Delaware ACA insurance rates expected to tumble

Commissioner addresses consumer issues in Coastal Point exclusive

Participants in Delaware’s health insurance exchange will see their rates decrease an average of 19 percent in 2020, state Insurance Commissioner Trinidad Navarro announced this week.

Navarro visited the Coastal Point on Thursday, Sept. 26, and discussed the decrease, as well as other insurance-related topics — particularly Medicare.

The decrease, Navarro said, “has never happened before in the history of the” Affordable Care Act.

“It’s going to lower rates probably near a negative 20 percent,” Navarro said. The decrease is made possible by a reinsurance program that is itself a result of a waiver, called a “1332 waiver,” which the State applied for and received from the federal government.

The program essentially sets up a separate pool of money from which high-dollar claims can be paid — also known as reinsurance. The reinsurance program was set up by assessing all insurance companies doing business in Delaware a 1 percent fee.

“For those folks who were paying more for their insurance than their mortgage, this is really going to help,” Navarro said.

Open enrollment for 2020 coverage in Delaware’s ACA healthcare exchange runs only from Nov. 1 to Dec. 15, 2019. Others with qualifying events can register year-round.

There are about 22,000 health insurance recipients currently on the state exchange. Navarro added that, despite “what I call efforts to kill the ACA through 1,000 papercuts,” the ACA marketplace in Delaware has now stabilized.

Navarro said that the Trump administration’s moves to lessen the availability of the ACA by shortening enrollment periods, reducing funding for consumer education and more have caused the number of enrollees in Delaware to drop, but he said he was not sure to what extent.

Even before the state’s recent waiver approval, health insurance rates on the state exchange were slated to decrease by 6 percent, Navarro said.

“We’re trending in the right direction, despite the efforts of Washington, D.C.” he said.

Highmark Blue Cross Blue Shield of Delaware — currently the only insurance company offering coverage on the exchange — “actually made money last year,” after losing “hundreds of millions of dollars” in the first several years of the ACA. “They’re supposed to” make money, he said.

Navarro said that Delaware’s size — with only one company (Highmark) on the exchange, and only three major hospitals across the state — makes it difficult to make change on a large scale, and, additionally, “We have a very sick risk pool.”

In contrast, he said, just across the state line in the Philadelphia area, there are five major hospitals competing to offer lower wait times — lower than any Delaware facilities.

“We don’t have any competition in Delaware,” Navarro said, “so it is very challenging to make a substantial impact.”

However, now that the state’s marketplace has stabilized, Navarro said, he hopes that other insurance companies will take note, and “there’s a likelihood that others will come back” to Delaware’s exchange. Aetna was on the exchange when it began, then left.

Navarro said his office is also looking at ways to reduce consumer costs through reducing prescription drug costs, and through encouraging residents to use stand-alone facilities for outpatient procedures such as x-rays and to use surgical centers rather than hospitals, which charge substantially more for the same services.

“There’s all of these efforts in place now to try to rein in the cost” of health care, he said.

“What can we do in Delaware with respect to prescription drugs?” Navarro asked. He referenced “pharmacy benefit managers” (PBMs), which are essentially a liaison between drug manufacturers and pharmacists. While PBMs were “self-regulated” in the past, this year, the Delaware General Assembly passed a bill requiring them to register with the State, “just like an insurance company,” he said.

The move will allow the state insurance office to determine “where the money is going” in terms of things like rebates and other programs in which manufactures and pharmacies engage.

Other moves to curb healthcare costs include encouraging “primary-care collaboratives” whose overarching goal is to keep patients from getting so sick they have to be hospitalized.

During his Coastal Point visit, Navarro also addressed the need for senior citizens to be informed about their Medicare eligibility and Medigap programs. Navarro noted that for-profit insurance companies are bombarding newly-eligible Medicare patients with information, while the State is working with a much smaller budget for consumer education. A separate program, called the Delaware Medicare Assistance Program (DMAP), has been set up to help residents with questions or concerns about Medicare.

The Department of Insurance’s Georgetown office can handle those with major questions or concerns through a one-on-one meeting with state workers well-versed in the issues, he said, but those appointments should be made in advance so that the pertinent staff is on hand.

Consumers with concerns about their existing health insurance coverage or needing help with Medicare or the state ACA exchange can contact the office for assistance. Navarro noted that the office has successfully helped consumers reverse insurance companies’ decisions on coverage of medications and more, and said that once a consumer has exhausted their avenues of dealing directly with the insurance company, they can contact the Department of Insurance to see if they can be of help.

He said the relatively new Georgetown location has been a boon for residents in the southern part of the state who need its services.

“We knew that 75 percent of the foot traffic that went to Dover came from Sussex County,” Navarro said, so the Georgetown office was opened two years ago.

The Sussex County office of the Delaware Department of Insurance is located at 28 The Circle, Suite 1, Georgetown. Walk-in services are available Monday through Friday from 8:30 a.m. to 3:30 p.m.; phone calls are accepted until 4:30 p.m. at (302) 674-7300 or 1-800-282-8611.

To reach the Delaware Medicare Assistance Bureau, call 1-800-336-9500 or (302) 674-7364.

The department’s website for all insurance-related concerns is at www.insurance.delaware.gov, and live chat is also available through the website.

 

By Kerin Magill

Staff Reporter