Key Facts for Delaware
Medicaid in Delaware
Delaware expanded Medicaid in 2014 under the Affordable Care Act. The state's Medicaid program, known as the Diamond State Health Plan (DSHP), provides comprehensive coverage to eligible Delaware residents.
Because Delaware expanded Medicaid, there is no coverage gap. Adults earning up to 138% of the Federal Poverty Level can access affordable coverage through Medicaid.
Who Qualifies for Delaware Medicaid?
- Adults ages 19-64: Up to 138% FPL (about $20,120/year for an individual)
- Children: Up to 217% FPL through Delaware Healthy Children Program
- Pregnant women: Up to 212% FPL
- Elderly and disabled: Based on SSI eligibility and income/asset limits
- Parents/Caretakers: Based on household income up to 138% FPL
Diamond State Health Plan (DSHP)
Most Delaware Medicaid recipients receive coverage through the Diamond State Health Plan, a managed care program. DSHP contracts with managed care organizations to provide:
- Doctor visits and preventive care
- Hospital services
- Prescription drugs
- Mental health and substance abuse services
- Dental and vision for children
How to Apply for Delaware Medicaid
- Online: Visit Delaware ASSIST
- Phone: Call 1-800-372-2022
- In Person: Visit your local Division of Social Services office
- Through HealthCare.gov: The marketplace will screen you for Medicaid eligibility
Health Insurance Marketplace
Delaware uses the federal Health Insurance Marketplace at HealthCare.gov. Residents who earn above 138% FPL can shop for private insurance plans with potential premium subsidies.
November 1, 2024 through January 15, 2025. Enroll by December 15 for coverage starting January 1, 2025.
How to Enroll
- Visit HealthCare.gov
- Create an account or log in
- Complete your application with income and household information
- You'll be screened for Medicaid eligibility first
- If not eligible for Medicaid, compare marketplace plans
- Select a plan and complete enrollment
Special Enrollment Periods
Outside of Open Enrollment, you can enroll if you experience a qualifying life event such as losing other coverage, getting married, having a baby, or moving to Delaware.
Average Costs in Delaware
Delaware's health insurance costs are moderate compared to the national average. Here's what to expect:
- Benchmark Silver Plan: Average of $450-600/month before subsidies for a 40-year-old
- With Premium Tax Credits: Many Delawareans pay $50-150/month after subsidies
- Medicaid: Free or very low cost for eligible individuals
- Bronze Plans: Lower premiums, higher deductibles
- Gold Plans: Higher premiums, lower out-of-pocket costs
If your income is between 138% and 400% of the Federal Poverty Level, you likely qualify for premium subsidies that reduce your monthly costs. Enhanced subsidies are available through 2025.
Frequently Asked Questions
Has Delaware expanded Medicaid?
Yes, Delaware expanded Medicaid in 2014. Adults ages 19-64 earning up to 138% of the Federal Poverty Level (about $20,120 for an individual in 2024) can qualify for Delaware Medicaid, also known as Diamond State Health Plan Plus.
What is the Diamond State Health Plan?
The Diamond State Health Plan (DSHP) is Delaware's Medicaid managed care program. Most Medicaid beneficiaries in Delaware receive their coverage through DSHP, which contracts with managed care organizations to provide comprehensive health services.
When is Open Enrollment for Delaware health insurance?
Delaware uses the federal HealthCare.gov marketplace. Open Enrollment for 2025 coverage runs from November 1, 2024 through January 15, 2025. Delaware Medicaid enrollment is available year-round for eligible individuals.
How do I apply for Delaware Medicaid?
You can apply online through the Delaware ASSIST portal at assist.dhss.delaware.gov, by phone at 1-800-372-2022, or in person at your local Division of Social Services office. You can also apply through HealthCare.gov.
Need Help Finding Coverage in Delaware?
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