Delaware Health Insurance Marketplace
Delaware is running its health insurance Marketplace, called ChooseHealth Delaware, in a partnership with the federal government.
Delaware now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.
Delaware Plans, Benefits, and Costs
Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $40 per month after tax subsidies. See if you qualify for a free or low cost plan.
Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.
NO TOBACCO SURCHARGE
Who Is Selling Insurance in the Delaware Marketplace?
On exchange plans in Delaware
Off exchange plans in Delaware
All approved plans in the state must cover the same package of benefits, called essential health benefits. In Delaware, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital. Home health visits are limited to 100 per calendar year. One adult routine eye exam is covered every two years.
- Emergency services, including transportation to the ER
- Hospital stays, including weight loss surgery if considered medically necessary. Also includes hospice services up to 240 days a year.
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment. Inpatient substance abuse services covered without limits
- Prescription drugs, including generic and all brand-name drugs
- Rehab and habilitative services, including those that help people recover from an accident or injury and those that help people with developmental issues. Diagnosis and treatment of autism is included. Cognitive, physical, and speech outpatient rehab is limited to 30 days.
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions
- Services for children, including dental and eye care
Some services that are not included: infertility, cosmetic surgery, weight loss programs, long-term care, and outpatient private duty nursing.
Will These Benefits Be in All Plans?
Although all health insurance policies have to follow the state’s benchmark plan, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab service may be substituted for another. Because Delaware allows substitutions, make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.
You may be eligible for financial aid to help pay for insurance. Not all states will offer all types of aid. Here’s what Delaware will offer:
Medicaid Expansion: Some states, including Delaware, are expanding Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is below $16,243 for one person or $33,465 for a family of four.
Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you’ll be eligible if you’re single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.
Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.
CHIP: The Children’s Health Insurance Program, called the Delaware Healthy Children Program, provides coverage for children of some families who have a low income but are not eligible for Medicaid.