Haris Ashley
Medicaid is a federal program that provides health coverage for eligible individuals with income below the state-specified threshold. In Delaware, residents may qualify for Medicaid if their household income is at or below 100% of the current Federal Poverty Level (FPL) for their household size. Delaware's Medicaid state plan is an agreement between the state and the federal government that describes how the state administers its Medicaid program. Several insurance companies service Medicaid in Delaware, including AmeriHealth Caritas, Highmark Health Options, and Ambetter. These companies offer various plans and benefits to eligible individuals, such as prescription and dental coverage, and additional services like Value Added Benefits (VAB) that provide extra benefits beyond regular Medicaid coverage.
| Characteristics | Values |
|---|---|
| Insurance Companies Servicing Medicaid in DE | AmeriHealth Caritas, Highmark Health Options, Ambetter |
| Medicaid Eligibility | Household income at or below 100% of the Federal Poverty Level (FPL) for household size; elderly adults, pregnant women, children and those with disabilities may also qualify |
| Medicaid Coverage | Medical services, prescription and dental coverage |
| Additional Benefits | Value Added Benefits (VAB) such as access to health care information, claims, new ID cards, etc. |
| Medicaid State Plan | Agreement between Delaware and federal government outlining administration of Medicaid program, including groups covered, services provided, provider reimbursement, and administrative activities |
| Delaware Healthy Children Program (CHIP) | Partnership between federal and state governments providing low-cost health coverage to children in families that earn too much to qualify for Medicaid |
| Customer Relations Contact | (866) 843-7212 |
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What You'll Learn
Highmark Health Options Duals (HMO SNP)
Highmark Health Options Duals provides a large provider network, care management, and comprehensive prescription coverage. The plan offers the same benefits as Original Medicare, plus additional benefits like prescription drug coverage, vision care, and dental care. Dental services provided by United Concordia include routine preventive and periodontal maintenance, full mouth debridement, and denture coverage. Members are responsible for all costs above the allowance amounts.
The Highmark Health Options Duals plan also offers a 24-hour nurse line, where members can receive coaching and advice from healthcare experts. The plan covers individuals in Delaware, New York, Pennsylvania, and West Virginia.
Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, and enrollment in these plans depends on contract renewal. Those interested in enrolling can contact the provided phone numbers for assistance in determining eligibility and finding a suitable plan.
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AmeriHealth Caritas Delaware
In addition, AmeriHealth Caritas Delaware provides a member handbook, which is a comprehensive guide to the plan's benefits, services, and policies. The handbook includes information on how to access services, what is covered, and what to do in case of an emergency. It also provides details on member rights and responsibilities, as well as contact information for customer service and other resources.
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Ambetter
The Ambetter Health mobile app is a convenient way for members to manage their healthcare anytime, anywhere. Through the app, members can access their online accounts, check their coverage, view claims, search for in-network care, and more. The app also includes a digital Member ID Card that can be easily shared and saved to a digital wallet.
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Delaware Aging and Disability Resource Center
The Delaware Aging and Disability Resource Center (ADRC) provides support and assistance to a diverse group of people throughout the state. This includes those seeking general information or assistance for themselves or someone else, caregivers looking for support, and those seeking information on behalf of someone in their professional care. The ADRC offers a self-help and guided approach, allowing individuals to search for resources easily.
The ADRC has a comprehensive collection of resources related to aging and disabilities in Delaware. Individuals can use the Keyword or Guided Search feature on the website to find the resources they need. Additionally, they can contact the ADRC by phone or email for assistance. The call center staff are readily available to help individuals get started with their inquiries.
The ADRC also provides specific resource requests and referrals. Individuals can submit an online request for information, assistance, or referral at any time, as their services are accessible 24 hours a day, 7 days a week. Requests made online are typically processed within 1 to 3 business days. For urgent situations, individuals can call 911, and for suspected abuse, neglect, or exploitation, the Delaware Adult Protective Services (APS) Report Line is available at 1-888-277-4302.
The ADRC assists eligible individuals in finding dental care and other services. For those seeking dental care for children, the Dentist Locator tool can help find a dentist who accepts Medicaid and CHIP. The ADRC also provides general information, referrals, and assistance to individuals inquiring about Medicaid benefits and services. This includes helping providers enroll in the Medicaid program, responding to inquiries, verifying client eligibility, and aiding in submitting electronic claims.
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Blue Cross Blue Shield Association
Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, offering Medicaid and D-SNP coverage with extra benefits in Delaware. Highmark Health Options Duals (HMO SNP) offers the same benefits as Original Medicare, plus extras, like prescription drugs, vision, and dental care.
Highmark Blue Cross Blue Shield provides Medicaid and D-SNP coverage with additional benefits to help protect all aspects of health and well-being. They also offer HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Highmark Health Options partners with local organizations, such as the Food Bank of Delaware and the YMCA, to offer wellness classes and monthly food distribution events. They also provide a free, anonymous search feature to help individuals navigate their healthcare choices and find care, education, housing, legal assistance, and more.
Blue Cross Blue Shield is a recognized association of independent Blue Cross Blue Shield plans, taking action nationwide to improve access to mental health resources and support. One notable initiative is their sponsorship of Bluebikes, with over 5,300 bikes across 13 municipalities, promoting community health and wellness.
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Frequently asked questions
I found multiple insurance companies that service Medicaid in DE, including AmeriHealth Caritas, Highmark Health Options, and Ambetter. The Delaware Division of Social Services Change Report Unit and the Delaware Aging and Disability Resource Center can also provide more information on Medicaid services.
According to MoneyGeek, Ambetter is the best health insurance provider in Delaware for 2024. They have low costs, low out-of-pocket maximums, and a record of denying fewer claims than competitors.
When choosing an insurance company, it is important to consider your unique circumstances and needs. Look for a plan with reasonable prices and sufficient coverage. Additionally, consider factors such as age, maximum out-of-pocket costs, plan flexibility, and claims management.
To enrol in Medicaid in Delaware, you can contact the Division of Medicaid and Medical Assistance (DMMA) or the Division of Social Services (DSS). They can provide information on eligibility requirements and help you with the enrolment process. You can also contact the Delaware Medical Assistance Program (DMAP) Providers to enrol in the Medicaid program and verify your eligibility.
Medicaid in Delaware offers a range of benefits, including medical services, prescription coverage, and dental coverage. Additionally, some insurance companies may offer extra services or Value-Added Benefits (VAB) in addition to regular benefits. Medicaid is designed to provide health coverage for eligible individuals with income below the state-specified threshold, including elderly adults, pregnant women, children, and those with disabilities.
