay more than $9,100 in out-of-pocket medical costs and families can’t pay more than $18,200.
For 2023:
- Highmark will offer 17 plans for individuals – three platinum plans, six gold, three silver, four bronze and one catastrophic.
- Aetna CVS Health will offer nine plans – two gold, four silver and three bronze.
- AmeriHealth Caritas will offer four plans – one gold, one silver and two bronze.
- Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – will offer a collective 13 stand-alone dental plans on the marketplace, seven with a low actuarial level (pay less monthly, but more when you get dental services) and six with a high actuarial level (pay more monthly, but less when you get dental care).
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, pediatric services, birth control and breastfeeding coverage, and COVID-19 vaccines, including the new bivalent booster. In addition, coverage cannot be terminated due to a change in health status, including diagnosis or treatment of COVID-19.
Assistance for Delaware enrollees
Consumers can go to HealthCare.gov or CuidadodeSalud.gov now to explore their options for 2023 coverage, and they can enroll anytime between Nov. 1 and Jan. 15, 2023.
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 (statewide) and Quality Insights, Inc., (New Castle and Sussex counties) and by certified application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown. Westside and Quality Insights each received increased 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):
- About 89% of Delaware’s marketplace enrollees received financial assistance in 2022 to help pay their monthly premiums and/or deductibles and co-pays.
- The overall average monthly premium in Delaware is $706, with the average premium reduced to $169 per month after tax credit. For the 89% of Delawareans who received financial assistance, the average premium after tax credit is $114 per month.
- Among the 32,113 people who signed up during last year’s open enrollment, about 78% were re-enrollees and 22% were new enrollees.
- Financial help is available for individuals with annual incomes up to $54,360; for a family of four the income limit is $111,000.
- About 62% of Delaware’s enrollees signed up during the three weeks before Dec. 15, 2021.
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 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 5.7% in 2021, according to the Census Bureau. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions.
