With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Delaware, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Delaware
Delaware ranked 35th overall in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include a low prevalence of pertussis infections (whooping cough), a low percentage of uninsured population, and high immunization coverage among children and adolescents. The state’s challenges include a high rate of drug deaths, a high violent crime rate, and a high infant mortality rate.
Delaware individual and family health insurance
Delaware rolled out a partnership health insurance exchange when the Affordable Care Act’s first open-enrollment period began Oct. 1, 2013. The state facilitates plan management and consumer information, while the federal government provides a platform through which application and enrollment occur. Those who buy health insurance through Delaware’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Delaware residents may also buy ACA-compliant health plans in the private marketplace through websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit Choose Health Delaware to learn more about health insurance options; then, shop and apply for coverage at the Federal Health Insurance Marketplace.
The U.S. Department of Health and Human Services reported that 14,087 individuals in Delaware selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Delaware enrolled in a marketplace plan increased to 25,036 during the open enrollment period.3
|Delaware’s health insurance exchange Information:||choosehealthde.com|
|Delaware department of insurance:||delawareinsurance.gov|
Delaware small group health insurance plans
In Delaware, small businesses with 50 or fewer employees may purchase small group health insurance plans through Delaware’s partnership exchange and in the private marketplace through websites such as such as HealthCare.com. Small businesses that shop Delaware’s partnership exchange and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
Delaware state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Delaware’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||1–19|
|Maximum continuation period – standard||9 months|
|Maximum premium Increase||102 percent|
|State legislation reference||Delaware House Bill 170 (HB 170) with House Amendment 1 (18 Del.C. § 3571F) or mini-COBRA|
|More Information||401-462-9517 – Office of the Health Insurance Commissioner|
|Additional notes||Available to covered employees and eligible dependents who were continuously covered by the group policy for the entire three months leading up to the qualifying event|
Delaware high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Delaware expanded its Medicaid program in 2014.7 The information below is specific to Delaware’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Delaware Health and Social Services Division of Medicaid & Medical Assistance|
|How to apply online||assist.dhss.delaware.gov|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to the Delaware Healthy Children Program, Delaware’s health insurance program for low-income children:
|Program name||Delaware Healthy Children|
|How to apply||Additional application options: dhss.delaware.gov/dhss/dmma/dhcpapply.html|
|Eligibility8||Children under age 19 who do not have comprehensive health insurance, are U.S. residents and qualified non-residents living in Delaware, are not dependents of a permanent State of Delaware employee, and meet income eligibility requirements|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Delaware Department of Insurance. Domestic/Foreign Insurers Bulletin No. 51. July 19, 2012. Retrieved from http://delawareinsurance.gov/departments/documents/bulletins/DomesticForeignInsurersBulletinNo51.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/
7 Centers for Medicare & Medicaid Services. “Delaware.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/delaware.html.
8 State of Delaware Health and Social Services. Division of Medicaid & Medical Assistance. “Delaware Healthy Children Program: Who Qualifies?” Last updated Jan. 16, 2009. Retrieved from http://dhss.delaware.gov/dhss/dmma/dhcpqualify.html.