The annual open enrollment period for the Affordable Care Act (ACA) marketplace has arrived. Through Dec. 15, individuals and families across Delaware can choose from a range of health insurance options for their particular health needs.
For those who don’t have health coverage through their employer or another government program, the ACA marketplace offers a number of plans. Bill Tuthill, vice president of federal markets for Highmark, offered his insights about the ACA and shared some tips to help marketplace buyers be smart shoppers during open enrollment.
Q. What kinds of services are covered by ACA health insurance plans?
A. ACA plans offer strong, comprehensive health coverage. All plans must cover certain “essential health benefits,” which include important items such as doctor’s visits, inpatient and outpatient hospital care, prescription drug coverage, mental health services, and pregnancy and childbirth. And, unlike many other plans, ACA plans cover a variety of preventive services — like vaccinations and annual wellness visits — for $0.
Q. Is there financial help available to individuals and families?
A. Absolutely. The ACA marketplace provides a range of affordable coverage options for individuals and families. A couple making up to about $68,000 — or a family of four earning up to about $108,000 — will qualify for tax credits that significantly reduce the cost of ACA insurance.
About three out of four of Highmark’s ACA members qualify for subsidies or tax credits that make coverage more affordable. We have nearly 3,500 members in Delaware who receive a tax credit that reduces their premium to less than $5 per month. Highmark also offers ACA plans in Delaware with very low or even $0 deductibles.
A new reinsurance program, implemented last year, has further reduced the cost of health insurance for our ACA consumers across Delaware. Through Highmark’s approved rate decreases, and the state reinsurance program, rates for ACA coverage have decreased on average by about 20 percent over the past two years.
Q. What can ACA shoppers expect from Highmark for 2021?
A. We realize that our ACA customers aren’t all looking for the same thing in a health plan, so we make a broad range of options available and help our customers make the right decision for them.
Delaware consumers can select an ACA plan from Highmark that provides in-network access to all acute-care hospitals in the state, as well as in-network coverage for services received from more than 95 percent of doctors and hospitals around the country through the BlueCard program. This includes access to contracted Blues providers in nearby states such as Pennsylvania, New Jersey and Maryland.
In 2021, we’re introducing ACA plans in Delaware that offer integrated adult dental and vision coverage. We rolled out integrated dental and vision plans in the ACA marketplace last year in Pennsylvania, and received extremely positive feedback. We’re pleased to offer these comprehensive coverage options to Delaware for 2021. We are also increasing the availability of high-deductible health plans that can be joined with a tax-advantaged Health Savings Account.
Overall, our goal is to offer consumers convenience, access and choice.
Q. What advice do you have for ACA shoppers?
A. The most important thing you can do is to make sure that you shop. If you already have coverage through the exchange, you are auto-enrolled into next year’s plan. But it’s important that you verify your eligibility and shop around because Highmark has new plans available this year. You might be able to find a new plan that saves you money while meeting your particular insurance and care needs.
Q. Where can people go to learn more?
A. To learn more about our ACA plans, you can visit https://www.discoverhighmark.com/plans/aca-plans.html or call 1-877-959-2563. We have an expert team available to help new and current shoppers sort through their options, and pick the right plan for them.