Delaware Health Insurance: Find Affordable Plans

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.

• 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 October 15, to December 7, 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.

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.

• Aetna CVS Health
• AmeriHealth Caritas Next
• Highmark Blue Cross Blue Shield

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.

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.

• 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 increased over the past three years, declining from $380 per month in 2020 to $403 per month in 2023.
• 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 three years, the cost of the most affordable Silver plan in Delaware has increased, falling from $506 per month in 2020 to $542 per month in 2023.
• Gold 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 2020, the cost of the most affordable Gold plan has increased from $510 per month to $528 per month in 2023.

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 $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.

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.

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.

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.

• American Council on Aging | Delaware Medicaid (Diamond State Health Plan) Eligibility for Long Term Care: Income & Asset Limits | Last accessed December 22, 2022
• Delaware ASSIST | Easily apply for benefits | Last accessed December 22, 2022
• Delaware.gov | Careful Consideration of Insurance Plans Urged During Special Enrollment Period | Last accessed December 22, 2022
• Delaware.gov | Delaware Healthy Children Program – Benefit Package | Last accessed December 22, 2022
• Delaware.gov | Delaware Healthy Children Program: Who Qualifies? | Last accessed December 22, 2022
• Delaware.gov | Frequently Asked Questions About Medicaid and Medical Assistance | Last accessed December 22, 2022
• Department of Insurance | Health Insurance Rate Filings | Last accessed December 22, 2022
• Department of Insurance | Highmark Blue Cross Blue Shield Delaware Individual | Last accessed December 22, 2022
• HealthCare.gov | No health insurance? See if you’ll owe a fee | Last accessed December 22, 2022
• HealthCare.gov | Qualifying Life Event (QLE) | Last accessed December 22, 2022
• HealthCare.gov | Your total costs for health care: Premium, deductible & out-of-pocket costs | Last accessed December 22, 2022
• KFF | Average Marketplace Premiums by Metal Tier, 2018-2021 | Last accessed December 22, 2022
• KFF | Health Insurance Coverage of the Total Population | Last accessed December 22, 2022
• KFF | Medicare Advantage Plans | Last accessed December 22, 2022
• Medicare.gov | Drug coverage (Part D) | Last accessed December 22, 2022
• Medicare.gov | Understanding Medicare Advantage Plans | Last accessed December 22, 2022
• Medicare.gov | What’s Medicare Supplement Insurance (Medigap)? | Last accessed December 22, 2022
• Social Security | Medicare Benefits | Last accessed December 22, 2022
• State of Delaware | 1320 Minimum Standards for Short-Term, Limited Duration Health Plans | Last accessed December 22, 2022