Delaware Health Insurance: Find Affordable Plans
See how you can get cheap health insurance in DE, including marketplace plans, Medicare, and Medicaid.
As a Delaware resident, you have access to a wide range of affordable health insurance options. Although group coverage is the most common, you can also sign up for an Affordable Care Act plan, use your military health benefits, or enroll in Medicare or Medicaid.
This guide explains your Delaware health insurance options in detail.
Q How Do I Join A Managed Care Organization
A. After being notified that you are eligible for Medicaid , you will receive in the mail a packet of information about the different MCO plan options for receiving your Medicaid benefits. You may choose any plan described in this mailing. You probably want to choose a Managed Care Organization to which your doctor belongs. If you need help making this decision, call the Health Benefit Manager at the phone number in the mailing.
What Are Delaware’s Medicare Options For Seniors And People With Disabilities
Medicare is an option for Delaware residents who meet the eligibility requirements regarding age and disability status.
- Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A , and Part B . It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs these plans are known as Medicare Part D.
- Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision.
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance covers deductibles, copays, and other out-of-pocket Medicare costs.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis .
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Q How Will I Receive My Medical Care
A. In Delaware, Medicaid benefits are provided mainly through a managed care organization, or MCO, under contract with the state. Managed care is an organized way to ensure that people receive the quality medical care they need in the most cost-effective manner. Some Medicaid recipients in Delaware those who also receive Medicare and those in Long Term Care Medicaid programs such as the Nursing Facility program do not receive their medical care through a managed care organization.
DMMA provides a choice of managed care organizations so you can select the MCO plan that is best for you and your family. Delaware contracts with two managed care plans AmeriHealth Caritas and Highmark Health Options.
The Medicaid MCO provides almost all of the care for Medicaid members who join their plan. Prescription and non-emergency medical transportation services are covered directly by Medicaid, not through the MCO. Medicaid recipients need to show their Medicaid card to pharmacies and transportation providers when receiving these services.
How Much Does Health Insurance Cost In Delaware
The Health Insurance Marketplace uses a metal tier system to classify insurance plans. This tier system makes it easy to look at each plan and estimate how high the premiums and other out-of-pocket costs are likely to be. The three main tiers are Bronze, Silver, and Gold.
|Average premiums in Delaware|
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Insurance For Families In Delaware
Shopping for a family plan is a little more difficult because you need to think about the health needs of multiple people. If your spouse or child has asthma, heart disease, or some other chronic health condition, it may cost you less in the long run to choose a plan with a higher monthly premium because you wont have to pay as much in deductibles, copays, and coinsurance.
You also need to think about maintaining access to preferred hospitals and specialists. People with chronic health conditions often have trouble finding a physician who understands their symptoms and knows how to manage them effectively. If someone in your family already has a good relationship with a local physician, you should look for a health plan that includes that physician in its insurance network. Otherwise, youll have to find a new physician or pay out of pocket if you want to keep seeing the current one.
Its also important to compare plans based on their coinsurance and copay requirements. Someone who typically stays in the hospital once or twice per year would benefit from having a plan with a 10% or 20% coinsurance requirement versus a 40% coinsurance requirement, for example.
In Delaware, you cant purchase family coverage directly from an insurance company. You must use the Health Insurance Marketplace if you dont qualify for some other type of coverage.
Delaware Medicaid Income Limit
The Delaware Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Delaware Medicaid Income limits listed below.
Here is the Federal Poverty Level for 2021.
|2021 Federal Poverty Levels for the 48 Contiguous States & D.C.|
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 212 percent of FPL
- Any child age 1-5 with a family income up to 142 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- CHIP for children with family income up to 212 percent of FPL
- Pregnant women with family income up to 212 percent of FPL
- Parents of minor children with family income up to 87 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 74% of the FPL
- Adults without dependents under Medicaid expansion with income up to 133% of the FPL
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What Are The Requirements For Medicaid In Delaware
The requirements for Medicaid in Delaware are decided by the state, alone. So, if a patient did qualify for Medicaid in the previous state of residence, that does not mean he or she is eligible for Medicaid in DE. Candidates must meet all Medicaid eligibility requirements in full in order to follow the Medicaid benefits application steps.
The general Medicaid requirements relate to a patients status and presence in both the state and the country. First, a future beneficiary must meet requirements to be eligible for Medicaid as a U.S. citizen. Without United States citizenship or legal presence in the country, applicants cannot collect Medicaid benefits. However, those that are illegally residing may qualify for emergency medical assistance under other circumstances.
Next, Medicaid qualifications require a candidate to reside lawfully in the state of Delaware. Simply put, if an applicant does not live within the DE state borders, he or she cannot qualify for Medicaid. Most times, a valid drivers license or a state ID card can prove a potential beneficiarys residency for Medicaid benefits eligibility purposes.
Furthermore, a registered Social Security Number is part of the requirements for Medicaid. Since Medicaid is also overseen by the federal government, a Social Security Number acts as an identifier when it comes to verifying income eligibility for Medicaid. In addition, Social Security Numbers are used to handle Medicaid benefits in Delaware.
Delaware Has Accepted Federal Medicaid Expansion
- 279,597 Number of Delawareans covered by Medicaid/CHIP as of September 2021
- 56,273 Increase in the number of Delawareans covered by Medicaid/CHIP fall 2013 to September 2021
- 32% Reduction in the uninsured rate from 2010 to 2019
- 20% Increase in total Medicaid/CHIP enrollment in Delaware since Medicaid expansion took effect
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Delaware Medicaid Income Limits Summary
We hope this post on Delaware Medicaid Income Limits was helpful to you.
If you have any questions about Medicaid in the state of Delaware, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Q What Documents Will I Need To Provide When I Apply
A. You will need to provide verification of your income. You do not need to provide proof of your assets or resources or come into our offices to be interviewed unless you are applying for one of the Long Term Care Medicaid programs .
If you are pregnant, you will need to provide proof that you are pregnant. If you are not a U.S. citizen, you will need to provide proof of your alien status. For example, you can provide a copy of your green card.
If you apply online using ASSIST, a web page at the end of the application will tell you exactly what documents must be sent by mail to support the application you are submitting, and the appropriate mailing address.
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Medicaid Certified Home Care Agency In Delaware
A homecare agency is considered to be eligible for Medicaid reimbursement if the agency is HHA certified as per the state regulations.
The agencies can get detailed information about the required certifications either through the Bureau of Licensing and Certification or through the Department of Human Services.
Governing Body: Diamond State Health Plan
Children’s Health Insurance Program
The Children’s Health Insurance Program is a public healthcare program for low-income children who are ineligible for Medicaid. CHIP and Medicaid are related programs, and the former builds on Medicaid’s coverage of children. States may run CHIP as an extension of Medicaid, as a separate program, or as a combination of both. Like Medicaid, CHIP is financed by both the states and the federal government, and states retain general flexibility in the administration of its benefits.
CHIP is available specifically for children whose families make too much to qualify for Medicaid, meaning they must earn incomes above 138 percent of the federal poverty level, or $33,948 for a family of four in 2017. Upper income limits for eligibility for CHIP vary by state, from 175 percent of the federal poverty level in North Dakota to 405 percent of the FPL in New York. States have greater flexibility in designing their CHIP programs than with Medicaid. For instance, fewer benefits are required to be covered under CHIP. States can also charge a monthly premium and require cost sharing, such as copayments, for some services the total cost of premiums and cost sharing may be no more than 5 percent of a family’s annual income. As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing.
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Unitedhealthcare Connected Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
Los servicios Language Line están disponibles para todos los proveedores dentro de la red.
What Happens After You Apply For Medicaid
The Delaware Department of Health and Social Services will review your application to verify if you are eligible for Medicaid. In some cases, the state may ask for additional information before approving your application. Delaware will mail applicants a letter detailing if their Medicaid application was approved or denied.
It takes approximately 45 days to process a Medicaid application. If you are approved, you will receive a Medicaid identification card within 2 weeks of when you receive your approval notification.
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How To Qualify For Medicaid In Delaware
To qualify for Medicaid in Delaware, you must:
- Be a resident of Delaware
- Be a U.S. citizen or have a qualifying immigration status
- Meet the Medicaid programs income limits
Income limits vary depending on household size, medical status and other factors and are subject to change annually. Find the current Medicaid income limits based on household size in Delaware here.
Learn what documents you can submit to prove your citizenship and identity here.
Find further information on Delaware Medicaid eligibility here.
Q Where Do I Go To Apply For Medicaid
A. There are several ways to apply for Medicaid and other medical assistance programs:
- On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
- You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
- By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or 255-9500 to be directed to the Division of Social Services office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
- For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.
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Mental Retardation/developmental Disability Waiver
DDDS has a waiver for individuals with mental retardation/developmental disabilities receiving residential services from the Division. Services included in the waiver are case management, respite care, residential services, day habilitation services, prevocational services, supported employment services, adult day health services, transportation, clinical support, and environmental adaptations and modifications. The Divisions waiver was renewed in 2004 to 2009. For more information, call the Division of Developmental Disabilities Services at 744-9600 or the Delaware Helpline at 464-4357 , 273-9500 or visit the Divisions Website .
How To Submit A Medicaid Application Form In Delaware By Mail
There are three ways to get a Medicaid application in Delaware. You can download and print a Medicaid application online, pick one up at any Health and Social Services office or call the toll free number to have a Medicaid application mailed to you.
Try to complete the Medicaid form to the best of your ability. If any of your family members live with you, you will need their names, birthdates and Social Security. Applicants who have a job will need supporting information from pay stubs and W-2 forms.
Candidates with health insurance may still qualify for Medicaid. Individuals with disabilities may be eligible for additional benefits but must have verifying documents ready.
If you do not understand a question or you are not sure how to answer, leave it blank. The state can still process incomplete applications. If your Medicaid application is missing any of the required information, someone will contact you to get it. When you are finished with your application, send it via the mail.
It may take a few weeks to process your Medicaid application you should hear something, whether your Medicaid application is accepted or rejected. If you have not heard anything within a month, you may need to follow up on your application. You can visit your local Health and Social Services office or call the Delaware Medicaid office.
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Delaware Diamond State Health Plan 1115 Demonstration Waiver 2019 Annual Report
In compliance with the Special Terms and Conditions of the Diamond State Health Plan , Section 1115 Demonstration, the State of Delaware ) publishes this most recently approved Annual Report.
Q Who Qualifies For Medicaid
A. Citizenship and Residency – To obtain full Medicaid benefits in Delaware, you must be a Delaware resident and either a U.S. citizen or a legally residing noncitizen. Full coverage for noncitizens which include DACA recipients is dependent on the availability of state funding. However, noncitizens can qualify for coverage for emergencies and labor & delivery services if income requirements are met.
Income Level – Qualifying for Medicaid is also based on need. Household income must be under certain limits as defined by the Federal Poverty Level and is based on family size. For Long Term Care programs, financial resources must also be under a certain amount. There are also specific programs for individuals who meet certain medical or disability tests, or who qualify due to age or pregnancy. To find out more about different Medicaid and other medical assistance programs, visit DMMA Programs & Services.
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