Delaware Health Insurance Marketplace to lower rates

DOVER — The Affordable Care Act has been under attack in recent years for its high premiums and lack of access to many families and individuals.

Now, Gov. John Carney and other state officials are pushing back with more affordable prices as they announced that Delaware’s Health Insurance Marketplace will have a 19 percent drop in rates for next year, which they hope will lead to even more Delawareans becoming insured.

This marks the first time in the Affordable Care Act’s (ACA) seven-year history that rates will be reduced.
Gov. Carney, U.S. Sen. Tom Carper, Insurance Commissioner Trinidad Navarro and Department of Health and Social Services Secretary Dr. Kara Odom Walker announced the rate drop at the Westside Family Healthcare Dover Clinic at 1040 Forrest Avenue on Monday morning.

“We have a lot of people who have attacked the Affordable Care Act, but in Delaware it’s been a really, really positive thing, cutting our uninsured rate in half, providing affordable plans for tens of thousands of Delawareans and now, with this innovative approach to that, providing even more affordable plans for so many people,” Gov. Carney said. “Today is particularly a happy day because for the first time in those seven years the premiums for the health care plans provided on the marketplace are going to go down by about 20 percent.”

Individuals and families can renew their marketplace coverage for insurance or sign up for a new plan for 2020 during the enrollment period that runs from Nov. 1 until Dec. 15 at

Gov. Carney remains a staunch supporter of the ACA — also known as Obamacare — and said the results speak for themselves.

“Prior to the Affordable Care Act, Delaware had anywhere from 110,000 to 120,000 uninsured folks on an annual basis,” he said, “but since the

Affordable Care Act and the great work of our delegations — Sen. Carper, Sen. (Chris) Coons and Rep. (Lisa) Blunt-Rochester — we have cut that uninsured rate basically in half, which means more than half the Delawareans who were formerly uninsured now have insurance.”
Last year, about 22,562 people enrolled for coverage through Delaware’s Health Insurance Marketplace, including about 78 percent who re-enrolled for 2019 and 22 percent who were new enrollees.

Sen. Carper also insists there still is a place for the Affordable Care Act.
“Lower average premiums across the country and a double-digit drop in Delaware shows that we should be focused on building on the success of the ACA — not tearing it down,” Sen. Carper said.

“By making common sense improvements, like our state has done with the reinsurance program, we can continue to provide Delaware families with access to quality, affordable health insurance which in turn can lead to better health outcomes and reduced costs.

“I often say, find out what works and do more of that — and the Affordable Care Act is working. Now, we must continue to build on this progress to achieve even lower costs for families across the country and protect the Affordable Care Act that insures over 20 million Americans, including more than 20,000 Delawareans, from continued partisan attacks and attempts to scrap the law entirely.”

Lowering the rates
Commissioner Navarro said that a lot of hard and often complicated work went into getting the lower rates.

He said that 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. The Delaware Health Care Commission will administer the program.

The reinsurance program required multiple approvals at the state and federal levels.
In June, Gov. Carney signed enabling legislation (House Bill 193) approved by Delaware’s General Assembly that same month. 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, Commissioner Navarro announced that he had approved an average rate decrease of 19 percent for the sole insurer on Delaware’s Marketplace — Blue Cross Blue Shield of Delaware.
Enrollees will be able to choose from 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.

“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,” Commissioner 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.”

Secretary Walker said now is the optimal time for those without insurance to sign up for coverage.
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 to reduce the cost of the monthly premium.

“When premiums decline in the individual market — both on and off the marketplace — that often helps to reduce health insurance costs for everyone,” Secretary Walker said. “With premiums down 19 percent for the 2020 marketplace plans in Delaware, 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 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.”

Multi-levels of plan options
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 an individual needs care; gold plans have high premiums but lower costs when care is needed.
In a silver plan, the insurer pays about 70 percent of medical costs and the consumer pays about 30 percent.
For any marketplace plan, the maximum annual out-of-pocket cap for 2020 is $8,200 for an individual and $16,400 for a family.

For 2020, Highmark Blue Cross Blue Shield of Delaware will offer a total of eight plans for individuals — two gold plans, 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).

Consumers who pick silver plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance. In Delaware, about 36 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.

Lolita Lopez, president and CEO of Westside Family Healthcare, said that for the second year in a row her organization is the only one in Delaware to receive federal funding for navigators to help people enroll for their coverage either in person or over the phone.

“Community health centers like Westside continue to play a critical role in ensuring that our most vulnerable populations have access to affordable coverage and because of this we’re honored to host this kickoff event to highlight the seventh open enrollment period in the Health Insurance Marketplace,” she said.

“Here in Delaware our efforts have resulted in educating and assisting thousands of individuals enrolling in coverage.

“Our uninsured rate has hit a historic low, meaning more Delawareans have access to primary and specialty care more now than ever before, and for the first time in Delaware’s ACA history premium rates for 2020 have dropped, making it more affordable for those who are not eligible for the financial help.”

Gov. Carney said that better, more affordable healthcare is a positive thing for everybody.

“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,” he 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.”

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