Sharply higher rates on the way for Health Insurance Marketplace policyholders

Carriers on the Delaware Health Insurance Marketplace have successfully filed for sharply higher rates for the coming year.

These increases are a result of "Big Beautiful Bill, changes made to federal Marketplace rules, and the expiration of enhanced Advanced Premium Tax Credits. The changes do not apply to Medicare, Medicaid, or those with group or individual policies purchased outside Healthcare.gov.

The Marketplace is designed for those between jobs, those working or owning businesses without health insurance coverage or do not qualify for Medicaid. That program will also see major changes.

"Enrollment in the Delaware Health Insurance Marketplace has more than doubled since we first saw rates decline in 2020. In that time, we've been able to enhance competition, invest in primary care, and improve the coverage and benefits offered by these plans. But, because of significant federal turmoil, premiums will rise in the coming year, and enrollment is likely to decline." said Delaware Insurance Commissioner Trinidad Navarro.

As of February 2025, Delaware's Marketplace enrollment was at an all-time high of 50,133. Advance Premium Tax Credits supported 45,885, or 92%, of policyholders, bringing premiums down $538 a month on average. In 2021, the credits were expanded to address the sharp subsidy cliff for those above 400% of the federal poverty level, which improved access and affordability. The expansion is set to expire at the end of the year.

"We continue to encourage Congress to protect health insurance affordability by extending or making permanent the credits Delaware consumers rely on to save more than $6,400 on premiums each year," said Navarro. "While carriers' proposed rates reflect costs if expanded credits do not continue, we will make every effort to ensure insurers can lower rates if Congress does act."

According to the Insurance Commissioner's office, Trump Administration changes include cutting 90% of funding for Marketplace navigators and new rules to make enrollment markedly more cumbersome and costly, as well as restrictions on access to $0 premiums and increases to consumer cost-sharing.

In Delaware, Special Enrollments grew the participant based by 5,562 throughout 2024, but provisions that eliminate the monthly Special Enrollment Period for income-based need will be effective soon. The rule also attempts to exclude gender-related care from essential health benefits.

Along with 20 other states, the commissioner worked with Attorney General Kathy Jennings to sue the administration over the rule changes.

State-originated causes for rate rise also exist, including continuing to have some of the highest health system prices in the country, with the creation of a regulatory entity to address this issue the subject of a lawsuit filed by ChristianaCare, the state's largest hospital system.

Open enrollment for the Marketplace takes place between November 1 and January 15. Residents may qualify to enroll or change plans based on special circumstances, such as a loss of qualifying health coverage, becoming a parent, and several other qualifying factors. Find out if you qualify for special enrollment.

Following in-depth reviews by the commissioner's , staff, independent actuaries, and the Office of Value-Based Health Care Delivery, rates for 40 regulated 2026 Marketplace plans have been finalized.

AmeriHealth Caritas' request to increase rates 46.2% was decreased to a final average increase of 34.98% after actuarial discussions with the department. Their eight plans are promoted as not requiring referrals.

Celtic Ambetter Health of Delaware demanded a rate change of 31.8%, threatening to exit the state's Marketplace and leave their policyholders scrambling for new coverage. Their request was approved despite best efforts to negotiate a smaller, but still actuarially appropriate increase. Their 17 plans include marketed offerings with connected health savings accounts (HSAs), vision, and dental.

Highmark requested a rate increase of 30.3% and an average increase of 25% was approved. They will market 14 comprehensive plans and one catastrophic plan which includes three primary care visits. Offerings include HSA accounts, as well as connected vision and adult dental coverage.

All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care, telehealth, lab services, and more. Plans on the Marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurer.

Off-market individual offerings include two plans from AmeriHealth Caritas and two from Highmark, both receiving increases that align with their on-Marketplace rates.

Delta Dental will increase rates by an average of 4.3% for two Marketplace family plans. Dominion Dental will increase their ACA premiums an average 4.8% on their 10 plans, including pediatric plans.

Off-market small group plan options for the coming plan year will be completed in October. Rate submissions show 32 plan options offered by Highmark at a requested a 22.73% increase, and United HealthCare has filed 33 plan options with an increase request of 30.33%.

More information on the rate review process

The commisioner's office also warned consumers to be aware of non-compliant alternative health plans, sometimes known as "junk insurance" that may not cover serious illnesses or injuries.