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What you need to know about health insurance marketplace

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Carrie Dennis-Mayer
“ACA removed my health care insecurity,” Carrie Dennis-Mayer said. “I’m back to a normal life.”

Delaware today unveiled its health insurance marketplace, with open enrollment on www.HealthCare.gov or CuidadodeSalud.gov starting Sunday and running through Dec. 15.

For 2021, Highmark will offer 12 plans for individuals: three gold plans, three silver, three bronze, two platinum and one catastrophic. Monthly premiums will be 1% lower on average than the 2020 plans, Insurance Commissioner Trinidad Navarro announced in August, atop a 19% dip last year.

Two dental insurers – Delta Dental of Delaware and Dominion Dental Services – will offer a total of 11 stand-alone dental plans.

Last year, 23,981 people signed up during open enrollment, with 86% having incomes low enough to get federal tax credits that cut premiums. Those credits apply to individuals earning $17,609 to $51,040 or families of four earning $36,156 to $104,800. The credits come from a $27 million fund that uses federal funding and assessments collected from health insurers doing business in Delaware.

At today’s news conference, Sen. Tom Carper was both optimistic and pessimistic about the Affordable Care Act, the federal law that created the marketplace.

“The Affordable Care Act is alive and well,” he said, quickly adding that it continues to be attacked by Republicans, even during a pandemic when people need affordable health care. “Health care is on the ballot,” he added, urging people to vote on Tuesday.

Carper also said that the future of ACA a “real concern” when the next lawsuit hits the Supreme Court, with its newly enlarged conservative majority.

Republicans have been destroying and dismantling health care “by a thousand paper cuts,” Navarro said, adding its elimination would be “catastrophic” nationwide. “More people are relying on the marketplace than ever before,” including 777 who signed up during a special pandemic enrollment.

Delawareans have less to worry about, said Tanisha M. Merced, deputy secretary of policy and social services for Delaware Health and Social Services, because of state laws that will maintain certain protections, such as rules on pre-existing conditions.

That said, lack of federal funding would reduce the tax credits and therefore increase premiums.

“ACA removed my health care insecurity,” said Carrie Dennis-Mayer, invited to talk about life before (high premium, high deductible) and life now with an ACA plan and a team from Westside Family Healthcare to handle her high blood pressure and diabetes. “I’m back to a normal life.”

She recommended people work with an enrollment specialist to figure out the best plan for them.

Such help is available through Westside Health, Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown. State-licensed insurance agents and brokers can also help.

Coverage for enrollees who sign up by Dec. 15 and pay their first premium will take effect Jan. 1. Individuals who don’t cannot get 2021 coverage unless they meet various qualifying factors.

The overall average monthly premium in Delaware is $668, with the average premium reduced to $192 per month after tax credit. For the 86 percent of Delawareans who receive financial assistance, the average premium after tax credit is $110 per month.

Consumers who pick silver health care plans might also qualify for additional savings through discounts on deductibles, copayment, and coinsurance. In Delaware, about 29 percent of current enrollees qualify for cost-sharing reductions.

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.

The marketplace and Medicaid expansion have helped reduce Delaware’s uninsured rate, decreasing from 10% in 2008 to 6.6% in 2019, according to the Census Bureau.

“Our uninsurance rate has hit a historic low,” said Lolita Lopez, CEO of Westside Health.

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