Tuesday is deadline to sign up for care through Marketplace

DOVER — Tuesday is the last day Delawareans can sign up or change their health coverage for 2021 through Delaware’s Health Insurance Marketplace.

For those who enroll by the deadline and pay their first premium, coverage will begin Jan. 1.

Residents can sign up at healthcare.gov or by calling (800) 318-2596 (TTY: 855-889-4325). Free assistance is available through Westside Family Healthcare at 472-8655 in New Castle County and 678-2205 in Kent and Sussex counties or enrollment@westsidehealth.org. State-licensed insurance agents and brokers also can help individuals enroll or reenroll and help employers update their coverage at no extra charge.

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

Individuals who don’t act by Tuesday 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, birth or adoption of a child, a permanent move, marriage or divorce.

Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace. Enrollees can choose from among 12 Highmark plans for 2021, or they will be reenrolled automatically in a plan similar to their current one.

Plans on the Marketplace are spread among 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, while 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%.

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. They 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.

For 2021, Highmark offers 12 plans: three gold, three silver, three bronze, two platinum and one catastrophic. Two dental insurers — Delta Dental of Delaware Inc. and Dominion Dental Services Inc. — offer a collective 11 stand-alone dental plans on the Marketplace, six with a low actuarial level (70%) and five with a high actuarial level (85%).

Consumers who pick silver health care plans might qualify for additional savings through discounts on deductibles, copayments and co-insurance. In Delaware, about 29% of current enrollees qualify for cost-sharing reductions.

Rates on Delaware’s Health Insurance Marketplace have decreased more than 19% on average over the past two years. Monthly premiums for 2021 plans in Delaware are 1% lower on average than the 2020 plans.

About 86% of last year’s enrollees in Delaware qualified for federal tax credits, which help reduce the cost of the monthly premium. Tax credits are available for those whose household income is between 138% and 400% 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.

To speed up the enrollment process, Delawareans should have the birth dates and Social Security numbers of those applying for coverage, as well as pay stubs, W-2 forms or other information detailing income, policy or member numbers for any current health insurance plans, information about any health insurance available through a job and login and account information for those who have previously enrolled on the Health Insurance Marketplace.

All plans on the Marketplace offer essential health benefits such as coverage of preexisting medical conditions, outpatient care (including telehealth services), emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services and pediatric services.

Marketplace plans can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19.

Through Nov. 28, 7,748 Delawareans had signed up for 2021 coverage through the Marketplace, an increase of 5.7% from a similar period last year. Last year, nearly 24,000 people signed up or renewed their coverage during open enrollment, which began Nov. 1.

In addition to the Health Insurance Marketplace, some Delawareans might be eligible for coverage through 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 eligibility or to apply for Medicaid benefits, go to Delaware ASSIST.