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Delaware Health Insurance

Medical Insurance Overview
All of Delaware’s residents will be able to have all of their health insurance needs met through many different programs and plans, whether that plan be individual, group, or state-sponsored.  The overall health of the residents of the state is considered to be somewhat low, and there is still room for improvement, despite the fact that Delaware itself has recently improved in terms of factors including air quality.

The percentage of Delaware’s population that benefit from healthcare benefits is actually quite high when compared to individuals who are insured across the entire country.  Regardless, many residents still don’t have insurance; however, new provisions located in the Patient Protection and Affordable Care Act are sure to change that.  It’s estimated that this kind of health care reform will benefit approximately 30 million Americans over the next few years, which means that many Delaware residents will have great opportunities that they can take advantage of.

Health Care Issues
According to the United Health Foundation, Delaware is currently ranked in 31st place when it comes to overall health as opposed to the remaining 49 states.  The state also rates poorly in a few different areas, even though recent improvements have been made to factors in the general health status.  There is hope that the state will continue to build upon those improvements since less amounts of the population lacks health coverage.

Understanding the Uninsured Population
According to the Henry J. Kaiser Family Foundation, approximately 11 percent of the population of Delaware currently does not have health insurance, which is five points lower than the total of uninsured individuals in the entire country.  However, it is still a large enough portion to cause a great deal of concern.  A little over half of all of the firms located in Delaware offer some kind of health insurance to all of their employees, with larger companies offering more benefits than smaller ones.  Individuals who do not have this option must settle for going with either an individual plan or a state-sponsored plan.

Here are some statistics that further detail the uninsured population of the state of Delaware:

  • 9 percent of low-income children in the state lack health insurance.
  • 4 percent of residents who earn over 400 percent of the federal poverty level never seek health insurance and, despite their high incomes, remain uninsured.
  • 35.8 percent of the state’s smaller businesses offer insurance to employees, while 96.7 percent of businesses with 50 or more employees offer more insurance.  Uninsured residents likely work for smaller businesses.

Group Health Plans
The best way to get any kind of health insurance is through your employer, and this can be done by speaking to your human resources representative regarding what specific plans are available for you to choose from.  Some of these plans are completely covered, though these usually vary depending on the specific plan.  This is a decision that must be considered as carefully and thoroughly as possible, and all private insurance providers are regulated through Delaware’s Department of Insurance.

Signing Up
Chances are you will likely have to wait for some sort of an enrollment period to begin at your place of employment before you can sign up for any kind of health insurance plan.  There are many different businesses that have specific periods before which employees can be added to their group insurance plans, and you will need to consult with your human resources representative in order to determine when that period will take place.  There are also a couple of important factors to consider which include the following:

  • What are your specific health care needs?
  • Who all are you responsible for?

Pre-Existing Condition Exclusion Periods
In the event that you have a pre-existing condition of any kind, you will likely have to wait approximately 12 months before your insurance policy will be able to go into effect.  New HIPAA regulations, however, forbid an insurer from imposing any new exclusion period on new members who are under the age of 19.  If you are using your plan to provide insurance to a younger dependent, you won’t have to worry that your dependent will have to wait through any kind of an exclusion period.

Waiting/Affiliation Periods
This is defined as the amount of time that you are required to wait once you begin the enrollment process before your health insurance plan takes effect.

Individual Health Plans
Even though it can be difficult to obtain sufficient health coverage, it’s said that healthy 20-year-old Delaware residents will be able to sign up for a monthly health insurance plan and pay premiums that cost less than $60 per month.  On the other hand, the coverage that they would be able to get would be rather limited and would also have a rather high deductible.  However, if you are someone who is self-employed, unemployed, or unable to otherwise obtain insurance by other means, you will likely be left with no other alternative.

Continuation Coverage
If you lack health coverage due to aspects such as a change of employment, you will likely be able to take advantage of services such as COBRA in order to obtain temporary insurance coverage benefits, which typically last for up to 18 months.  Eligibility generally depends on the size of the firm that sponsored the previously-applicable health insurance plan.

Health Benefit Exchange
This is a joint partnership between Delaware’s state government and the United States federal government.  The state’s responsibility will include consumer assistance and plan management, while the federal government will be responsible for everything else.  All responsibilities for developing this entity will be handled by the state’s Health Care Commission, which has existed since 1990 and is part of the Department of Health and Social Services.  The Exchange consists of ten individuals, all of whom represent the public and private sectors of health care, as well as the executive and legislative branches of the government.

State Insurance Programs
These programs cover approximately 32 percent of the entire state’s population, and there are many different ones to choose from for individuals who cannot get coverage through either an individual or group plan. These plans include the following:

Pre-Existing Condition Insurance Plan (PCIP)
This plan is designed for individuals who may have been denied coverage due to a pre-existing condition.  In order to be eligible, you must have been without health insurance for approximately six months.  Benefits for this program include hospital care, primary/specialty care, and prescription drugs.

This program assists low-income individuals and families with obtaining health benefits.  Eligibility is determined by your overall income.  Benefits for this program include prescription drugs, doctor visits, hospital care, and more.

Children & Families First
This program is aimed at providing medical assistance to parents of all types, including foster parents.  It offers training, counseling, therapy, and more to those who qualify.

Healthy Children Program
Participants may be required to undergo a waiting period before this program’s benefits take effect.  Furthermore, kids under the age of 19 who are from families at an income level of 200 percent or below the national poverty level, will be guaranteed coverage.  Benefits of this program include immunizations, checkups, prescription drugs, hospital care, physician services, and more.

Screening for Life
This program provides coverage to men and women who are ineligible for both Medicaid and Medicare, as well as who earn between 100%-250% of the federal poverty level. Benefits offered vary between gender.

Medicare/Medicare Prescription Drug Program/ELDER
These programs are available to seniors aged 65 or older and who (or their spouse) have worked at a job that has been covered by Medicare for the last ten years.  They are also guaranteed coverage if they are suffering from end-stage renal disease or any other kind of disability.

VA Medical Benefits Package
This program is designed to service veterans who have served for 24 consecutive months or have completed their entire service.  Comprehensive coverage will be provided as long as the participant has not been dishonorably discharged from service.

Partnership for Prescription Assistance
This program assists individuals with finding and paying for all of the necessary prescription drugs that they need.  In all, there are a total of 475 different programs that offer this kind of assistance.

Women-Infants-Children (WIC)
This is a program that is both implemented and managed by the USDA Food and Nutrition Service that, as the name suggests, benefits lower-income women, infants, and children by providing assistance with aspects such as nutritional assistance and even immunizations.

Family Planning
This program is provided by the state’s Health and Social Services and offers residents reproductive and family planning health services, such as birth control, physical exams, STD testing, and more.

Child Development Watch
This is another program offered by Health and Social Services that is designed to facilitate growth and development in younger-aged children who may be exhibiting either developmental delays and/or early disabilities from birth to age three.

National Association of Mental Illness (NAMI)
This is a program designed to assist those who may be suffering from any kind of a mental illness and wish for assistance in coping with their condition.  Volunteers assist these individuals by providing them with resources on how they can receive available treatments.

HIPAA/Conversion Health Plans
In you are looking for a decent health insurance plan, you should make yourself aware of HIPAA, or the Health Insurance Portability and Accountability Act, as well as how it can affect your chances at obtaining coverage.  Many benefits have been made available to those without health insurance thanks to HIPAA’s ability to reduce the chances of an insurer rejecting a potential enrollee thanks to a pre-existing condition that they may have.  This doesn’t mean that employers are still required to provide their workers with medical coverage, nor does HIPAA exercise strict requirements with individual plans as it does with group ones.  There is also the issue of both self-employed and unemployed individuals not being able to take full advantage of HIPAA improvements regarding group health plans.

HIPAA also offers continuation coverage to individuals that have lost coverage through their employer for any reason.  Furthermore, those who have exhausted their 18-month COBRA coverage can potentially obtain additional coverage through HIPAA, though the total cost will vary depending on the plan that you choose.