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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.
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.
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:
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.
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:
In Delaware, you can only buy an individual insurance plan if you use the Health Insurance Marketplace.
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.
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 premium in Delaware||2020||2021||2022||2023|
|Most affordable Bronze plan||$380||$358||$343||$403|
|Most affordable Silver plan||$506||$470||$445||$542|
|Most affordable Gold plan||$510||$464||$435||$528|
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.
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 $137,400 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.
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:
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.
Medicare is an option for Delaware residents who meet the eligibility requirements regarding age and disability status.
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.
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).
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:
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.
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.
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.
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.
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.
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.
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.
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.