The Diamond State may be the second smallest in the country, but residents still have plenty of options for health care. According to a study by US News, Delaware has the 25th best health care in the nation when it comes to access, quality, and good public health.
Health insurance options in Delaware
According to the Delaware Department of Insurance, residents have several health care options:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Delaware residents get their health care coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 50% | ||
| Individual or family | 5% | ||
| Medicaid | 21% | ||
| Medicare | 17% | ||
| Military | 1% | ||
| Uninsured | 6% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Six percent of DE residents are uninsured, below the national average. That’s a good sign for policyholders. The more uninsured people there are, the higher rates are for insured people.
Delaware health insurance costs and rate factors
DE residents spend an average of $10,254 per year on health care expenditures, more than the national average. What determines your rates in the Diamond State? Prices vary person to person but are based on these factors:
Health insurance plan type
Marketplace plans come in metal tiers: bronze, silver, gold, and platinum. The more coverage you want, the more you’ll have to pay.
How does health insurance cost in DE? These are the monthly premiums for each plan type for a middle-aged resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $372 | $521 | $531 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
A gold plan costs about 43 percent more than a bronze plan. That’s not a big surprise considering gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of marketplace coverage available. Catastrophic plans come with low monthly premiums but a high yearly deductible of $8,150. The plan is designed to prevent medical bankruptcy, but it doesn’t offer much for preventative care. Because of that high deductible, you may save money by investing in a bronze or silver plan if you need health care.
Body mass index
Due to the serious health conditions that come with a high body mass, health insurance companies analyze your BMI to determine your risk-level. A high BMI leads to high health care premiums.
In 2018, DE had a 33.5 percent obesity rate, the 18th highest rate in the country. Of the Delaware shoppers who used QuoteWizard to compare health insurance plans, 28 percent have a BMI in the obese range.
Tobacco use
Smokers pay more for health care because of the serious health risks from tobacco use. About 17.7 percent of DE residents are smokers, the 27th lowest rate in the country.
Age
Health insurance plans cost up to three times more for older people than younger people. DE residents who used QuoteWizard to shop for health insurance are, on average, 39 years old.
Location
Where you live also plays a huge role in your health insurance costs. That’s because every state has different rules, regulations, and providers surrounding their marketplace. Even within states, insurance options vary between counties.
Also, health insurance rates are community-rated, meaning the price of your plan is partly based on the combined claims everyone files. If your neighbors file a high number of claims, your rates could jump.
That means that how healthy your state is impacts your premium. According to America’s Health Rankings, DE is the 30th healthiest state in the country.
Delaware health insurance companies
DE residents have one option for marketplace health care providers:
- Highmark
Delaware health insurance laws
The Affordable Care Act limits what insurers can use to determine your rates.
- Pre-existing conditions: Health insurance companies can no longer deny you coverage or charge you more for pre-existing conditions. People with pre-existing conditions used to pay considerably more for health care.
- Gender: The Affordable Care Act mandates that insurers can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to analyze your medical history and your past insurance coverage. Consumers with previous medical problems or lapses in insurance used to pay more for health insurance.
There's a limit to how much you’ll pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
DE state law requires health insurance companies to offer at least some coverage for the following services:
- Emergency care
- Child immunizations
- Mental health
- Cancer monitoring test
- Hearing aid coverage
- Dental services for children with severe disabilities
- Autism
- Diabetes
- Clinical trials
There are additional services that providers need to cover. Find the full list on cms.gov.
Medicare and Medicaid in Delaware
Medicare and Medicaid are both government-funded programs available to DE residents. Medicare helps seniors, whereas Medicaid covers low-income families and children.
Medicare
Medicare aids DE seniors 65 and older. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage programs. You may also qualify for these Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid offers affordable coverage to low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Delaware Department of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Trinidad Navarro
- Insurance Hotline:
- (800) 282– 8611
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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