As a Delaware resident, you have access to a wide range of affordable health insurance options. Although group coverage is the most common, you can also sign up for an Affordable Care Act plan, use your military health benefits, or enroll in Medicare or Medicaid.

This guide explains your Delaware health insurance options in detail.

What to know about insurance in Delaware

  • Marketplace plans: If you live in Delaware, you can use the Health Insurance Marketplace to sign up for an ACA plan. Delaware is somewhat unusual, as it has no health insurance companies offering plans outside the health exchange.
  • Open enrollment: Delaware’s 2022 enrollment period runs from November 1 to January 15, 2022.
  • Special enrollment: You can’t sign up for health coverage outside of open enrollment unless you qualify for a special enrollment period. You may qualify for an SEP if you have a qualifying life event that changes your insurance eligibility. Qualifying events include job loss, divorce, and the birth or adoption of a child.
  • Health Insurance Marketplace: Delaware doesn’t have its own affordable health insurance exchange, so it uses the federal Health Insurance Marketplace. If you want an ACA plan, you can use the Health Insurance Marketplace to compare plans and enroll. You should know that Highmark is the only insurance company that currently offers plans on the exchange.
  • Coverage types: In Delaware, 49.7% of the insured population has group health coverage through an employer. Another 37.7% of the insured population has Medicare or Medicaid, 1.8% have military coverage and 4.1% have non-group coverage. Approximately 6.6% of the Delaware population is uninsured.

How do I enroll in Delaware's health insurance marketplace?

To enroll in health insurance via the Health Insurance Marketplace, visit HealthCare.gov and create an account. You’ll be asked if you want to start a new application or work on an existing application.

The first part of the application asks if you need coverage for yourself, a spouse, or any dependents. It also asks you to estimate your income for the year and indicate whether or not you want to see if you can get help paying your health premiums. Once you answer these initial questions, you’ll need to fill out your name and contact information.

As you click through each page of the application, you’ll answer questions about the number of people in your household, your marital status, and your existing health coverage. You’ll also have the opportunity to enter your alimony payments and student loan interest payments to determine if these expenses have any effect on your eligibility for tax subsidies.

Once you finish your application, you’ll be able to view available health plans and compare them based on their monthly premiums, annual out-of-pocket costs, and coverage levels. The Health Insurance Marketplace even has a side-by-side comparison tool that makes it easy to compare two or three plans based on their costs and coverage.

Only one company offers health insurance plans to Delaware residents in the marketplace:

  • Highmark Blue Cross Blue Shield

How do I enroll in Delaware individual and family insurance?

If you need affordable health insurance coverage, it’s important to understand how to choose the best plan for your needs. Many people focus on the cost of the monthly premium, but there are other factors to consider: These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Delaware

When buying coverage for yourself, you have the freedom to choose a plan based on your income, health history and personal preferences. It’s important to understand all the out-of-pocket costs that come with each plan.

  • A premium is the amount of money you pay each month to keep your coverage active. You have to pay the premium even if you don’t use your insurance.
  • Many plans also have an annual deductible, which is the amount you need to pay for medical services before your insurance starts to pay. If your deductible is $500, for example, you need to pay for $500 in covered services before your insurance company pays anything.
  • After you meet your deductible, you may also have to pay copays or coinsurance. A copay is a set amount paid toward each covered service, and coinsurance is a percentage of the cost of each covered service. For example, you may have to pay a $20 copay to see your primary care physician or 30% coinsurance for surgical procedures.

You also need to consider the amount of coverage provided, especially if you have any chronic health conditions. If you need to see multiple specialists or take daily medications, the cheapest plan may not give you the coverage you need. It’s important to choose a plan that has a good balance of coverage and affordability.

There are different types of plans you can choose from:

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

In Delaware, you can only buy an individual insurance plan if you use the Health Insurance Marketplace.

Insurance for families in Delaware

Shopping for a family plan is a little more difficult because you need to think about the health needs of multiple people. If your spouse or child has asthma, heart disease, or some other chronic health condition, it may cost you less in the long run to choose a plan with a higher monthly premium because you won’t have to pay as much in deductibles, copays, and coinsurance.

You also need to think about maintaining access to preferred hospitals and specialists. People with chronic health conditions often have trouble finding a physician who understands their symptoms and knows how to manage them effectively. If someone in your family already has a good relationship with a local physician, you should look for a health plan that includes that physician in its insurance network. Otherwise, you’ll have to find a new physician or pay out of pocket if you want to keep seeing the current one.

It’s also important to compare plans based on their coinsurance and copay requirements. Someone who typically stays in the hospital once or twice per year would benefit from having a plan with a 10% or 20% coinsurance requirement versus a 40% coinsurance requirement, for example.

In Delaware, you can’t purchase family coverage directly from an insurance company. You must use the Health Insurance Marketplace if you don’t qualify for some other type of coverage.

How much does health insurance cost in Delaware?

The Health Insurance Marketplace uses a metal tier system to classify insurance plans. This tier system makes it easy to look at each plan and estimate how high the premiums and other out-of-pocket costs are likely to be. The three main tiers are Bronze, Silver, and Gold.

Average premiums in Delaware  2019 2020 2021 2022
Most affordable Bronze plan $449 $372 $400 $400
Most affordable Silver plan $660 $521 $522 $538
Most affordable Gold plan $672 $531 $517 $529

  • Bronze plans have the lowest premiums, but they’re not always the most affordable when you consider other out-of-pocket costs. For example, the Shared Cost Blue EPO Bronze 3800 plan has a base premium of $313.12 per month for a 21-year-old who doesn’t use tobacco, but it also has a $60 copay for primary care visits and a 50% coinsurance requirement for specialist visits, emergency room care, and hospital care. The cost of the most affordable Bronze plan has decreased over the past four years, declining from $473 per month in 2018 to $415 per month in 2022.
  • Silver plans have higher premiums than Bronze plans, but they also tend to have lower out-of-pocket costs. One example is the Shared Cost Blue EPO Silver 2900 plan. The monthly base premium is $422.18, but specialist visits only require a $50 copay. In the past four years, the cost of the most affordable Silver plan in Delaware has decreased, falling from $573 per month in 2018 to $538 per month in 2022.
  • Gold plans are some of the most expensive, but they also have much lower out-of-pocket costs than Bronze and Silver plans. For example, the Shared Cost Blue EPO Gold 800 plan has $15 copays for primary care and specialist visits and 20% coinsurance for hospital care. The base premium for this plan is $413.76 per month, making it a little cheaper than the Shared Cost Blue EPO Silver 2900 plan. Since 2018, the cost of the most affordable Gold plan has decreased from $706 per month to $529 per month in 2022.

Can you get cheap health insurance in Delaware?

If you are disabled or don’t earn enough to pay for other types of health insurance, you may qualify for Medicaid, a cooperative effort between Delaware and the federal government to ensure that low-income residents have access to health care. Delaware also has a low-cost health insurance program for children, the Delaware Healthy Children Program.

Medicaid in Delaware

To qualify for Medicaid in Delaware, you must live in Delaware and be a U.S. citizen or lawful immigrant. For most families, the income limit is 100% of the Federal Poverty Level (FPL); however, you can qualify with a higher income if you meet other eligibility requirements.

For example, children between the ages of 1 and 6 qualify for Medicaid if they live in households with incomes at or below 133% of the FPL. Because pregnant women count as two household members, you may qualify for Medicaid if you’re pregnant and have a household income at or below 200% of the FPL.

The Medicaid program also has financial resource limits. For a single person, the asset limit is $2,000. If both spouses are applying for Medicaid, the asset limit increases to $3,000. If you apply for Medicaid and your spouse doesn’t, you can have $2,000 in assets and your spouse can have up to $130,380 in assets. Financial resources include things like cash in a checking account, stocks, bonds, and the value of certain insurance policies.

The easiest way to apply for Delaware Medicaid is to use the ASSIST website. If you click the “Do I Qualify?” button, you’ll be able to fill out a screening questionnaire that helps determine your eligibility for several assistance programs. When you’re ready to apply, click the “Apply for Benefits” button. You’ll be prompted to create an account or log in with your existing credentials.

Delaware Healthy Children Program

The Delaware Healthy Children Program offers low-cost insurance for children in households with incomes below a certain threshold. While the income limit for traditional Medicaid is anywhere from 100% to 133% of the FPL depending on a child’s age, the Delaware Healthy Children Program has a higher limit: 200% of the FPL. This means your children may qualify for the Delaware Healthy Children Program even if your household income is too high for them to get Medicaid coverage.

To qualify for the Delaware Healthy Children Program, a child must meet the following requirements:

  • No comprehensive health insurance
  • Under the age of 19
  • Lives in Delaware
  • U.S. citizen or lawful immigrant
  • Not a dependent of someone who works for the State of Delaware

The Delaware Healthy Children Program covers many medical services with no copays. These services include routine checkups, speech therapy, prescription drugs, physician services, lab tests, and hospital care.

What are Delaware's Medicare options for seniors and people with disabilities?

Medicare is an option for Delaware residents who meet the eligibility requirements regarding age and disability status.

  • Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D.
  • Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision.

If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

If you need help signing up for Medicare, visit your local State Health Insurance Assistance Program (SHIP) office or call 888-696-7213 for free Medicare counseling and assistance choosing plans and filling out forms.

Are there short-term health insurance plan options in Delaware?

Although you can purchase a short-term health insurance plan, this type of coverage is heavily regulated by the state’s government. As of 2019, any short-term plan sold in Delaware must have an initial term of no more than three months. Insurance companies also aren’t permitted to extend the coverage by renewing the policy. This means that you only have three months to find new coverage before your short-term plan expires.

A short-term plan may be a good option if you only need to fill a short gap in coverage. For example, you may lose your coverage from one job and not be able to enroll in coverage at the new job for 30 to 90 days. A short-term plan would fill this gap in coverage.

Delaware Insurance FAQs

Does Delaware require health insurance?

No, Delaware residents aren’t required to have health insurance. At the federal level, the Affordable Care Act’s individual mandate requiring all Americans to obtain health insurance or pay a tax penalty was repealed in 2019.

Do I have to use the Health Insurance Marketplace in Delaware?

Yes. Delaware doesn’t have its own health insurance exchange, nor do any insurance companies offer plans outside of the exchange, so you must use the federal Health Insurance Marketplace to enroll in coverage.

What types of alternative health insurance plans (like cost sharing plans) are available in Delaware?

As a Delaware resident, you have access to some health insurance alternatives that can help with your medical expenses. One of the most common is a health care sharing ministry, which uses funds contributed by members to pay for hospital fees and other health-related costs. HCSMs don’t offer traditional health insurance, and they’re not regulated like regular health insurance, so they’re allowed to deny you based on pre-existing conditions or charge you more money based on your health history.

Do I need health insurance if I have an HSA/FSA?

Medical savings accounts are helpful, but there are limits to how much you can save each year. In many cases, the cost of a hospital stay or an ER visit exceeds those limits, which means it’s good to have health insurance as a backup. Otherwise, you’ll have to pay the remaining costs out of your own pocket.

Do I need short-term disability coverage in Delaware if I have health insurance?

Short-term disability coverage replaces your lost wages if you can’t work due to a serious injury or illness. Although you can use the money to pay your medical bills, it’s likely that your bills will exceed the limits of your short-term disability plan. Therefore, you should have health insurance in place to ensure you don’t have to pay the costs on your own.

Do I need long-term disability coverage in Delaware if I have health insurance?

Long-term disability covers lost wages, but it doesn’t pay hospitals, physicians, physical therapists, and other health care providers. You should have health insurance just in case your long-term disability policy doesn’t pay out enough to cover our medical expenses.

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Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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