What The Affordable Care Act Means For Delawareans

In 2007, nearly 10 percent of adults in Delaware reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, Delaware families saw their insurance premiums increase by 21 percent to an average annual cost of $12,682. Individual policyholders saw a rate increase of 29 percent over the same period. [1] Of the Delaware residents who do have health insurance, 53 percent are insured through employment, four percent purchase individual policies, and 32 percent are covered through public programs such as Medicaid and Medicare. This leaves 11 percent of the Delaware population, approximately 96,000 people, lacking health insurance. [2]

Who are the uninsured in Delaware?

Children, ages 18 and younger, are uninsured at a rate of six percent in the state. This figure rises to eight percent among children in households with incomes less than 139 percent of the Federal Poverty Level. Non-elderly adults, those ages 19 to 64, at this income level, are uninsured at a rate of 29 percent. Nearly one-third of the non-elderly Hispanic population in Delaware lack health insurance. Among the non-elderly White population, 10 percent are uninsured, and 9 percent of the non-elderly Black population in Delaware has no health insurance. [3]

How does the Affordable Care Act affect Delaware residents?

The Affordable Care Act (ACA) requires states to offer its citizens access to a health insurance marketplace where they can shop for and enroll in quality health plans. States have the options of creating their own exchanges, turning operation of an exchange over to the federal government or running an exchange in cooperation with the federal government. In November 2012, Governor Jack Markell informed the Department of Health and Human Services (HHS) that Delaware plans to implement the Partnership model for its exchange.

Under the ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles. Insurers may not place a lifetime cap on benefits and residents may not be denied health insurance for pre-existing health conditions. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

Delaware Health Insurance Exchange

In December 2012, HHS approved Delaware’s plan to establish a state-federal partnership exchange. Under this model, Delaware will regulate insurers and perform educational outreach functions. The federal government will operate the exchange website and call center. [4]

Policies offered in the Delaware exchange, which is called Choose Health Delaware, are based on the Blue Cross/Blue Shield of Delaware Simply Blue EPO health plan.

In September 2013, the Delaware Department of Insurance announced that Coventry Health Care, Coventry Health and Life, and Highmark Blue Cross/Blue Shield of Delaware will offer a total of 19 different plans for individuals on the exchange. Monthly average rates for individual medical policies range from $148 to $330. Additionally, stand-alone dental policies will be offered by Delta Dental, Dentegra Insurance Company and Dominion Dental Services.

Delaware residents who are U.S. citizens that are not offered affordable health insurance through their employment are eligible to enroll in a Choose Health Delaware plan. Tax credits and subsidies are available for households with incomes up to 400 percent of the Federal Poverty Level. Consumers must purchase a plan through the state exchange to access these subsidies.

Delaware is expanding its Medicaid program to include households with incomes up to 138 percent of the Federal Policy Level. To check for eligibility or apply for Medicaid, access the Delaware Assist website.

Open enrollment opened October 1 for policies that take effect January 1, 2014. Delaware residents seeking health insurance can compare plans and determine their eligibility for tax credits by accessing the Choose Health Delaware website.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Delaware small business owners may access SHOP through HealthCare.gov.

External resources for Delaware residents



[1] http://www.commonwealthfund.org/Publications/Issue-Briefs/2010/Dec/State-Trends-Premiums-and-Deductibles.aspx
[2] http://kff.org/other/state-indicator/total-population/?state=DE
[3] http://kff.org/state-category/health-coverage-uninsured/?state=DE
[4] http://www.healthinsurance.org/delaware-state-health-insurance-exchange/

Gillian Burdett is a freelance writer in New York. Her writing focuses on education, public policy and family issues. Her work can be found here.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.

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