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.² 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.³
• File a joint tax return with your spouse, if you’re married.⁴ (with very limited exceptions)⁵
• Not be able to be claimed by someone else as a tax dependent.⁶

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.⁷ 

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.⁸ 

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, 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.⁹ 

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 early 2024, more than nine out of ten Marketplace enrollees in Delaware were receiving premium subsidies. The subsidies reduced their average health insurance premiums by $588/month. After subsidies were applied, the average Delaware Marketplace enrollee’s premium was about $188/month, including those who weren’t eligible for a subsidy.¹⁰

Source: CMS.gov¹¹

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.¹²

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. As of 2024, more than a quarter of Delaware’s Marketplace enrollees were receiving CSR benefits.¹⁰

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.¹³ And cost-sharing for specialty drugs is capped at no more than $150/month for Delaware residents enrolled in state-regulated health plans.¹⁴

Four insurers offer individual/family coverage through the Delaware Marketplace for 2024, including one newcomer, Celtic.¹⁵

All four have filed rates and plans for 2025.¹

The following table shows each Delaware Marketplace insurer’s approved rate changes for 2025 individual/family health plans.¹⁶ Based on the market share listed in each insurer’s rate justification (details below), the weighted average overall rate change amounts to an increase of about 8.4%.¹ 

Source: Delaware Department of Insurance¹¹⁶

Here is the market share for each carrier, according to their filings:¹

• Aetna: 4,069 enrollees
• AmeriHealth: 4,181 enrollees
• Celtic: 954 enrollees
• Highmark: 33,116 enrollees

Based on those numbers and the final approved rates, the overall weighted average rate increase amounts to about 8.4% for 2025. But there’s a lot of variation from one carrier to another. The final approved rates for some of the carriers were significantly lower than the carriers had initially proposed; the initial proposals amounted to a weighted average rate increase of 13.3%. But Highmark’s rates were approved as filed, and they have by far the majority of the market share in Delaware’s individual market.¹⁶

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 2024, more than nine out of ten Delaware Marketplace enrollees were receiving premium subsidies that reduced their monthly payments.¹⁰

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

• 2015: Average increase of 3%¹⁷
• 2016: Average increase of 22%¹⁸
• 2017: Average increase of 30%¹⁹
• 2018: Average increase of 25%²⁰
• 2019: Average increase of 3%²¹
• 2020: Average decrease of 19%²² (reinsurance program took effect)
• 2021: Average decrease of 1%²³
• 2022: Average increase of 3%²⁴
• 2023: Average increase of 5.5%²⁵ (plus two new insurers)
• 2024: Average increase of 3.1%²⁶ (plus one new insurer)

During the open enrollment period for 2024 coverage, 44,842 people enrolled in private health plans through the Delaware Marketplace.²⁷

This was a significant record high, far exceeding the previous record high set the year before, when 34,742 people selected private plans through Delaware’s Marketplace.²⁸

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023,²⁸ 2024³⁸

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.³⁹

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.