The First State only has one carrier selling Marketplace plans for 2022. 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 25,000 Delawareans have private coverage through the Health Insurance Marketplace in 2021.1 Most residents with Marketplace coverage get subsidies to lower their monthly premiums.
Check a 2022 subsidy chart and calculator to see which subsidies you might qualify for.
Delaware and the Affordable Care Act (ACA)
About 7% of Delaware residents don’t have health insurance. This number amounts to 58,000 uninsured out of roughly 975,000 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 ($17,774 in 2021).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 25,000 Delaware residents enrolled in Marketplace coverage during the 2021 Open Enrollment Period (OEP) and subsequent Special Enrollment Period.5 Sign ups for 2022 coverage start from November 1, 2021 and end on January 15, 2022.
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.
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 fluctuated from 2020 to 2021. Below are the average monthly rates for bronze, silver, and gold plans.
- Average lowest-cost bronze premium: $372 in 2020 | $400 in 2021
- Average lowest-cost silver premium: $521 in 2020 | $522 in 2021
- Average lowest-cost gold premium: $531 in 2020 | $517 in 2021
Highmark Blue Cross Blue Shield has requested a 4% premium rate increase. 7
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Average Rate Changes
Financial Help With Marketplace Plans for Low-Income Delawareans
Financial help with Marketplace health insurance costs is based on your income and household size.
Prior to 2021, premium tax credits were based on how much you made in relation to the federal poverty level (one to four times). In 2021, the federal government changed the rules so households pay no more than 8.5% on health insurance for the benchmark plan (second-cheapest silver plan).
The cap on income to receive subsidies was removed as well.
The federal government offers help in two ways:
- Premium tax credits (subsidies) that lower your monthly payments. The average amount received in 2021 was $572 per month.8 Eighty-sixpercent of Marketplace enrollees in Delaware received subsidies in 2020.9
- 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 250,000 Delawareans have Medicaid as of November 2021.11 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. Here are a few examples.
|Household Size||Federal Poverty Level Limit||Monthly Income Limit|
|Two (parents and caretaker relatives)||87%||$1,226|
|Three (eligible children six through 18)||133%||$2,365|
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 February 2021.13 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: 212% of the FPL ($4,680 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 210,000 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 39,000 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.