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Health Care Reform:

Health Insurance & Affordable Care Act

Choose Health Delaware

Plans and Costs

What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Delaware, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital. Home health visits are limited to 100 per calendar year. One adult routine eye exam is covered every two years.
  2. Emergency services, including transportation to the ER
  3. Hospital stays, including weight loss surgery if considered medically necessary. Also includes hospice services up to 240 days a year.
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment. Inpatient substance abuse services covered without limits.
  6. Prescription drugs, including generic and all brand-name drugs
  7. Rehab and habilitative services, including those that help people recover from an accident or injury and those that help people with developmental issues. Diagnosis and treatment of autism is included. Cognitive, physical, and speech outpatient rehab is limited to 30 days.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care

Some services not included: infertility, cosmetic surgery, weight loss programs, long-term care, and outpatient private duty nursing.

Health Insurance Advisor: Check out WebMD's Health Insurance Advisor to compare different kinds of plans based on your needs. 

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what's available:

Premium Subsidies (also known as Tax Credits): Find out if you qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you’ll be eligible if you’re single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.

You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost-sharing subsidies are available only if you buy a silver-level plan.

Medicaid Expansion: Some states expanded their Medicaid program so more people can get health insurance coverage. Because Delaware is one of them, you may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,500 for a family of four. 

CHIP: The Children’s Health Insurance Program, called the Delaware Healthy Children Program in Delaware, provides coverage for children of some families who have a low income but are not eligible for Medicaid.  

Check with Choose Health Delaware to see if you are eligible for these programs.

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