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Enrollment in the health insurance marketplace starts Tuesday, with premiums for those without subsidies rising sharply.
The open enrollment period for 2017, runs from Nov. 1 through Jan. 31, 2017, at http://www.healthcare.gov/. Individuals must sign up by Dec. 15 for their coverage to be effective Jan. 1.
This year, the Delaware Department of Health and Social services will make an education push on the availability of subsidies for many people under the Health Insurance Marketplace, also known as Obamacare.
The marketplace is a small part of the total health insurance markets. The rates can dent wallets of higher-income individuals who need the coverage due to early retirements, or work as s a solo professional or free-lancer.
At the same time, those with group health coverage have seen skyrocketing out-of-pocket costs. Also, the Affordable Care Act brought an end to bare-bones health coverage policies that came with low premiums but offered little protection against catastrophic illnesses. The plans were popular with some businesspeople.
“Many people still don’t realize they can get financial help paying for their Marketplace coverage,” said Rita Landgraf, secretary of the state Department of Health and Social Services. “This year, more than 80 percent of Delawareans who have a Marketplace plan are receiving tax credits to lessen the costs of their premiums. 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 pick a plan that meets their health needs and budget.”
Individuals who need help enrolling in coverage will again have access to free in-person assistance from specialists at several Delaware organizations, including Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center and La Red Health Center.
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).
DHSS highlighted the following:
Sixty-three percent of Delawareans who now have Marketplace coverage could get 2017 coverage for a monthly premium of $100 or less after tax credits, 55 percent could get coverage for $75 or less, and 45 percent could get coverage for $50 or less.
Sixty-three percent of current Marketplace enrollees whose annual household incomes are between 100 percent and 250 percent of the federal poverty limit (from $11,880 to $29,700 for one person and from $24,300 to $60,750 for a family of four) are receiving financial assistance. Financial help is available for individuals with annual incomes up to $47,520; for a family of four the income limit is $97,200.
The median annual income of Marketplace enrollees in Delaware is about $25,000 for one person and $51,400 for a family of four.
As in previous years, three insurers will offer Marketplace medical plans in Delaware for 2017: Highmark Blue Cross Blue Shield of Delaware, Aetna Health, and Aetna Life Insurance Company. Across the insurers, they will offer a total of 21 plans for individuals and 11 SHOP plans for small businesses. Two insurers – Delta Dental and Dominion Dental – will offer a collective 15 stand-alone dental plans, 10 for individuals and five for small businesses.
Rates in 2017 will increase an average of 32.5 percent for Highmark plans, 23.6 percent for Aetna Health and 22.8 percent for Aetna Life.
All plans cover pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.
Medical plans will be available in three metal-level categories – bronze, silver, and gold – 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.
Tax credits are especially beneficial to consumers who pick the second-lowest cost silver plan since the credits adjust to match any changes in premium. 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 $6,350 for an individual and $12,700 for a family.
In Delaware in 2017, the average monthly premium for a second-lowest cost silver plan for a 27-year-old non-tobacco user will be $347 before tax credits based on eligibility are applied.
Consumers who pick silver plans might also qualify for additional savings through discounts on deductibles, copayments, and coinsurance.
Individuals who can afford coverage but who choose not to buy it will pay a fee equal to the higher of these amounts: 2.5 percent of annual household income or $695 per person ($347.50 per child under 18). The maximum penalty will not exceed $2,085 per household or the total yearly premium for the national average price of a bronze-level plan sold through the Marketplace. In addition to the penalty, consumers will be responsible for the total cost of health expenses they incur.
Consumers can estimate their penalty using the penalty calculator available on ChooseHealthDE.com.
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.
Delaware’s uninsured population decreased from 83,000 in 2013 to 54,000 in 2015, according to a recent Census Bureau report.
Access to health care coverage is the first step toward a healthier Delaware, Landgraf said. “Through the Delaware Center for Health Innovation, we are striving to ensure that our health care system delivers quality care, produces better health outcomes, reduces costs and enhances the experience of health care providers. Those goals are at the heart of the Affordable Care Act.”
At the same time, Landgraf has warned that Delaware needs to deal with high rates of chronic diseases, such as diabetes, and other factors, or face increases in health costs.
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