Do you have health insurance? If you don’t you could be gambling with both your health and your wallet. Use our guide to get the health insurance you need at a price you can afford.
Get Health Insurance in Delaware
Tip: compare 2-3 companies
The Best Health Insurance in Delaware:
- Best Overall in Delaware: Highmark BCBS
- Best for Short Term Health Insurance: Pivot Health & UnitedHealthcare
- Best for Dental & Vision: Humana & Ameritas
- The Best Health Insurance in Delaware:
- What is Health Insurance?
- Average Cost of Health Insurance in Delaware
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance Not Cover?
- Best Health Insurance Providers in Delaware
- Best Short Term Health Insurance Providers in Delaware
- Best Dental and Vision Insurance Providers in Delaware
- You Don’t Need to Live Without Insurance
- Frequently Asked Questions
What is Health Insurance?
Health insurance is a type of coverage that pays a percentage of your medical bills if you get sick, are injured or need to go to the hospital. Having insurance protects you financially from the rising cost of medical care and can potentially help you avoid medical bankruptcy if you become ill. Health insurance helps pay for things like hospital stays, emergency room treatment and annual physicals.
There are a few different ways that you can get health insurance:
- An employer-sponsored group plan: Most Americans get their health insurance through their employers. Business owners receive group discounts on health insurance coverage, which lowers the amount you pay per month.
- Medicare: Medicare is a government-sponsored, low-cost health insurance program. You may qualify for Medicare if you’re over 65 or you have a disability that limits your ability to work.
- Medicaid: Medicaid is another government-sponsored health insurance program for low-income families.
- A private insurance provider: You can buy a private individual or family plan through the Affordable Care Act (ACA) Marketplace. We’ll be focusing on private insurance options in this article.
The specific health insurance plans you’ll be able to choose may vary depending on where you live and your annual income. When you compare plan prices, you might see multiple dollar amounts listed. Here are a few need-to-know terms you should be familiar with before you shop for insurance.
- Premium: Your premium is the amount of money you pay to your insurance company every month in exchange for coverage. You must pay your premium every month, even if you don’t go to the doctor or hospital in a certain month.
- Deductible: Your deductible is the amount of money you need to pay toward your healthcare costs before your insurance kicks in and starts paying for your medical care. If you choose a plan with a $1,000 deductible, for example, you need to spend $1,000 on your medical care out of pocket before your insurance pays for anything.
- Coinsurance: Your coinsurance percentage is the percentage of your medical care costs you need to pay once you meet your deductible. If you have a plan with a 20% coinsurance rate and you get a medical bill for $100, for example, you’ll need to pay $20. Your insurance provider covers the remaining $80.
- Out-of-pocket maximum: This is the maximum amount of money you’ll spend on your health insurance in a single year. If you hit your maximum, your insurance pays for 100% of your medical care costs.
Average Cost of Health Insurance in Delaware
The average resident of Delaware pays about $475 per month for their health insurance plan. However, you may qualify for a subsidy through the Marketplace exchange. Begin by creating a profile at Healthcare.gov and entering your income and personal information. About 8 out of 10 Delaware residents who qualify for a Marketplace plan also qualify for a subsidy — so you’re likely to get some form of assistance.
Types of Health Coverage
There are a few different types of health insurance plans you’ll need to navigate when you shop. Here are a few of the most common plan types you’ll see and what they mean for you as the policyholder:
- Exclusive provider organization (EPO): An EPO is a type of managed care plan that requires you to see doctors, specialists and hospitals in the plan’s network. EPOs are often available in areas dominated by a single healthcare provider and are often the most affordable health insurance option if available.
- Health maintenance organization (HMO): An HMO is like an EPO in that the plan requires you to visit care providers in the plan’s network. Many HMOs contract out doctors and specialists to widen their network. With an HMO, you’re usually required to get a referral from your primary care provider (PCP) before you can see a specialist.
- Preferred provider organization (PPO): If you want to see doctors and specialists without worrying about your plan’s network, consider a PPO plan. PPO plans allow you to see both in-network and out-of-network care providers and still use your insurance. You also typically don’t need a referral to see a specialist.
Outside of the ACA Marketplace, you might have the option to buy a short term health insurance plan. These affordable plans are very limited and don’t include the same ACA protections as long-term Marketplace plans. For example, your short term health insurance provider can deny you coverage based on a pre-existing condition — something that’s now against the law for ACA plans. Delaware state law also dictates that your short term plan cannot stay in effect for more than 3 months or be renewed after a policy expires.
You should only consider a short term plan if you missed Open Enrollment for a long-term ACA plan. Short term health insurance plans are not a substitute for long-term insurance.
What Does Health Insurance Cover?
The ACA established a number of essential benefits your long-term plan needs to cover. When you buy a plan through the Marketplace, you’ll have at least some type of coverage for the following treatments and services.
- Ambulatory patient services: This includes treatments and services you receive without being admitted to a hospital or emergency room, for example, having a mole removed in a dermatologists’ office.
- Emergency care: Your insurance needs to cover treatment at both in-network and out-of-network emergency rooms — even if you have an EPO or HMO plan. It is against the law for your insurance provider to deny you coverage for visiting an out-of-network emergency room.
- Hospitalization: This includes overnight stays at hospitals and surgeries.
- Rehabilitative and habilitative treatments: This includes both treatments and devices used to help restore physical mobility and mental responsiveness after an accident or illness. Physical therapy appointments after breaking your leg in a car accident is a common example.
- Prescription drugs: Your insurance must offer some form of coverage for all major classes of prescription drugs. They don’t have to cover every drug in each class, however.
- Preventive care and wellness screenings: This includes non-diagnostic tests and services. For example, cholesterol tests and an annual checkup.
- Lab tests: This includes diagnostic testing and additional types of bloodwork.
- Mental health and substance abuse treatment: Your insurance must cover both inpatient and outpatient mental health and substance abuse treatment.
- Pregnancy and maternity care: Your insurance must cover any care you need before, after and during birth.
- Pediatric services: Your insurance must cover all of the above services for any children enrolled in your plan. They must also extend dental and vision coverage to children under 19.
- Female birth control: If you’re a woman, your insurance must cover most types of birth control.
Keep in mind that these benefits only apply to long-term plans purchased through the ACA Marketplace. If you buy a short term plan, your insurance provider can choose which services are and aren’t covered. Be sure to completely read your plan’s terms before you enroll.
What Does Health Insurance Not Cover?
Even the best health insurance plan won’t cover every treatment and service. Let’s take a look at a few of the most common exclusions you’ll see when you shop for coverage.
- Cosmetic surgery: No insurance plan will cover elective, non-necessary procedures.
- Travel vaccines: Insurance plans must cover routine vaccinations on the standard schedule set by the CDC. Vaccines that fall outside of the standard schedule (like yellow fever and rabies immunizations) usually aren’t covered.
- Adult dental and vision services: Insurance providers must cover dental and vision services for children on your plan. And there’s no requirement that they extend these services to adults. You can buy an independent dental or vision plan if you’d like coverage for adults on your plan.
- Male birth control: ACA plans only need to cover female methods of birth control. Male methods (including condoms and vasectomies) typically aren’t covered.
This isn’t a comprehensive list of services excluded from insurance. So long as a treatment isn’t considered an essential benefit, your insurance provider is free to limit or deny coverage. If you aren’t sure if a plan covers a specific treatment, contact a representative from your insurance company.
Best Health Insurance Providers in Delaware
Now that you understand how health insurance in Delaware works, let’s take a look at a few of your plan options.
1. Highmark Blue Cross Blue Shield
Highmark Blue Cross Blue Shield is the only company offering ACA-compliant, long-term plans in Delaware. It offers a wide range of plan choices that can help you control your insurance costs and keep a high level of coverage.
Many of Highmark’s plans include $0 deductibles for the most common prescription drugs and 2 free visits to your primary care doctor per year. Its plans also include free contraceptives, more free mental health visits and new lower deductibles for 2020.
Best Short Term Health Insurance Providers in Delaware
Are you looking for a short term plan to fill the gap until Open Enrollment? Consider one of these providers.
2. Pivot Health
Pivot Health provides a number of affordable 3-month plan options for Delaware residents. You can get up to $1 million worth of coverage for as little as $57 per month.
Many of its plan options include exceptionally reasonable rates when compared to other short term options. You’ll pay 20% coinsurance on most plan options and deductibles begin at just $1,000. You can also see any doctor with a short term plan from Pivot — no need to worry about networks.
If you’re looking to fill a gap in your coverage while spending as little as possible, be sure to get a quote from UnitedHealthcare. UnitedHealthcare offers a number of short term solutions in Delaware, and coverage starts at just $28 for a 3-month plan.
Many of its plans even include coverage for prescription drugs, which are usually excluded from short term plans. UnitedHealthcare has been offering short term plans for over 30 years — and they continue to be an excellent option while you search for long-term insurance.
Best Dental and Vision Insurance Providers in Delaware
You’ve learned about how to get health insurance, you’ve compared your options, and you’ve chosen a plan. Now, all that’s left is to supplement your coverage with vision and dental insurance.
Looking to quickly add both vision and dental insurance to your health insurance package? Humana offers exceptionally affordable options for both coverages in most areas of Delaware. You can get a dental insurance package for as little as $20 per month, while vision benefits begin at just $15 per month.
Securing your plans through Humana’s website is also exceptionally easy — just enter your ZIP code and date of birth, browse your options, and get enrolled for the next coming month.
If you’re interested in getting a little more protection on your supplemental coverage, consider dental and vision plans from Ameritas. Ameritas dental plans begin at $36 per month in most parts of Delaware but include more comprehensive coverage.
For example, you’ll get 50% coverage for orthodontia for children under the age of 19 and 100% coverage for preventive care. Its vision plans begin at just $10 per month and include 100% coverage for frames and lenses every 24 months if you choose an in-network provider.
You Don’t Need to Live Without Insurance
Getting health insurance outside of an employer-sponsored plan can be confusing — but you don’t need to live without coverage. The key to selecting the right plan for your needs is to leave yourself with plenty of time to compare your options. Don’t be afraid to contact representatives to discuss your plan choices and ask for recommendations. You’ll sleep easier at night knowing that your health is protected.