Delaware health insurance marketplace guide 2023

Delaware’s exchange is a partnership between the state (Choose Health Delaware) and HHS, with residents enrolling through HealthCare.gov. Delaware is responsible for plan management and consumer assistance while the federal government handles all other functions.

The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Delaware. If you have questions about open enrollment, you can read more in our comprehensive guide to open enrollment.

Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage. But Native Americans can enroll year-round, as can subsidy-eligible applicants whose household income doesn’t exceed 150% of the poverty level. 

For 2023, three insurers will offer plans in Delaware’s exchange:

• Aetna
• AmeriHealth
• Highmark BCBSD

Aetna and AmeriHealth are both new for 2023. From 2018 through 2022, Highmark was the only insurer that offered exchange plans in Delaware, after Aetna exited the state’s market at the end of 2017. 

For 2021 and 2022, Delaware was the only state in the country with just one participating exchange insurer (there were partial areas of other states with just a single insurer offering plans). Although Aetna rejoined the marketplaces for 2022 in several states where they had previously exited, they did not rejoin Delaware’s marketplace at that point. But they rejoined as of 2023, with plans that became available for purchase as of November 2022.

For 2023 coverage, Highmark implemented an average rate increase of 5.5%. The two new insurers — Aetna and AmeriHealth — didn’t have any applicable rate changes, since their plans were new for 2023.

So the overall average rate change for existing plans is 5.5%. But that doesn’t account for the plans from Aetna and AmeriHealth, which are newly available to all applicants in Delaware as of the 2023 plan year. 

And average rate changes only tell part of the story. They don’t account for premium subsidies, which offset premium costs for the majority of Delaware’s exchange enrollees. They also don’t account for the fact that premiums increase with age, even if an insurer doesn’t increase its overall average rates.

There are a lot more plans available in Delaware for 2023 than there were in 2022. But the influx of new plans does not appear to have had a significant effect on the amounts that people pay for their coverage. If we consider a 40-year-old in Dover who earns 300% of the poverty level, their subsidy amount was $355/month in 2022, and has dropped to $346/month in 2023. But the cheapest plan (after the subsidy was applied) was $60/month in 2022, and the cheapest plan in 2023 is $57/month.

For perspective, here’s a look at how premiums have changed in Delaware’s exchange in prior years:

• 2022: Average increase of 3%. Highmark has increased its overall average premiums by 3%, after initially proposing an average increase of 4%.
• 2021: Average decrease of 1%. Highmark proposed an overall average rate decrease of half a percent for 2021. But after the rate review process was complete, Delaware’s Insurance Commissioner, Trinidad Navarro, announced that Highmark’s average premiums would decrease by 1% for 2021. Without Delaware’s reinsurance program, the overall rate change would have been an increase rather than a decrease.
• 2020: Average decrease of 19%. Highmark initially proposed an average rate decrease of 5.85% for 2020, but this was before the state enacted legislation to create the reinsurance program. The 1332 waiver proposal that Delaware submitted to CMS in July noted that with the reinsurance program in place, premiums were expected to be 13.7% lower in 2020 than they would otherwise have been. Ultimately, a 19% average rate decrease was approved for Highmark’s plans, which was very much in line with the state’s initial projections (ie, the 5.9% decrease that Highmark had proposed, in addition to the 13.7% estimated decrease due to the reinsurance program). Unsubsidized premiums in Delaware were among the highest in the country in 2019. The average unsubsidized premium in Delaware was $842/month, versus $612 across all of the states that use HealthCare.gov. So the sharp decrease from the reinsurance program was badly needed, for people who don’t receive premium subsidies. 
• 2019: Average increase of 3%. When the Delaware Department of Insurance published final rates for 2019, the approved average rate increase for Highmark was just 3%. The final rate approval notice clarifies that the cost of CSR was added only to silver plan rates for 2019, as opposed to the broad load strategy that was used for 2018. And the approved rate notice also clarified that the cost of CSR was not added to premiums for plans purchased outside the exchange, which means that Highmark only added the cost of CSR to on-exchange silver plans. That’s the best approach for consumers, as it allows people who don’t qualify for premium subsidies to purchase an off-exchange plan (if they want a silver plan) and not have the added cost of CSR baked into their premiums. In 2018, the Delaware Insurance Department had been working on regulations to limit short-term health insurance plans to three months in duration and prohibit renewals. Highmark’s initial filing had included higher rates (a 1% load) to offset the fact that the risk pool was expected to be sicker once the federal regulations were relaxed to allow much longer short-term plans (the Trump administration implemented that rule change in August 2018). But Delaware regulators stepped in to prevent that, ensuring a more stable individual market (since healthy people don’t have the option to leave the ACA-compliant market and switch to year-long short-term plans instead).
• 2018: Average increase of 25%. Highmark Blue Cross Blue Shield of Delaware had the majority of the market share in the state’s exchange in 2017, and they became the only available option as of 2018, with Aetna’s exit from the marketplace. The Trump administration’s lack of commitment to funding the ACA’s cost-sharing reductions (CSR) was a driving factor in the rates that insurers filed for 2018. Insurers in most states — including Delaware — added the cost of CSR to premiums for 2018. The Trump administration announced in mid-October that CSR funding would end immediately. (In Delaware, a broad load approach was used for 2018, with the cost of CSR spread across all plans. Only a few other states took this approach — Colorado, Mississippi, West Virginia, and Indiana. Only Mississippi and Indiana are continuing to use it as of 2022.) Highmark initially proposed an average rate increase of 33.6%, but ultimately agreed to a 25% average rate increase. Their rate filing noted that the average rate increase would have been about 16.8% if CSR funding had continued and if the federal government had been robustly enforcing the individual mandate.
• 2017: Average increase of 30%. In Delaware, the approved average rate increases for 2017 amounted to about 23% for Aetna, and almost 33% for Highmark. The weighted average increase was about 30%.Initially, Delaware Insurance Commissioner Karen Weldin Stewart had approved a lower-than-requested rate for Highmark, and forwarded that on to CMS for review. But in light of the carriers opting to leave exchanges in numerous states around the country, CMS urged Delaware to accept Highmark’s initial rates, and the state agreed. As a result, no carriers left the Delaware exchange at the end of 2016, while most other states saw at least some insurers exit their exchanges.Highmark, which also offers coverage in the exchanges in Pennsylvania and West Virginia, recorded their first profitable year in the ACA-compliant market in 2017, after losing a billion dollars in the ACA-compliant market from 2014 through 2016
• 2016: Average increase of 22%. The approved rate increases for 2016 included a 22.4% average increase for Highmark (which had 95% of the individual market share in Delaware at that point) and a 17% increase for Aetna. Across the whole market in Delaware, the overall weighted average increase was about 22% for 2016.
• 2015: Average increase of 3%. A study released in December 2014 by The Commonwealth Fund showed just a 3 percent increase in average marketplace premiums for Delaware between 2014 and 2015. The weighted analysis looked at rates across all metal tiers and in urban/suburban/rural areas of most states.

During the open enrollment period for 2022 coverage, 32,113 people enrolled in medical insurance plans through Delaware’s health insurance marketplace. This was by far a record high for the state’s exchange, driven in large part by the American Rescue Plan‘s subsidy enhancements (which have been extended through 2025 under the Inflation Reduction Act).

In line with most other states, Delaware’s exchange enrollment had dropped each year from 2016 through 2019. But enrollment began to trend back up again in 2020, driven in part by Delaware’s new reinsurance program (which resulted in lower premiums for people who don’t get premium subsidies, making coverage more affordable for that population).

Enrollment in individual market plans through Delaware’s exchange has reached the following totals during open enrollment each year:

• 2014: 14,087
• 2015: 25,036
• 2016: 28,256
• 2017: 27,584
• 2018: 24,500
• 2019: 22,562
• 2020: 23,961
• 2021: 25,320
• 2022: 32,113 

Although enrollment in the exchange dropped about 20% from 2016 through 2019, Delaware’s 1332 waiver proposal noted that total individual market enrollment in the state (including on-exchange and off-exchange enrollment) had dropped by 37% in that same time period.

Off-exchange enrollees don’t get premium subsidies, but the state’s new reinsurance program has made their coverage more affordable, potentially resulting in enrollment gains outside the marketplace as well. But it’s noteworthy that the American Rescue Plan has temporarily eliminated the “subsidy cliff” (income cap on subsidy eligibility), and the Inflation Reduction Act has extended that through 2025. So for the time being, there are fewer people who don’t qualify for subsidies, since subsidy eligibility now extends to higher income levels. 

Two insurers currently offer dental plans through the Delaware marketplace. Learn about dental coverage options in Delaware.