Cost and Coverage of Medicaid in Delaware

Concerning what services are covered by Medicaid in Delaware, it is important to note that covered services and equipment within DE may be different from what is offered outside the state. The types of Medicaid insurance services provided by Delaware Medicaid will differ from those provided by Florida’s program, for instance. Similarly, the answer to, “How much does Medicaid cost?” varies across the nation. For instance, while Medicaid coverage in DE will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services. In July of 2016, Delaware Medicaid covered more than 200,000 Delaware residents. This represents a 74 percent increase since the state’s 2013 inaugural Marketplace Open Enrollment Period. If you live in Delaware, and do not earn enough money to afford the health care coverage options available on the private market, you may qualify for Medicaid.

For more information on Medicaid cost estimates in Delaware, and for details on what services Medicaid covers and what services it does not, review the sections provided below:

  • What is covered under Medicaid in Delaware?

  • What does Medicaid not cover in Delaware?

  • Medicaid costs in Delaware

What is covered under Medicaid in Delaware?

You might expect that all types of Medicaid insurance cover the same services and equipment. In fact, the federal government does require every state’s version of Medicaid to cover a basic set of mandatory services. However, once you go beyond the mandatory services, each state is free to develop its own mix of covered services. Because the coverage can vary significantly from one state to another, you need to ask the question, “What services are covered by Medicaid in my state of residence?” to find out if the state medical assistance program will meet your needs. Delaware Medicaid coverage pays for a wide variety of services and equipment for eligible beneficiaries. These services include:

  • Prescriptions.

  • Doctor visits.

  • Inpatient and outpatient hospital care.

  • Lab tests.

  • X-rays.

  • Home health care.

  • Hospice care.

  • Medical equipment and supplies.

  • Medical transportation services.

Medicaid services not listed above may be covered as well if your physician determines that they are medically necessary. Furthermore, if your Medicaid denies a procedure or piece of equipment, you can always appeal the decision. Your appeal rights are spelled out in the paperwork you received when you signed up. This process is similar in every state.

To file a Medicaid service appeal, you will need a prescription from your doctor. You may also need some additional supporting documentation explaining why you need the service, how the service will benefit you and what, if any, alternative treatments are available. Depending on how busy the Medicaid department is, an appeal can take three to six months or more.

Children may be eligible for additional services that adults will not qualify for, such as dental exams, teeth cleanings, X-rays or even oral surgery, in extreme cases.

What is not covered under Medicaid in Delaware?

While Medicaid coverage in Delaware insures beneficiaries for a number of helpful services, there are certain procedures and pieces of equipment that Delaware Medicaid will not cover. The Delaware Medicaid program establishes covered services based on medical necessity. Therefore, any service that is not medically necessary will not be covered in Delaware. The following services are not covered:

  • Cosmetic surgery

  • Autopsies

  • Hearing aids

  • Infertility services

  • Podiatric services

  • Chiropractic services

  • Over-the-counter medications

You can still receive these services, but you will need to pay for them yourself.

Medicaid Costs in Delaware

For those wondering, “How much is Medicaid in Delaware?” the answer depends on a variety of factors. Many Medicaid beneficiaries pay nothing at all for their coverage due to their low incomes. For instance, Medicaid in Delaware may cover 100 percent of your healthcare costs if your individual income is less than $ 1,317 per month. For a couple, this threshold is $1,776 per month. In every case, your income must be less than the income limits set by law in Delaware. In addition, you have to possess Medicaid hospital insurance.

If your income is above this threshold, you may still qualify for Medicaid, but you will have to pay a portion of the cost of your coverage.

“How much will my Medicaid coverage cost?” is another important question to ask. Unfortunately, there is no absolute answer to this question. The amount you pay can change based on your income, the size of your household and the exact level of coverage you have. Options for paying your Medicaid bills are more clear-cut. You can pay for your coverage electronically using your debit or credit card. Also, you can pay in person or by mail by using cash, a check or a money order.

If paying for your Medicaid coverage ever becomes a financial burden, be sure to let your caseworker know right away. You may qualify for additional financial assistance, especially if your income, health or living situation has changed. Even if there are no assistance programs available for you, you may be able to work out an extended payment plan.



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