The First State only has one carrier selling Marketplace plans for 2020. You can still enroll if you have a qualifying life event.
Delaware Health Insurance Overview
Delaware is one of the least populated states with just under 1 million residents. Close to half of the population have government-funded health insurance through Medicaid and Medicare.
Roughly 24,000 Delawareans have private coverage through the Health Insurance Marketplace.1 Most residents with Marketplace coverage get subsidies to lower their monthly premiums.
Check a 2021 subsidy chart and calculator to see which subsidies you might qualify for.
Delaware and the Affordable Care Act (ACA)
About 6% of Delaware residents don’t have health insurance. This number amounts to 54,000 uninsured out of roughly 938,000 residents.
The First State has maintained one of the lowest uninsured rates since the Affordable Care Act (Obamacare) was implemented in 2013. About 10% of the state’s population (90,500 people) lacked coverage at that time compared to 15% across the country.2
Delaware’s expansion of Medicaid in 2014 gave more residents access to health insurance. Under the ACA, states can use federal funding to expand Medicaid to childless adults who earn up to 138% of the federal poverty level ($17,609 in 2020).3 As of October 2019, 62,500 residents gained coverage because of Medicaid expansion.4
Buying Delaware Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs
Delawareans can buy ACA-qualified coverage through the Health Insurance Marketplace at Healthcare.gov. Plans are open to individuals and families, which include self-employed entrepreneurs with no employees.
Plans come in four metal levels: bronze, silver, gold, and platinum. Each level pays a percentage of your covered expenses ranging from 60% to 90%. Bronze plans pay the least and usually have the lowest monthly premium. Platinum plans pay the majority of your costs and have the highest monthly premium.
ACA plans provide guaranteed coverage regardless of your health or any preexisting condition. All policies include 10 essential health benefits, such as hospitalization, maternity care, and prescription drug coverage. Vision and dental coverage are also provided to any children enrolled.
Delaware Health Insurance Marketplace Enrollment
Nearly 24,000 Delaware residents enrolled in Marketplace coverage during the 2020 Open Enrollment Period (OEP).5 Sign ups for 2021 coverage start from November 1, 2020 and end on December 15, 2020.
If you miss buying a plan at that time, you can still sign up if you have a qualifying life event, such as marriage or relocation.
Only one Delaware insurance company offers Marketplace plans for 2021: Highmark Blue Cross Blue Shield.6
Special Enrollment Period
The federal government re-opened sign-ups on the federal Marketplace with a Special Enrollment Period from February 15, 2021 to August 15, 2021.
Health Insurance Costs in Delaware
Marketplace premiums in Delaware have declined from 2019 to 2020. Below are the average monthly rates for bronze, silver, and gold plans.
- Average lowest-cost bronze premium: $449 in 2019 | $372 in 2020
- Average lowest-cost silver premium: $660 in 2019 | $521 in 2020
- Average lowest-cost gold premium: $672 in 2019 | $531 in 2020
That trend continues for 2021. The state approved a 1% premium rate decrease for Highmark Blue Cross Blue Shield. 7
Financial Help With Marketplace Plans for Low-Income Delawareans
Financial help with Marketplace health insurance costs is based on your income and household size. In 2020, a single Delaware resident earning between $12,760 and $51,040 can qualify.8 This figure represents 100% to 400% of the federal poverty level (FPL).
The federal government offers help in two ways:
- Premium tax credits (subsidies) that lower your monthly payments. Eighty-nine percent of Marketplace enrollees in Delaware received subsidies in 2019.9 The average amount received was $751 per month.
- Cost-sharing reductions (CSRs) that lower your out-of-pocket expenses, such as copayments. Thirty-seven percent of Delaware enrollees received CSRs in 2019.10
Medicaid for Low-Income Delaware Residents
Medicaid is a state and federal government program for certain low-income adults and children. It provides comprehensive medical benefits, such as hospital and mental health care, doctor visits, and prescription drug coverage.
About 235,000 Delawareans have Medicaid as of November 2019.11 This number represents roughly one-quarter of the state’s population. Most residents get benefits through the Diamond State Health Plan. This is a managed care plan that coordinates your medical needs with your primary care doctor.12
Below is a list of people who qualify for Medicaid in Delaware:
- Children under 19
- Pregnant women
- Certain children who live with grandparents, stepparents, or siblings who have income
- Households with children that receive Temporary Assistance for Needy Families
- Childless adults ages 19 to 64 who qualify under Medicaid expansion
- Seniors aged 65 and older
- Individuals who are blind or have disabilities
Income requirements vary among these different groups. For example, parents and caretaker relatives can earn up to 87% of the federal poverty level (FPL) or $1,226 per month for a family of two. A household with eligible children ages six to 18 must earn no more than 133% of the FPL, or $2,365 a month for a family of three.
Delaware Children’s Health Insurance Program (CHIP)
Delaware Healthy Children Program serves uninsured children from birth through age 19. More than 11,000 children in the state enrolled as of November 2019.13 They must be citizens or legal residents from low-income households to qualify. But those who are dependents of a State of Delaware employee are not eligible.
The maximum income limit to qualify is 212% of the FPL ($4,550 a month for a family of four). Families pay a low monthly premium of either $10, $15, or $25 a month for all eligible children in the household. The program offers one premium-free month of coverage for every three months you pay in advance.
There are no copays for covered services, which include check-ups, immunizations, and eye exams.14
Medicare for Delaware Seniors and Younger Adults With Disabilities
Medicare is a federal health insurance program generally for people aged 65 and older. But younger adults qualify if they have disabilities or certain chronic illnesses, such as End-Stage Renal Disease (ESRD).
More than 175,000 Delawareans get coverage through the federal government’s Original Medicare program.15 It’s divided into two parts: Part A covers inpatient care at hospitals, hospice, and skilled nursing facilities. Part B covers medical benefits, such as doctor visits, same-day surgeries, ambulance, and limited drug coverage.
Another 26,000 Delaware beneficiaries choose an alternative program called Medicare Advantage.16 This is a private health plan that includes Part A, Part B, and extra benefits, such as Part D prescription drug coverage. Private insurers also sell individual Part D drug plans. People with Original Medicare typically buy these plans to get comprehensive drug benefits. Nearly 128,000 Delawareans have a standalone Part D plan.17
Another option for Original Medicare enrollees is Medicare Supplement, also called Medigap. Delaware, like most states, offers 10 standard plan options. Policies pay some to all of your covered out-of-pocket expenses, including copays, coinsurance, and deductibles.
Delaware Short-Term Health Insurance
Short-term health insurance is designed to fill a temporary coverage gap. For example, if you’re waiting for benefits to start at a new job or you missed the annual enrollment period for Obamacare.
States are allowed to have specific rules for short-term policies. For instance, Delaware limits policies to three months and they cannot be renewed.18 Other states choose to follow federal laws, which allow policies to last as long as 364 days with renewals up to 36 months.
Here are some things to keep in mind about short-term health plans:
- They are not the same as comprehensive health insurance under Obamacare
- You typically need to answer health questions to apply
- You can be denied a policy based on your health
- Policies aren’t required to include all 10 essential health benefits or cover preexisting conditions
Some advantages of short-term plans are that they usually cost less than Obamacare and you can get a policy within 24 hours. But it’s important to understand the policy’s limitations before you enroll. You should also compare costs (such as premiums and deductibles) with a major medical plan to decide which type of coverage is right for you.
