Health Insurance Marketplace in Delaware
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Delaware will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Delaware 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)?
Chatman, LLC will serve as a navigator within the state of Delaware by assisting consumers in accessing health coverage and conducting outreach and public education. Chatman, LLC has extensive experience in the areas of health benefits and the policy and benefits structure of the
private health insurance providers.
Who you can contact for more help?
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
[contact-form-7 id=”73″ title=”Contact form 1″]
Accountable Care Organizations in Delaware
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- National Council Of Young Men’s Christian Associations Of The United States Of America (YMCA Of The USA) DE – Health Care Innovation Award
- Christiana Care Health System DE – Health Care Innovation Award
- Nemours Alfred I. Dupont Hospital For Children DE – Health Care Innovation Award
- University Of North Texas Health Science Center DE – Health Care Innovation Award
- State of Delaware DE – State Innovation Models Initiative: Model Design Award
Health care facilities where Innovation Models are being tested
- Bayada Home Health Care, Inc. Wilmington, DE – BCPI Initiative: Model 3
- Christiana Care Health Services Wilmington, DE – Independent at Home Demonstration
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Delaware
In July 2012, Governor Jack Markell (D) indicated that Delaware would begin planning for a state-federal partnership exchange.1Delaware will retain plan management and consumer assistance functions, and defer other exchange management functionality to the federal government.2
The Delaware Health Care Commission, housed within the Department of Health and Social Services, leads the process of planning for an exchange in Delaware. The Commission, originally created in 1990 with the goal of improving the provision of health care for residents of Delaware, includes 10 members representing the executive and legislative branches of government and public and private sectors.3 The Commission also works with the Governance and Policy Subcommittee of the Health Care Reform Steering Committee, which was created in 2010 within the Department of Health and Social Services to implement health reform within the state.
Contracting with Plans: In September 2012, the Health Care Reform Steering Committee and Department of Insurance developed recommendations for state-specific certification standard of qualified health plans (QHPs). Stakeholders submitted comments on the draft QHP standards and the Health Care Commission approved the QHP certification standards on November 1, 2012.4The approved standards include: network adequacy standards aligned with standard used for Medicaid and the Department of Public Health; transition plans to support continuity of care for consumers moving between a QHP and Medicaid; quality improvement strategies for participating issuers, such as submitting data to the Delaware Health Information Network (DHIN); and requiring participating issuers to offer at least one bronze-level plan.
Risk Adjustment, Reinsurance, and Risk Corridors: Delaware anticipates that the federal government will administer the state’s reinsurance program.5
Consumer Assistance and Outreach: Delaware plans to select and train marketplace assistors in early 2013.6 The marketplace assistors will act as the main outreach point to communities and the state will monitor and evaluate them on an on-going basis. Delaware received public comment on proposed certification standards for applicants to the marketplace assistor program and revised its standards based on stakeholder response. Current draft requirements include that applicants commit to training after initial certification and that they cannot be employed by an insurer and must disclose any compensation received from plans in the previous 24 months. The Health Care Commission plans to release an RFP for marketplace assistor organizations in January 2013.7
Small Business Health Options Program (SHOP) Exchange: In March 2012, a subcontractor provided Delaware with an assessment of the impact of merging the small group and individual markets.8 The analysis found that merging the two markets would increase premium rates for current individual enrollees and small group premiums. However, there are considerations besides cost, such as sustainability and stability of the exchange. An alternative strategy offered by the subcontractor would be to keep the individual and small group markets separate but implement similar requirements, such as mandating that all QHPs participate in both markets or requiring plan standardization.
Coordination with Medicaid/CHIP: Delaware intends to retain the authority to make final eligibility determinations for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals that apply directly through the Exchange.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Delaware selected the Blue Cross Blue Shield Small Group EPO as the benchmark plan.9 Delaware will supplement the benchmark plan with the Federal Employee’s Dental and Vision Insurance Program for pediatric dental and vision services.10 In addition, Delaware adopted the standard requiring habilitative services to be offered at parity with rehabilitative services.
The Delaware Department of Health and Social Services received a federal Exchange Planning grant of $1 million in 2010. In November 2011, Delaware was awarded a Level One Establishment grant for $3.4 million to ready business and information technology systems for an exchange. Delaware received a second Level One Establishment grant for $8.5 million in January 2013 to support the review of qualified health plan (QHP) applications, to implement a consumer assistance program, and to fund an outreach and education campaign.11
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Delaware is participating in Medicaid expansion.
On December 20, 2012, Delaware received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange.12 Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time; complying with future guidance and regulations; signing a memorandum of understanding with CMS outlining the roles and responsibilities for the state’s operation of plan management, consumer assistance, outreach and education functions; and obtaining the appropriate authorities to enforce all ACA health insurance market reforms.
Additional information about the Delaware exchange planning process and the Commission’s activities can be found at: http://dhss.delaware.gov/dhss/dhcc/
1. “How Each State Will Approach Health Care Act.” USA Today. July 13, 2012.http://www.usatoday.com/news/nation/story/2012-07-12/states-health-care-status/56181438/1
2. “Delaware QHP Certification Standards: Final Draft for HCC Approval”. (Accessed November 14, 2012) http://dhss.delaware.gov/dhss/dhcc/files/certificationstandardsNov1.pdf
3. State of Delaware, “Who Serves on the Delaware Health Care Commission?” (Accessed July 31, 2012) http://dhss.delaware.gov/dhss/dhcc/serve.html
4. Public Consulting Group. “Delaware Health Benefit Exchange (HBE) Project Update.” November 1, 2012.
5. Letter from Governor Jack Markell to Secretary Sebelius. November 14, 2012.http://www.healthcare.gov/law/resources/letters/de-exchange-letter.pdf
6. “Delaware Health Benefit Exchange (HBE) Project Update.” Presented to the Delaware Health Care Commission on December 6, 2012.http://dhss.delaware.gov/dhss/dhcc/files/hbe_projectupdate120612.ppt
7. “Delaware Health Benefit Exchange (HBE) Marketplace Assister Certification.” January 3, 2013.http://dhss.delaware.gov/dhss/dhcc/files/hbe_mpacert010313.ppt
8. Peper J, Rodgers L, Bradley C. “Impact of Merging the Small Group and Individual Markets in Delaware.” Wakely Consulting. March 26, 2012. Available at:http://dhss.delaware.gov/dhss/dhcc/files/impact_merging_sgindmkt.pdf
9. Delaware Health Care Commission. “Essential Health Benefits- Supplemental Plan Packet.” Accessed November 14, 2012.http://dhss.delaware.gov/dhss/dhcc/files/supplementalplanppacket.pdf
10. “Delaware Health Benefit Exchange (HBE) Project Update.” Presented to the Delaware Health Care Commission on December 6, 2012
11. Delaware Affordable Insurance Exchange Grants Awards List. Available at:http://cciio.cms.gov/archive/grants/states-exchanges/de.html
12. Letter from Secretary Sebelius to Governor Markell. December 20, 2012.http://cciio.cms.gov/resources/files/de-blueprint-exchange-letter-12-20-2012.pdf
Provided by the Henry J. Kaiser Family Foundation