Medicaid Eligibility in Delaware: Income Limits & How to Apply
Medicaid Eligibility in Delaware
Under the ACA's Medicaid expansion, Delaware residents earning up to 138% FPL can enroll in Diamond State Health Plan. For a single adult, that's roughly $21,597 annually; for a four-person household, the cutoff is about $44,367 in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Diamond State Health Plan with free or very low-cost coverage. No premiums, no deductibles.
Under Delaware's expanded program, coverage extends to:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About Diamond State Health Plan
If you're a Delaware resident trying to understand your health coverage options, the Diamond State Health Plan is Delaware's Medicaid program, and it plays a significant role in providing healthcare to many in the state. Adults with incomes up to 138% of the Federal Poverty Level (FPL) are eligible. For a single individual, this means a monthly income of about $1,835, and for a household of three, it's around $3,142 per month. Pregnant women and infants have higher income limits, up to 212% FPL, while children ages 1-5 qualify up to 142% FPL, and children 6-18 up to 133% FPL. As of 2024, approximately 255,500 Delawareans were covered by Medicaid, representing about 24.4% of the state's population, demonstrating it's a widely utilized and essential program.
If your income is slightly above the Medicaid cutoff, you might qualify for subsidies on the federal HealthCare.gov marketplace. With Delaware's benchmark Silver plan costing around $658 per month, which is higher than the national average, subsidies can significantly reduce what you'd actually pay. It's important to remember that even small changes in your income can shift your eligibility between Medicaid and marketplace subsidies, so always report any household income changes. Delaware saw a peak in Medicaid enrollment in 2023, but experienced a 12.8% decrease in 2024, with over 43,000 people disenrolled since mid-2023 due to the end of continuous enrollment provisions. If you were among those who lost coverage during this "unwinding" period, you can reapply at any time if your circumstances change and you believe you now qualify.
The Diamond State Health Plan offers comprehensive benefits, including doctor visits, specialist care, immunizations, maternity care, family planning, and pharmacy services. For adults, behavioral health and substance disorder services are covered, and for members under 21, vision services like routine eye exams and eyeglasses are included. There are also dental benefits for adults, with a limit of $1,000 per year for preventive and basic restorative care, with potential for an additional $1,500 for extended benefit criteria. Delaware also has the Diamond State Health Plan-Plus (DSHP-Plus), a managed long-term care program for elderly or physically disabled residents, which can cover nursing home care and a variety of home and community-based services like adult day care, home-delivered meals, and personal care assistance. Some of these services, like attendant care, can even be participant-directed, allowing you to hire friends or family, including spouses and adult children, as caregivers.
When navigating the system, be aware that while there is no asset test for most Medicaid programs for adults and children, there are asset limits for specific programs like long-term care Medicaid and Aged, Blind, and Disabled Medicaid. For example, in 2026, a single applicant for nursing home or home and community-based services Medicaid has an asset limit of $2,000. You can apply for Medicaid online through HealthCare.gov or Delaware ASSIST, by mail, or in person at a DSS office. Make sure your contact information is up-to-date with the state, especially since many people were disenrolled during recent redeterminations for not responding to renewal notices. Your concrete action step should be to visit Delaware ASSIST online to use their screening tool and begin the application process to see what programs you qualify for.
Delaware Medicaid Income Limits 2026
The following table shows the key income thresholds for Delaware in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for Diamond State Health Plan. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
At $658/month for a benchmark Silver plan, Delaware sits well above the national average of ~$525. However, because subsidies are calculated as the difference between the benchmark and your expected contribution, higher premiums actually mean more generous subsidies.
Marketplace Insurance in Delaware
Delaware residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Delaware costs approximately $658/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Delaware might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Residents of Delaware shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to Delaware's program if you qualify.
Delaware adopted Medicaid expansion, bringing Diamond State Health Plan coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.
How to Apply for Diamond State Health Plan
- Start online at HealthCare.gov — the application automatically screens for Diamond State Health Plan eligibility based on your household income.
- Go through the state directly — Delaware's Medicaid office accepts applications year-round with no enrollment window.
- Get phone support — Delaware's Medicaid hotline can walk you through the process and verify eligibility.
- In-person options — Local social services offices and community health navigators can assist with your application.
Have the following ready: recent pay stubs or tax returns, proof that you live in Delaware, Social Security numbers for everyone in your household, and details on any existing health insurance.
Calculate Your Subsidy in Delaware
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Delaware.
Check Your Eligibility →Frequently Asked Questions
What is the Delaware Medicaid income cutoff for 2026?
In 2026, the Medicaid income limit in Delaware is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Does Delaware have Medicaid expansion?
Yes, Delaware has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Diamond State Health Plan.
Am I eligible for health insurance subsidies in Delaware?
Yes. Delaware residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of Delaware's Medicaid program?
Delaware's Medicaid program is known as Diamond State Health Plan. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What happens if I lose Medicaid coverage in Delaware?
If your Diamond State Health Plan coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Delaware?
Yes. Medicaid eligibility in Delaware is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for Diamond State Health Plan even if you work full-time. Many Diamond State Health Plan enrollees are working adults.
Diamond State Health Plan vs. marketplace insurance — which is better?
Medicaid (Diamond State Health Plan) is free or very low-cost with no premiums or deductibles. Marketplace plans in Delaware average $658/month before subsidies — among the highest in the country. If you qualify for Medicaid, it will almost always be the better financial choice. If your income is just above the Medicaid limit, subsidies can still make marketplace coverage affordable.
Medicaid Eligibility in Nearby States
- Maryland Medicaid Eligibility — Expansion state
- New Jersey Medicaid Eligibility — Expansion state
- Pennsylvania Medicaid Eligibility — Expansion state