Delaware health insurance Marketplace 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.⁴ 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.
• Not be eligible for premium-free Medicare Part A.⁵
• File a joint tax return with your spouse, if you’re married.⁶ (with very limited exceptions)⁷
• Not be able to be claimed by someone else as a tax dependent.⁸

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.⁹ 

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.¹⁰ 

Starting in the fall of 2026, for coverage effective in 2027, the open enrollment period will be shorter. It will end on December 15, and all plans selected during open enrollment will take effect January 1.

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-based 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, Navigator, or certified application counselor. These individuals can provide help online, over the phone, or in-person.
• Enroll via an approved enhanced direct enrollment entity.¹¹ 

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.

During the open enrollment period for 2025 coverage, more than nine out of ten Marketplace enrollees in Delaware were eligible premium subsidies. The subsidies reduced their average health insurance premiums by $586/month. After subsidies were applied, the average Delaware Marketplace enrollee’s premium was about $217/month, including those who weren’t eligible for a subsidy.¹²

Reinsurance: Delaware has a reinsurance program, which has helped to keep full-price premiums lower than they would otherwise have been over the last few years. Although the majority of Delaware’s Marketplace enrollees qualify for premium subsidies, the reinsurance program keeps coverage more affordable than it would otherwise be for those who aren’t subsidy-eligible.¹³

Cost-sharing reductions: If your household income is no more than 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. Thirty percent of Delaware’s Marketplace enrollees were receiving CSR benefits as of early 2025.¹⁴

Medicaid/CHIP: 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 eligibility criteria for Delaware Medicaid/CHIP. 

Insulin cost-sharing cap: Delaware caps insulin out-of-pocket costs at $35/month for people with state-regulated health insurance, which includes Marketplace plans.¹⁵ And cost-sharing for specialty drugs is capped at no more than $150/month for Delaware residents enrolled in state-regulated health plans.¹⁶

Four insurers offer individual/family coverage through the Delaware Marketplace for 2025. But Aetna is exiting the Delaware Marketplace at the end of 2025, as is the case in all states where Aetna offers Marketplace coverage in 2025.

There will be three insurers offering plans in the Delaware Marketplace for 2026.¹⁷

The following table shows each Delaware Marketplace insurer’s proposed rate changes for 2026 individual/family health plans,³ amounting to a weighted average proposed rate increase of 32.5% (details below).

Source: Delaware Department of Insurance¹⁷

Here is the market share for each carrier that will continue to offer coverage in 2026, according to their filings:¹⁸

• AmeriHealth: 5,782 enrollees
• Celtic: 10,619 enrollees
• Highmark: 32,425 enrollees

Based on those numbers and the proposed rates, the overall weighted average rate increase amounts to about 32.5% for 2026. But there’s a lot of variation from one carrier to another.

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 2025, more than nine out of ten Delaware Marketplace enrollees were receiving premium subsidies that reduced their monthly payments.¹⁹

For perspective, here’s an overview of how average full-price premiums have changed in Delaware over time:

• 2015: Average increase of 3%²⁰
• 2016: Average increase of 22%²¹
• 2017: Average increase of 30%²²
• 2018: Average increase of 25%²³
• 2019: Average increase of 3%²⁴
• 2020: Average decrease of 19%²⁵ (reinsurance program took effect)
• 2021: Average decrease of 1%²⁶
• 2022: Average increase of 3%²⁷
• 2023: Average increase of 5.5%²⁸ (plus two new insurers)
• 2024: Average increase of 3.1%²⁹ (plus one new insurer)
• 2025: Average increase of 8.5%³⁰

During the open enrollment period for 2025 coverage, 52,931 people enrolled in private health plans through the Delaware Marketplace.³¹

This was a significant record high, far exceeding the previous record high set the year before. Enrollment in Delaware’s Marketplace has grown every year since 2019 (see chart below).

Source: 2014,³² 2015,³³ 2016,³⁴ 2017,³⁵ 2018,³⁶ 2019,³⁷ 2020,³⁸ 2021,³⁹ 2022,⁴⁰ 2023,⁴¹ 2024,⁴² 2025⁴³

The enrollment growth in recent years, illustrated above, stems in large part from the subsidy enhancements created by the Amerian Rescue Plan and Inflation Reduction Act.

The enrollment growth in 2024 is also partially due to the “unwinding” of the pandemic-era continuous coverage rule for Medicaid, which prevented Medicaid disenrollments for three years. By April 2024, nearly 15,000 people in Delaware had transitioned from Medicaid to a Marketplace plan.⁴⁴

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.