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From its charming coastal communities and vibrant cultural attractions to its reputation as the First State, Delaware remains a desirable place to live — and understanding your health insurance options here is key to protecting your health and finances.
The uninsured rate in Delaware reflects significant progress in access, with one of the lowest uninsured rates in the country since the Affordable Care Act was implemented. If you’re currently without coverage, here’s what you need to know about getting insured in Delaware.
Health Insurance Options in Delaware
Delaware offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:
Employer-Sponsored Insurance
Many Delaware residents receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.
ACA Marketplace Plans (Healthcare.gov)
Individuals and families without employer coverage can shop for insurance through Delaware’s official ACA marketplace, Healthcare.gov. Subsidies may be available to reduce premium costs. You can check your eligibility using our ACA Subsidy Calculator.
Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.
Marketplace Plans:
- Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
- Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
- Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
- Platinum: Highest premiums, lowest out-of-pocket costs.
Metal Tier Breakdown:
| Metal Tier | Insurance Company Pays | Consumer Pays |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Medicaid
Diamond State Health Plan provides free or low-cost coverage for eligible low-income residents. Medicaid plan benefits typically include preventive care, hospital visits, mental health, prescriptions, and more.
Children’s Health Insurance Program (CHIP)
Known as the Delaware Healthy Children Program, this program helps children and pregnant women in families that earn too much for Medicaid but need affordable insurance.
Medicare
Medicare plans are available for residents age 65+ and younger individuals with qualifying disabilities. Options include:
- Medicare Advantage (Part C)
- Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
- Prescription Drug Plans (Part D)
- Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
- Medicare Supplement (Medigap)
- Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.
COBRA Coverage
If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily—typically at full cost.
Short-Term Plans
Short-term medical (STM) plans offer flexible, low-cost coverage for up to four months, ideal for healthy individuals in transition. However, STM plans aren’t guaranteed issue, lack subsidies, and may exclude key benefits like maternity, mental health, and pre-existing conditions—making them less suitable for long-term or comprehensive needs.
Explore all non-ACA health plans that may fit your needs and lifestyle.
Enrollment Periods in Delaware
Open Enrollment for 2026 Coverage:
November 1, 2025 – January 15, 2026
During this window, all eligible residents can apply for, renew, or change their marketplace health plans.
Special Enrollment Period:
Available year-round for those experiencing qualifying life events such as:
- Job loss
- Marriage or divorce
- Birth/adoption of a child
- Relocation
- Change in income
You typically have 60 days from the event to enroll.
Health Insurance Providers in Delaware
This insurer typically offers individual and family plans:
Plan availability may vary by county or zip code.
Understanding Health Insurance Costs
When selecting a plan, be sure to understand these common cost terms:
- Premium: Monthly payment to maintain your plan.
- Deductible: What you pay before insurance covers services.
- Copayment (Copay): Fixed amount per visit/service.
- Coinsurance: Shared costs with your insurer after the deductible.
- Out-of-Pocket Maximum: Your yearly cost cap for covered services.
- In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.
Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.
Bottom Line
Health insurance in Delaware comes with many choices—whether from your employer, through the ACA marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the right enrollment periods, you can secure affordable, reliable coverage that supports your well-being and budget.
Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.
