Everyone needs health insurance. A new federal law, the Affordable Care Act, requires most people to have health insurance in 2015 or else pay a penalty tax. If you have health insurance from a job (or a family member’s job), you are considered covered and will not have to pay the fee that uninsured people must pay. If you have medical assistance, like Medicaid or Medicare, you are also considered covered and do not have to pay the penalty. For more information, visit https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/.
If you do not have health insurance from your job, or from Medicare or Medicaid, you must purchase a policy (Under the new law, every health insurance plan will cover a core set of benefits called “essential health benefits.” Generous subsidies in the form of tax credits are available for many people to offset the costs of premiums and co-insurance. There is an open enrollment period every year when you can enroll or change plans. To learn more about buying health insurance under Affordable Care Act, visit https://www.healthcare.gov/what-is-the-health-insurance-marketplace/.
For more information on the Affordable Care Act in general and what it means to you, call 1-800-318-2596 (TTY: 1-855-889-4325) or visit: http://www.delawareinsurance.gov/health-reform/ACA.shtml or healthcare.gov.
It can take a while to get insurance in place, so it is very important to start thinking about where you will get your health insurance at least six-months before you turn 18. If you get sick and do not have health insurance you have to pay for the healthcare you obtain, which can be very costly. If you received medical assistance or disability benefits before you turned 18, your eligibility may change after you turn 18. In some cases, you may need to apply for these benefits again when you turn 18. It is a good idea to find out ahead of time whether your eligibility will automatically continue, whether your eligibility will be reviewed at age 18, and whether you will need to reapply for benefits as an adult.
Some young adults have private health insurance through their parents. You can remain insured on your parents’ private health insurance, if it is available and if it is cost effective for you, up until you are 26. If you work, your employer may also provide health insurance coverage as a benefit of your employment. However, every policy is different and you will have to do a careful review to see which option is best for you.
If your healthcare insurance is provided by your employer, there are certain protections under another federal law, the Employee Retirement Income Security Act (ERISA). Under this law, health insurance companies are required to give you important information about covered plans. They also must have a fair process for handling benefit claims and appeals. For more information on your rights and responsibilities under ERISA, call 1-866-444-EBSA (3272) or visit www.dol.gov/ebsa.
The Delaware Insurance Commission is another important source of information about health insurance in Delaware. If you have questions about insurance or complaints about an insurance company or insurance agent, contact the Commissioner’s Consumer Services division:
1-800-282-8611 toll-free in Delaware or (302) 674-7310
Or review their “A Guide To Insurance and Health Care Programs For People
with Disabilities,” http://delawareinsurance.gov/Guides/DisabilitiesGuide.pdf.
The Delaware Insurance Commissioner also houses the Delaware Medicare Assistance Bureau. DMAB provides counseling and assistance on questions and problems related to Medicare, Medicaid, Medigap (Medicare supplemental insurance), Medicare Part D, long-term care insurance and other types of health insurance. There is no charge for the service. 800-336-9500.
For more information about insurance options in Delaware, see http://www.choosehealthde.com/Health-Insurance.
You can also get information about healthcare insurance, government benefits, and other social services programs at the State Service Centers. These centers offer a wide range of public and non-profit services to help with many health and human service needs. They offer assistance with emergency services, such as finding housing or paying utilities; individual and family services, which include help for children and elderly citizens; and community services. See: www.dhss.delaware.gov/dhss.dssc. You can call 211 to find out the contact information for the State Service Center in your area.
 See 26 U. S. C. § 5000A.
 Pub.L. 93–406, 88 Stat. 829, enacted September 2, 1974, codified in part at 29 U.S.C. ch. 18. For more about ERISA see: http://www.dol.gov/dol/topic/health-plans/erisa.htm