The First State is one of the smallest in the country, and many times no one remembers it (unless you live there). A memorable mention in the movie Wayne’s World (“Hi, I’m in Delaware.”) is a testament to the vast amount of rural area that takes up most of the tiny state. Many banks and the DuPont company operate out of Wilmington, and an annual car race takes place in the capital, Dover. Delaware also contains a few beaches in its southern region, which during the summer, brings in the highest population the state sees all year.

Residents of Delaware have access to several reliable health insurance companies, including Aetna, Celtic, Coventry, and UnitedHealthOne. To get a quote, enter your zip code below and compare plans, or call one of East Coast Health Insurance’s licensed agents for assistance at 888 803 5917.

 

 

Health Status

Delaware residents could use some improvement when it comes to overall health according to the UnitedHealth Foundation rankings, which showed many statistics that make Delaware unhealthy. Though it ranked 30 in the nation, it did increase by two spots from one year ago. Areas of concern include obesity, which is growing around the U.S., but has increased to 199,000 adults in Delaware. This is 101,000 more than a decade ago, and given the total population being very small, this is a significant number. A related statistic includes the prevalence of diabetes, increasing by over 50% in the past ten years.

Another issue for Delawareans is excessive alcohol consumption and a high rate of violent crime. There are a few positives, as there are reasons why Delaware moved up a few places in the rankings this past year. One of the better attributes of Delaware is the use of health care, as only 12% of the population is uninsured. There is also a low rate of infectious disease within the state, and public health funding is moderate. If the residents of Delaware take initiative, locate some healthy food and find a regular physical activity to do, the health status may continue to improve. Also, the use of health care is still very important and can benefit everyone, no matter their age or medical background.

 

Health Insurance Plans

 

Aetna

  • PPO plans from Aetna in Delaware are available in PPO and Value PPO types, both of which connect you to the Aetna preferred network or give you the option of seeing out-of-network providers as well. These plans have a copay for doctor’s office visits to primary care and specialists for non-preventive care, in addition to other services like prescription drugs and emergency room care, as soon as your plan starts. After you have reached the deductible amount, you can choose to receive care from an in-network provider for 20% coinsurance. Services covered with PPO plans include outpatient surgery, hospitalization, lab and X-ray and chiropractic. Some of these plans come with the option of unlimited primary care visits and dental coverage.
  • PPO High Deductible plans are qualified for use with a health savings account (HSA), which helps you manage your medical spending. These plans have deductibles of $3,500 or $5,000 to choose from, and cover either 90% or 100% of your health care costs once you meet the deductible. After deductible, primary care and specialist office visits, emergency care, surgery, lab and X-ray, inpatient hospital care and more services are covered by your plan. At any time before meeting the deductible, you can receive preventive care services from an in-network provider for no charge. Prescription drugs are also covered by your plan, for either 10% coinsurance or no cost after deductible.
  • Preventive & Hospital Care plans cover a basic set of benefits, with preventive care available before you meet the deductible, and major medical services covered after you have met the deductible. Once the deductible is met, the plan covers 80% of hospital services such as outpatient surgery, inpatient hospital stays and emergency room visits. Preventive care includes immunizations, routine physicals, well child care, mammograms and more, which is covered at 100% in-network. These plans do not cover office visits, prescription drugs, diagnostic lab and X-ray, or maternity, but you do have the option of using non-network providers.

 

Celtic

  • Celtic Basic PPO plans are available in two types of coinsurance coverage, 70% or 80%, and have a variety of deductibles to choose from. Immediately when your plan starts, you have access to preventive care with in-network providers at no cost. Also as soon as your plan starts, you can see a primary care physician or specialist for a $30 copay for non-preventive services such as injury or illness. Generic prescription drugs are also available for a copay, and brand names cost a percentage of coinsurance. There is an additional deductible when using hospital services such as surgery or inpatient hospitalization, and you are responsible for 20 or 30% coinsurance after the deductible.
  • CeltiCare Preferred Select PPO plans have 80/20 coinsurance coverage after meeting the deductible, and give members access to a variety of services before meeting the deductible. The first two doctor’s office visits to a specialist or non-specialist are a $15 copay, and prescription drugs are available for a copay, which varies based on generic, brand name or non-formulary. You also have the option of using a retail pharmacy or the home delivery pharmacy service. Preventive care is available as soon as your plan begins, covered at 100% with in-network providers. After deductible, you can receive services such as outpatient lab and X-ray, surgery and inpatient hospital care for 20% coinsurance.
  • CelticSaver HSA PPO plans are high deductible health plans with the ability to be paired with a health savings account for use with medical expenses. These plans have the option of 80/20 coverage or 100% coverage after satisfying the deductible. After you have met your deductible, CelticSaver HSA PPO plans cover in-network services such as doctor’s office visits, prescription drugs, lab work and X-ray, inpatient hospital care, outpatient surgery, mental health and chiropractic services. In-network preventive care is covered at 100% as soon as your plan starts, including periodic health exams, well baby care and vaccinations. Plan members can use funds from an HSA to pay for cost sharing, or save it for the future and receive tax advantages either way.

 

CoventryOne

  • 80%/60% PPO plans come in a range of deductibles, from $1,000 to $5,000 for individuals, and $3,000 to $15,000 for families in Delaware. Once you meet the deductible, your plan covers 80% of qualified in-network expenses and 60% of out-of-network expenses for various inpatient and outpatient hospital services and medical supplies. From the start date of your plan, you can receive care from a primary care physician or specialist for a set copay (varies with deductible choice) as well as prescription drugs for a copay. Preventive care is also available immediately for no cost when you use an in-network provider. There is also a Tier One Only plan option for prescription drugs, which saves money by using only generics.

 

UnitedHealthOne

  • Copay plans offer simplicity and ease of use for individuals who want to pay a predictable rate for health care services. These plans work similarly to an employer-sponsored plan, but you have the option of using providers in or out of the UnitedHealthOne network. At any time before meeting the deductible, Copay plan members can receive preventive care such as yearly health exams, vaccinations, well-child care and other preventive testing for no charge. Prescription drugs are available for a rate of $15 for generics, and $30-40 for brand names through Copay 100 and 80 plans. When the deductible is met, you can receive hospital care or physician services for 20% coinsurance or no cost, depending which plan you choose.
  • High Deductible plans are available in three types, including Plan 80, Saver 80 and Plan 100, which means you can either have your plan cover 80 or 100% of your health care costs after deductible. Plan 100 is the most comprehensive coverage option, with more services available for no cost after you meet your deductible in exchange for higher premiums. Plan 100 and Plan 80 cover physician and specialist visits and prescriptions drugs, while the Saver plan does not, due to its low premiums. High deductible plans all cover preventive care at 100% before deductible.
  • Health Savings Account plans come with 100% in-network coverage on most major medical services after having met your deductible, and the ability to pair your plan with an HSA. Money from your HSA can be used to pay for specified medical costs, including your deductible, coinsurance and other cost-sharing. Premiums are lower due to the high deductible, and preventive care is available for no charge from the start date of your plan. Most medical services are covered, including inpatient and outpatient hospital care, emergency room visits, home health care and more.

 

 

Public Health Options

Delaware residents who have a low income and cannot afford health insurance have access to several state-administered programs. These programs, such as Medicaid, are available to people in Delaware who have children, are pregnant, elderly, blind or disabled or have a costly medical condition. There are also state funded programs for disease prevention and health promotion that provide services such as immunizations and nutritional assistance. For a full list of programs, visit the Delaware Health and Social Services Public Health page. Below is a list of important public health alternatives to health insurance and other programs in Delaware:

  • Medicaid: health care coverage for low-income families and other eligible individuals such as aged, blind and disabled persons and pregnant women.
  • Delaware Healthy Children Program: affordable medical coverage for uninsured child residents of Delaware.
  • Delaware Prescription Assistance Program: assistance for elderly and/or disabled individuals with paying for prescriptions when they cannot afford the full cost.
  • Chronic Renal Disease Program: assistance for Delaware residents with End Stage Renal Disease (ESRD) on medication costs, nutritional supplements, and transportation.
  • Women, Infants and Children (WIC): nutritional assistance for low-income pregnant women and new mothers to maintain a healthy diet for themselves and their children.

 

Health Insurance Laws

Regulations on health insurance are changing throughout the country as a result of health care reform, though some laws have not yet taken effect. Some of the most important laws have to do with the treatment of individuals with pre-existing conditions in regards to health insurance. In Delaware, insurance companies qualify pre-existing conditions by the prudent person standard. This definition opens up a pre-existing condition to any health concern an individual has received care for, or could have but did not receive care for prior to enrollment. Once a Delaware insurer has decided someone has a pre-existing condition, they have the right to turn them down for coverage or sell them a plan for a higher monthly rate than normal.

If a health insurance company in Delaware accepts an individual with a pre-existing condition for a plan, they are legally allowed to issue an exclusion period or elimination rider. Exclusion periods make it possible for the insurer to provide you coverage on all other services except for care related to the pre-existing condition. In Delaware, there is no limit on exclusion periods, so the insurance company can make it anywhere from six months to 10 years. They can also give you an elimination rider, which acts as a permanent exclusion period. This will all change in 2014, when the Affordable Care Act has designated health insurance approval for all adults regardless of health status.

According to the ACA, adults with pre-existing conditions and those who are considered high-risk must be accepted by any insurer, including state health exchanges as of January 1, 2014. This means that elimination riders and exclusion periods will no longer be allowed, and all rates charged must be fair so that no one shies away from buying a plan. In the meantime, there is the Pre-Existing Condition Insurance Plan. PCIPs provide persons with pre-existing conditions with health insurance coverage for an affordable rate. These plans will expire at the end of 2013, and those who are on a PCIP plan will have to switch to a private insurance plan.

An important law that affects those who have insurance in Delaware is guaranteed renewability. This provision ensures that individuals with insurance keep their benefits once they have purchased a plan. If a policy-holder has not violated their plan in any way and is paying their premiums, they have the right to stay insured, even if they become ill after their plan starts. Under this law, insurance companies must ask the policy-holder if they wish to renew the same plan at the end of a term. Guaranteed renewability is part of the HIPAA law, which protects many rights of the insured individual.