Going without health insurance coverage can be a very scary thing. But that doesn’t have to be your reality if you live in Delaware. Thanks to the passage of things like the Affordable Care Act and other recent legislative changes, finding affordable health care coverage is easier than ever before. But even if you don’t qualify for a plan through the Exchange, there are other relatively affordable options you can pursue. This article is going to take a look at them now so that you can get more information and make a well-informed decision.
Major Medical Insurance in Delaware
For people who can’t get an affordable or comprehensive health plan through their employer, a major medical plan through the federal Exchange is usually the most affordable and the most attractive option. The Health Insurance Marketplace (the Exchange) was established thanks to the passage of the Affordable Care Act in 2010. This act helped establish the Exchange where healthcare providers and potential customers can more easily connect. Applying for coverage through the Exchange can help people who don’t make enough money to afford coverage on their own qualify for generous subsidies. It also helps establish certain guarantees and protections so that people can get the most out of their healthcare.
In Delaware, the annual Open Enrollment period for ACA coverage begins on November 1st and was extended from December 15th to December 18th during 2019 enrollment for 2020 health plans. Most people fill out an application for coverage through HealthCare.gov, but Delaware residents may want to start by visiting the Choose Health Delaware website and learning more information about specific discounts and financial help programs which are unique to your state.
Why should you choose a major medical policy offered through the federal Exchange? Because these policies offer you coverage that no other health insurance option can right now: a guaranteed issue policy with the 10 guaranteed Essential Health Benefits established by the ACA legislation. With guaranteed issue policies, your health insurance company cannot deny you coverage based on things like your gender or your pre-existing conditions. In fact, by law, they can’t deny you coverage at all if you apply for it. And the only factors which can make your premiums more expensive are the following:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Furthermore, the benefits these policies offer must include the Essential Health Benefits promised according to the ACA. Experts have determined these benefits are necessary to keep the population optimally healthy, lower medical expenses over the long-term, and provide the highest quality of life:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Back in 2014, Delaware expanded financial assistance for individuals and families making between 100% And 138% of the federal poverty level. The chart below shows where you might fall along that threshold based on household size. If you make between 138% and 400% of the federal poverty limit, then you will likely qualify for a subsidy through the federal Exchange. If you make less than 138% of the federal poverty level, you can apply for Medicaid or other medical care assistance through the ASSIST website. Just keep in mind that qualifying for Medicaid is usually based on more than just income, and not everyone who is below a certain poverty threshold will be able to enroll.
|Household Size||Annual Income (138% of FPL)||Annual Income (100% of FPL)|
Short Term Health Insurance in Delaware
Thanks to the Medicaid expansion, most Delaware residents will qualify for some sort of subsidized, low-cost major medical plan through HealthCare.gov and the Health Insurance Marketplace. But if you still don’t qualify for a subsidy, or if you don’t want a major medical plan, you might want to take a look at short-term health insurance.
Many consumers will be pleased to know that short-term health insurance premiums may cost as much as 33% less compared to an unsubsidized major medical Marketplace plan. Some companies even offer to sell you coverage which is similar to the Essential Health Benefits promised from the Exchange. You can also add extras like vision, dental, or indemnity insurance to supplement your care. The only paper trail you leave is whatever the short-term health insurance company asks of you; there’s no need to fill out an application through HealthCare.gov. Out of all of the health insurance options you have outside of major medical, short-term health insurance has the most consumer protection laws on the books. So if you get into a dispute with your short-term health insurance provider about a claim, there’s a good chance you may be able to take them to court and get the dispute settled in your favor.
So that’s the good news about short-term health insurance. But short-term health insurance isn’t perfect. For starters, there’s no such thing as guaranteed issue with short-term health insurance. So if you apply for coverage, your insurance provider can deny you coverage flat out, or they can charge you more in monthly premiums if the medical underwriting process deems you a risky investment. Furthermore, they don’t have to sell you coverage that they don’t want to pay for, unlike major medical plans which promise the Essential Health and Wellness Benefits that the ACA legislation mandates. Lastly, the rules surrounding short term plans in Delaware are a little different compared to other states. Most providers are only able to issue you a plan for three months at a time, and aren’t legally allowed to sell you back-to-back plans. So if you’re in a situation where you are without a major medical plan for longer than three months, finding continuous coverage could involve a lot of complicated shopping around and juggling of different policies from different providers.
Short-term health insurance tends to be the most affordable for people who want to have some type of insurance coverage just in case, but are otherwise relatively healthy and don’t need that much medical care. But what happens if you do end up needing medical care under short-term health insurance? The vast majority of these policies start with a deductible of around $5,000 or so. This means that the first $5,000 of medical care you need in any given plan period will be 100% out-of-pocket – once you exceed that limit, then your short-term health insurance provider will start helping you cover your medical costs.
Christian Health Plans/Health-Sharing Plans in Delaware
When the original ACA legislation passed into law, it came with something called the individual mandate. This individual mandate made it so that anyone who failed to either purchase health insurance through the Marketplace or find a qualifying health plan from somewhere else had to pay an annual tax penalty. But that law was abolished a few years ago. Now, only two states and Washington DC still carry an individual mandate for residents. Delaware it’s not one of those states, so you do technically have the option of going without coverage if you wish; however, that is a very expensive gamble that most people are afraid to take (and for good reason).
Christian health plans became very popular during the years of the individual mandate because their religious status gave people who purchased these plans an exemption from the individual mandate. Despite this exemption, these plans are very different from major medical insurance offered by the Exchange or employer health plans. As a matter of fact, they work more like short-term health insurance, and have the following in common with such policies:
- No guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
Yet at the same time, Christian health plans are still very different from short-term health insurance. For starters, there are fewer consumer protections because there is no official, legally binding contract between your Christian health plan provider and you. If you ever run into a dispute over a claim, you likely won’t be able to take them to court and get it settled legally. Furthermore, unlike short-term health insurance, most Christian health plans impose “participation guidelines” for you to follow. These guidelines include things like declaring a specific faith, abstaining from unhealthy habits such as tobacco use or alcohol, and potentially adopting other biblical life habits which may make you healthier (and therefore less costly to insure). Finally, the language is a little bit different with a Christian health plan. You don’t pay a monthly premium for your benefits; you pay a monthly share amount. You also may be required to pay a “personal responsibility amount” or an “unshared amount” out-of-pocket which takes the place of deductibles, coinsurance, and co-pays that you would find in other types of health coverage.
Fixed Indemnity Plans in Delaware
If you’ve ever seen a commercial for something like Aflac, then you might have a basic idea of what fixed indemnity insurance it is. But in case those advertisements weren’t clear, fixed indemnity plans are supplemental insurance products which helped cut the cost of (mostly hospital) bills by paying out a fixed amount of money for specific types of care. Usually these payouts are based on something like a per day, per week, or per month basis; other times the payouts come per visit or per event. The payout you receive usually doesn’t cover all of your expenses; but depending on the plan you purchase and the care you receive, it may come close, or it may at least help to take the edge off the total financial burden.
Fixed indemnity plans have similar limitations to the other insurance options we’ve discussed so far. They usually come with lifetime and annual benefit caps, much like short-term health insurance or Christian health plans. There’s also a lack of guaranteed issue because there is medical underwriting involved. Yet these are still very popular plans and are often purchased right alongside a major medical policy, especially by people whose health status is such that they know they can benefit financially from the extra coverage.
Discount Cards in Delaware
Medical discount cards, sometimes also referred to as pharmacy discount cards or prescription discount cards, are a type of discount program sold alongside major medical coverage. It is completely optional, and only offered by private companies; organizations like AARP or AAA operate off of a similar business model. You agree to pay a membership fee, you receive a card in the mail, and you present that card at participating eye doctors, dentists, pharmacies, and even some medical facilities for a discount off your total bill. Depending on how much the membership fee is and how often you get care, these discount cards could be very helpful at saving you money off your out-of-pocket costs.
But always remember: medical discount cards are not major medical insurance, nor are they an adequate substitute for full coverage. They can help the coverage you purchase cost less, and they can help take some of the sting off of your medical bills if you don’t have coverage and you’re paying 100% out-of-pocket. Unfortunately, it’s not uncommon to run across medical discount card programs which make lofty claims and don’t deliver on their promises, essentially costing more money in fees than they’re worth in discounts and savings that you receive. If you think you have been scammed by a medical discount card company, or if you come across an offer that seems too good to be true, it might be a good idea to contact the Delaware Department of Insurance Fraud or the Delaware Better Business Bureau to get information and help dealing with the situation.