As health care reform moves forward under the provisions of the 2010 Patient Protection and Affordable Care Act, many aspects of state regulations will change over the next two years. Children already enjoy protection against insurance exclusions and denials for pre-existing conditions, and adults will gain the same safety net in 2014. Additionally, children may remain on their parents health coverage until age 26 even if they are not currently enrolled in school, or if they have married. These and other federal mandates will affect state insurance regulations in coming months.
Basic Insurance Regulations
Currently, insurance companies in Delaware can review an applicant’s medical history going back five years to determine the presence of a pre-existing condition and then either deny coverage or insist a rider be attached to the health policy eliminating benefits for the specific condition.
Eligible employees cannot be denied group coverage in Delaware, but there is frequently a waiting period before job-related benefits become available. It’s especially important when changing jobs to have a temporary policy in place. Currently, an insurer can refuse coverage for a pre-existing condition if there is a lapse of more than 63 days in insurance coverage.
Currently, insurance companies in Delaware can review an applicant’s medical history going back five years to determine the presence of a pre-existing condition and then either deny coverage or insist a rider be attached to the health policy eliminating benefits for the specific condition.
Federally Mandated Health Care Exchanges
Currently Delaware is studying options for the implementation of the health care exchange required under the Affordable Care Act. Although federal monies have been received and are in use to plan the necessary business and information technology to manage an exchange, no further progress has been made to date.
Pre-Existing Condition Insurance
The high-risk pool, or Pre-Existing Condition Insurance Plan, that will be in place in Delaware until January 1, 2014 is administered by the U.S. Department of Health and Human Services. The coverage will provide benefits for hospital stays, prescription drugs, and primary and specialty care among other services. By age and option class, premiums range from $109 to $219 with deductibles falling in the range of $1000 to $3000. There may be separate drug deductibles, and out-of-pocket limits go as high as $7000 if you are treated outside the network.
Medicaid Eligibility
Medicaid eligibility is determined as a percentage of the Federal Poverty Level as are benefits under the CHIP-funded Medicaid Expansions. Infants under 1 year of age may qualify for Medicaid Assistance at 185% FLP and 200% for CHIP. Under age 5, the level is 133%, and from age 6 to 19, 100%. (CHIP assistance is not applicable to those two groups.)
Pregnant women can qualify for Medicaid at 200% FPL; adults at 100%; and the non-elderly disabled on Social Security at 133%.
Medicare
In addition to standard federal Medicare benefits, there are 45 Medicare Prescription Drug Plans available in Delaware.