Delaware Health Insurance Consumer Guide

In order to sign up for private health coverage through the Marketplace in Delaware, you must:

• Live in Delaware and be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

By those rules, most Delaware residents qualify to use the Marketplace.⁵ But a more important question for most people is eligibility for financial assistance, and there are a few additional parameters in order to qualify for subsidies in the Marketplace. To be eligible for income-based Advance Premium Tax Credits (APTC) or cost-sharing reductions (CSR), you must:

• Not be eligible to enroll in affordable health coverage offered by an employer. If you have access to an employer’s plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.

In addition to those basic parameters, eligibility for Marketplace subsidies depends on your household income and how it compares with the cost of the second-lowest-cost Silver plan in your area (the cost of this plan will depend on your age and location).

You can sign up for an ACA-compliant individual or family health plan in Delaware between November 1 and January 15, the annual open enrollment period.⁶ 

To have a January 1 coverage effective date, you need to complete your application by December 15. Plan selections made between December 16 and January 15 will have a February 1 coverage effective date.⁷ 

Outside of the annual open enrollment window, you may still be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event. 

Enrollment in Delaware Medicaid/CHIP is available year-round.

To enroll in an ACA Marketplace plan in Delaware, you can: 

• Visit HealthCare.gov to compare plans, see your subsidy eligibility (if applicable), and enroll in the plan that best meets your needs. 
• Use the state-run Choose Health Delaware website to learn about the available health plans. You’ll be directed to the HealthCare.gov platform in order to enroll. 
• Purchase Marketplace coverage with the help of an insurance agent or broker, Navigators, certified application counselors or an approved enhanced direct enrollment entity.⁸ 

You can reach HealthCare.gov’s call center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except holidays.

The Affordable Care Act (ACA) created income-based subsidies that can help lower your premium payments each month. These subsidies are available to Delaware residents who meet the eligibility requirements and enroll in Marketplace coverage.

As of 2023, nine out of ten Marketplace enrollees in Delaware were receiving premium subsidies. The subsidies reduced their average health insurance premiums by $599/month. And after the subsidies were applied, the average Delaware Marketplace enrollee’s premium was about $144/month.⁹

If your household income is below 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR), as long as you select a Silver-level plan. These subsidies result in lower out-of-pocket costs, including deductibles. As of 2023, more than a quarter of Delaware’s Marketplace enrollees were receiving CSR benefits.⁹

Depending on your income and circumstances, you may be able to enroll in free or low cost health coverage through Medicaid or CHIP (Delaware Healthy Children). Check to see if you meet the criteria for Delaware Medicaid/CHIP. 

Source: CMS.gov¹⁰

Four insurers plan to offer individual/family coverage through the Delaware Marketplace for 2024, including one newcomer:¹¹

• Aetna Health
• AmeriHealth Caritas
• Highmark BCBSD
• Celtic (new for 2024)

The following table highlights each Delaware Marketplace insurer’s approved rate changes for 2024 individual/family health plans. 

Source: Delaware Department of Insurance ¹¹

(Note that the approved rate increase for Highmark is a little lower than the insurer initially proposed. Rate filings are reviewed and finalized by the Delaware Department of Insurance.)

It’s important to keep in mind that average rate changes are calculated based on full-price premiums, and most enrollees do not pay full price: As of 2023, nine out of ten Delaware Marketplace enrollees were receiving premium subsidies that reduced their monthly payments.⁹

During the open enrollment period for 2023 coverage, 34,742 people selected private plans through Delaware’s Marketplace.⁹

Source: 2014,¹² 2015,¹³ 2016,¹⁴ 2017,¹⁵ 2018,¹⁶ 2019,¹⁷ 2020,¹⁸ 2021,¹⁹ 2022,²⁰ 2023,⁹ 2024²¹

HealthCare.gov
This is the Marketplace enrollment platform in Delaware. Residents can use it to enroll in individual/family health plans and receive income-based subsidies. You can contact HealthCare.gov at 800-318-2596.

Choose Health Delaware
Delaware’s partnership exchange/Marketplace. Helps consumers learn about coverage options in the Marketplace, and directs them to HealthCare.gov for enrollment. 

Quality Insights, Inc.
Delaware’s federally funded Navigator organization, helping residents find affordable coverage through the Marketplace and the state’s Medicaid/CHIP program.

Delaware Health and Social Services
Administers Medicaid and Delaware Healthy Children (CHIP), as well as other social services programs. 

Delaware Department of Insurance
Regulates and oversees the insurance industry in Delaware, and assists consumers and businesses with insurance-related questions and concerns. 

Delaware Medicare Assistance Bureau
A resource for Delaware Medicare beneficiaries and their caregivers. Provides information and assistance with questions related to Medicare eligibility, enrollment, and claims.