Delaware Health Insurance
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Facts and Figures
-
Place in State
Health Report Card 30th - Insured 764,368
- Uninsured 105,900
-
Insurance
Carriers 11 -
Number of
Primary Care Physicians 2430 -
Number of
Hospitals 7 -
Average Cost of
Health Insurance* $885
Breakdown of Insureds
- Employer-sponsored health insurance 63%
- Private plans 5%
- Medicaid 16%
- Medicare 16%
Insurance Carriers
- Aetna
- Assurant Health (Formerly Fortis)
- Celtic
- Companion Life
- Golden Rule
- Humana One
- John Alden
- MEGA Life and Health Insurance Company
- Principal Life
- Security Life
- United Healthcare
State Health Report Card
1. Adult smoking rate decreased from 22.9% to 17.3% over the past ten years; Still, there are 120,000 adult smokers in Delaware.
2. Obesity has risen from 101,000 to 199,000 over the past ten years in Delaware.
3. The rate of preventable hospitalizations has decreased from 63.8 to 57.3 discharges per 1,000 Medicare enrollees in the past year.
4. Diabetes cases increased more than fifty percent to 60,000 over the past ten years.
5. The percentage of children living in poverty increased from 14.2% to 17.5% in the past five years.
Delaware Health Insurance Laws and Regulations
Health insurance companies in Delaware are required to offer their customers guaranteed renewability. A subscriber’s insurance policy will not be cancelled and must be renewed as long as there is no breach in contract. Providers cannot cancel an existing policy because of an illness. Premium rates may depend on the age, health, and geographic location of the subscriber, and because Delaware does not control rates and premiums on health coverage, prices can vary significantly. Insurers may deny coverage to an applicant who is already ill or who may be at special risk. Health insurers in Delaware are allowed to exclude coverage for pre-existing conditions on the health plans they offer. This exclusion may be permanent or may have limitations depending on the company and plan policy in question. Small businesses in Delaware can purchase any form of small group health insurance policy available to other small businesses in the state. However, they may be required to meet certain requirements like minimum participation and employer contribution. Insurance companies in Delaware are allowed to set the premium rates for small business health insurance. Rates are usually based on age, sex, and health status of the plan holders. Existing policies cannot be cancelled because of an illness of a member. Self-employed individuals in Delaware can choose to purchase an individual or a small-business health insurance, provided the company has at least one employee.
There is guaranteed issue for small group plans.
Heath Care Reform
With the new health care law, children under the age of 26 can choose to stay under their parent’s health plan as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Delaware, nearly 4,000 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed almost 13,000 Medicare policyholders in Delaware to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, more than 12,000 Medicare subscribers were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $757 per person or a total of $9,358,894 was saved in the state of Delaware.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 153 individuals in Delaware have benefited from this new law.
The new health care law requires all health insurers to allocate at least 80 percent of the premium payment on health care and related improvements. A rebate or premium discount shall be provided if the minimum is not met. All private policyholders in Delaware will get greater value for their premium payments because of this 80/20 rule.
With the new law, insurance companies are now required to provide their subscribers with preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits with no dedictible or co-pay. In 2011, more than 117,000 Medicare subscribers and more than 160,000 individuals with private policies received such services in Delaware.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit-a cap on the yearly spending for your benefits, or a lifetime dollar limit-a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 320,000 Delaware residents have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Delaware received a total of $1 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Delaware, 15 community health centers received a total of $3.8 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Delaware has already received a total of $1.7 million to support its policies, programs, and communities to help its residents lead healthier lives.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Delaware peace of mind.
State Government Insurance Programs Offered
Pre-existing Condition Insurance Plan (PCIP)
866-717-5826
This plan is a temporary high-risk pool created by the Health Care Reform and in Delaware, it is run by the U.S. Department of Health and Human Services. This program provides coverage for individuals with a pre-existing condition who have a hard time finding private coverage. Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs. Eligibility: 1. Must be a U.S. resident living in Delaware. 2. Must be uninsured for at least six months. 3. Must have a qualified pre-existing health condition.
Medicaid
302-255-9500
800-372-2022
Medicaid provides coverage for low-income families who cannot afford health insurance on their own. Benefits for this plan include hospital care, doctor’s services, prescription drugs, emergency-only ambulance services, emergency room services, lab tests and x-rays, physical and occupational therapy, vision care, and more. Eligibility: 1. Must be U.S. citizens or legal residents living in Delaware. 2. Must meet income limits.
Children & Families First
800-734-2388
Children and Families First is a private and non-profit social service agency which aims to improve the status of families and communities in the state of Delaware by providing an integrated program of social, educational, and mental health services. This agency operates several programs: Special Medical Foster Care — provides training for foster parents to take care of children with medical problems. Treatment Foster Care Program — provides therapy for adolescents with mental health issues or behavioral problems. Resource Mothers Program — provides prenatal and pediatric care to pregnant mothers to help them deliver healthy babies. Adolescent Resource Center (ARC) — offers counseling for teenagers in need of guidance and support. Eligibility: 1. Special Medical Foster Care: Foster parents of children aged 0 to 18 years having medical issues and may need supportive technology. 2. Treatment Foster Care: Foster parents of adolescents aged 12 to 17 years mental health issues or behavioral problems. 3. Resource Mothers Program: Pregnant women in Delaware who are not receiving prenatal care. 4. Adolescent Resource Center (ARC): Adolescents aged 12 to 19 years.
Delaware Healthy Children Program
888-822-4530
Delaware Healthy Children Program offers low-cost, health insurance to uninsured children in Delaware. The program offers a wide range of services including physician services, hospital care, immunizations, lab and x-rays, well-child checkups, eye exams, therapies (physical, speech, hearing), drug and alcohol abuse treatment, and many more. Eligibility: 1. Must be U.S. citizens or qualified residents living in Delaware. 2. Must be under the age of 19. 3. Must not have a comprehensive health insurance. 4. Must not be dependents of a State of Delaware employee. 5. Must meet income eligibility requirements.
Delaware Screening for Life
800-464-4357
Screening for Life is a specialized program providing coverage for cancer screening tests to adult Delaware residents. This program’s benefits include: mammograms and clinical breast exams, Pap tests, colorectal cancer screening test, prostate cancer screening test, and more. Eligibility: 1. Must be residents of Delaware. 2. Must be 18 to 64 years old. 3. Must be uninsured or underinsured. 4. Must not be eligible for Medicaid or Medicare. 5. Must meet income requirements.
Delaware Cancer Treatment
Delaware Cancer Treatment program offers residents of the state free cancer treatment for up to two years. Eligibility: 1. Must be a resident of Delaware. 2. Must be diagnosed with cancer on or after July 1, 2004. 3. Must not have a comprehensive health insurance plan. 4. Must not go above the 650% Federal Poverty Level.
Medicare
800-633-4227
This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.
Health Coverage tax Credit
866-628-4282
Health Coverage Tax Credit covers up to 80% of premiums for qualified trade-impacted workers or TAA recipients. This is a federal tax credit created by Congress through the Trade Act of 2002 which aims to make health coverage more affordable and accessible for those who may not afford it. Benefits for HCTC plans include doctor visits, prescription drugs, inpatient and outpatient care, preventive care, medical care, mental health, and substance abuse care. Eligibility: 1. Must be 55 years or older and receiving pension from Pension Benefit Guaranty Corporation; or receiving Trade Adjustment Assitance. 2. Must have a qualified health insurance plan and must be paying for more than 50% of the premiums. 3. Must NOT be in prison, be listed as a dependent in tax returns, belong to certain state plans, be a recipient of 65% COBRA subsidy.