DOVER — There’s good news ahead regarding affordability associated with the Affordable Care Act, State Insurance Commissioner Trinidad Navarro says.
While coverage costs through the Delaware Health Insurance Marketplace (DHIM) won’t drop like the approximate 19% rate of 2020, monthly premiums will still be reduced by 1% on average in 2021, according to the Delaware Department of Insurance.
Highmark Blue Cross Blue Shield Delaware provides 12 plan options to choose from, or current participants will be re-enrolled automatically into a similar plan to existing coverage if applicable.
Small group plans will drop by an average of 3%, according to the DOI.
The company is the lone health insurer available through the DHIM. It’s not ideal, Commissioner Navarro said, but noted there are 12 different plans offered by Highmark.
“Consumer choice is an important aspect to any purchase, whether in something as complex as insurance or as simple as a meal,” he said.
“… Of course, increased provider options would allow residents increased choice, but having one company offering plans does not mean there are no choices, and there are counselors throughout the state to help residents pick the best plan for their needs.”
The commissioner stressed that “having a sole offering insurer does not provide that insurer with increased flexibility or benefit. Our team will always scrutinize premium filings, and involve independent actuaries to ensure that consumer costs are justified.
“Highmark is held to all the standards of the ACA, including, for example, the medical loss ratio (MLR). The MLR requires insurers to pay a majority of their premium dollars to medical costs, and when that does not occur the company must refund consumers — they aren’t keeping dollars for profit.”
According to Highmark Blue Cross Blue Shield Delaware President Nick Moriello, the insurer “works closely in partnership and collaboration with the (Commissioner Navarro) and his department to ensure affordable coverage is available to everyone.
“Together we evaluate the expected cost of care for ACA consumer to determine rates, which have again decreased for 2021.”
Also, Mr. Moriello noted the variety of plans “that have low or even $0 deductibles. Many consumers—including about 75% of Highmark’s current ACA members—are eligible to receive subsidies or tax credits to help make coverage even more affordable.
“Following great collaboration between the Department of Health and Social Services, Department of Insurance, and our teams, the recently implemented reinsurance program has further reduced the cost of health insurance for ACA consumers.”
Mr. Moriello touted ACA plans “that offer integrated adult dental and vision coverage, as well as increasing the number of plans that can be joined with a Health Savings Account.”
The DHIM debuted in 2014 through the Affordable Care Act. The DOI said it has cut the number of uninsured residents in Delaware by half since its opening.
The ongoing enrollment period (the eighth overall this year) ends Dec. 15. The signup for marketplace coverage can be done online at HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). For more information, go to ChooseHealthDE.com.
Coverage may still be available after Dec. 15 through 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, DOI said.
Dr. Julia Pillsbury, who made an unsuccessful run for Insurance Commissioner this year, described Highmark as an “excellent insurer” but believes “there are many other plans which do a good job of representing their insured.
“Under (Centers for Medicare & Medicaid Services), Medicaid must provide the insured a choice. I do not understand why those covered under the ACA are not offered the same. I feel the State of Delaware should require those covered by the ACA the same plans offered to State employees.
“This way, all citizens will have a choice of payers not just plans. This will create competition and improve rates.”
Ultimately, Dr. Pillsbury said, “I think the primary change needs to be competition for the insured. I have heard that groups cannot negotiate rates e.g. Farmers, small businesses, etc. as an organization for their members in the past they were able to.
“This creates a hardship on many of these groups and should be reconsidered. I feel strongly that the Insurance Commissioner needs to address these issues as many people are canceling their insurance and taking their chances.”
Last year, almost 24,000 people registered for coverage during open enrollment, an increase of more than 6% from the year before. About 75% of last year’s enrollees were renewing their coverage and 25% were new enrollees, the DOI said.
Data for the current signup period was not available, but the DOI said an update would provided in the weeks ahead. A late surge was expected before the Dec. 15 deadline, and DOI said described the ongoing signups as proceeding smoothly with no issues.
That’s par for the course as consumers settle in to the lowering rates, the DOI said.
“In the early years of the ACA, consumers would complain about high premiums and deductibles,” according to the agency.
“However, as the rates have steadied and fallen over the past two years, fewer complaints have been made. We often hear higher-than-normal reports of scams during the enrollment period but have not seen that uptick this year.
“It’s important to note that while our department promotes the marketplace and engages with consumers, we do not facilitate enrollment or provide navigation assistance.”
The DOI described its relationship with Highmark as a “fruitful and productive relationship with our state’s largest insurer. They are very responsive and quick to fix problems and contribute a great deal to our community.”
Delaware Health Care Association President and CEO Wayne Smith described the rate drops as “a very positive change … That improved Marketplace affordability for Delawareans. Next year’s additional modest decrease in rates also helps maintain affordability for many Marketplace participants.”
Also, Mr. Smith said, “Given the adversarial nature of the payer-provider relationship, Highmark has been a good partner with hospitals on policy issues. Certainly for consumers more than one marketplace insurer would be a benefit.”
According to the U.S. Department of Health and Social Services:
• 86% of Delaware’s marketplace enrollees receive financial assistance to help pay their monthly premiums and/or deductibles and co-pays.
• The overall average monthly premium in Delaware is $668, with the average premium reduced to $192 per month after tax credit. For the 86% of Delawareans who receive financial assistance, the average premium after tax credit is $110 per month.
• Among the 23,981 people who signed up during last year’s open enrollment, about 75% were re-enrollees and 25% were new enrollees.
• Financial help is available for individuals with annual incomes up to $51,040; for a family of four the income limit is $104,800.
• About 70% of Delaware’s enrollees signed up during the final three weeks of open enrollment in 2019, Nov. 25-Dec. 1, Dec. 2-8, and Dec. 9-17 (HHS extended last year’s sign-up period by two days because of technical issues on Dec. 15, the final scheduled day to buy coverage.)
• As of 2019, there is no longer a federal tax penalty for individuals who can afford coverage but who choose not to buy it.
While the lower rates are duly noted, DOI oversight has detected adverse issues as well, ones that are apparently being remedied.
On Nov. 19, the DOI announced that $597,000 fines had been levied due to mental health parity violations by Highmark and Aetna; spokeswoman Christina Haas said the penalties were split relatively evenly between the companies and she believed the fines had been paid.
Thousands of mental health parity violations were discovered, and Commissioner Navarro said he believed the action “brought about important conversations that will result in action, and insurers have been cooperative throughout the process and are already making improvements.”
The infractions included, according to the announcement, policy and practice issues involving “a lack of parity between mental health and medical/surgical procedures, medications and procedure preauthorization requirements. Mental health patients often had to meet higher standards for Non-Quantitative Treatment Limitation (limits on the scope or duration of benefits) than other patients, and pharmacy requirements appeared to differ as well.”
Highmark has been a regular contributor to community betterment and said its grant fund BluePrints has given more than $17 million dollars since 2007 to the nonprofit community to support health-related projects and programs that improve health outcomes in Delaware.
During the pandemic, according to Highmark, BluePrints donated $200,000 to support the statewide relief efforts, and continued its normal giving operations, as well as announced a $1 million commitment to address social determinants of health in September.
Also, according to Highmark, the company has provided tens of thousands of face coverings to its members, the community and partner organizations. It donated free back-to-school kits to many school districts throughout the state, hosted a free health and wellness webinar with ChristianaCare for Delaware educators, and partnered with Blue Bear Protection to offer deep discounts to PPE supplies for everyone, regardless of their affiliation with Highmark.
According to the DOI, insurers were losing substantial amounts of money and not being reimbursed by the federal government as expected. Insurers nationally thus left the DHIM, including Aetna prior to the 2018 plan year. Besides Delaware, Aetna opted not to participate in any marketplaces nationwide.
The DOI said it recognizes the value of increasing consumer options. With the Supreme Court’s ruling that insurers must be paid the $12 billion lost “as a part of the Obama Administration’s risk corridor agreement, insurers may feel more comfortable engaging.”
While COVID-19 hasn’t had a direct affect on the marketplace rates, but lowered individual incomes resulting from the pandemic could bring qualification for more subsidies, the DOI said. The DHIM website directs those eligible for Medicaid and other programs to the proper entities.
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