Key Takeaways
- Delaware requires a 10-day free look period for individual health insurance policies
- Delaware Department of Insurance (DOI) regulates health insurance including HMOs
- Delaware uses Healthcare.gov as its health insurance marketplace
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Delaware expanded Medicaid under the ACA
Last updated: January 2026
Delaware Health Insurance Policy Requirements
Delaware regulates health insurance through state law and federal ACA requirements.
Regulatory Structure
Delaware health coverage is regulated by the Department of Insurance:
| Agency | Regulates |
|---|---|
| Delaware DOI | All health insurance, HMOs, PPOs |
| Division of Medicaid | Medicaid, Diamond State Health Plan |
| Healthcare.gov | Federal marketplace for individual plans |
Free Look Period
Delaware provides a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual health policies
Healthcare.gov Marketplace
Delaware uses Healthcare.gov, the federal health insurance marketplace:
- Federal enrollment platform
- Only place to get premium subsidies in Delaware
- Open enrollment: November 1 - January 15
- Special enrollment periods for qualifying life events
- Premium tax credits available based on income
- Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
Marketplace Features
- All plans cover essential health benefits
- No annual or lifetime limits on essential benefits
- Preventive care covered with no cost sharing
- Cost-sharing reductions available for Silver plans
ACA Compliance in Delaware
Delaware's health insurance market operates under federal Affordable Care Act (ACA) requirements:
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual (ACA) | Prohibited |
| Small Group (ACA) | Prohibited |
| Large Group | Federal rules apply |
Delaware Medicaid Expansion
Delaware expanded Medicaid under the ACA:
- Available to adults with income up to 138% FPL
- Known as Diamond State Health Plan
- Covers comprehensive health services
- Managed care delivery system
Mental Health Parity
Delaware follows federal mental health parity requirements:
- Mental health benefits must be equal to medical benefits
- Same copays, deductibles, and limits
- Covers mental illness and substance use disorders
Test Your Knowledge
What health insurance marketplace does Delaware use?
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Test Your Knowledge
What is the free look period for individual health insurance policies in Delaware?
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Test Your Knowledge
Do ACA requirements apply in Delaware?
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