Do You Qualify for Diamond State Health Plan?
Enter your household size and income before taxes to see where you land in Delaware.
Estimate using 2026 federal poverty guidelines and Delaware's income limits as of January 2026. If you are pregnant, count the baby you are expecting in your household size. People 65 and older or with disabilities follow different rules. This is not an official determination — only Delaware's Medicaid agency or the marketplace can confirm eligibility.
Key threshold: If your income is below $22,025 (individual) or $45,540 (family of 4), you likely qualify for Diamond State Health Plan with free or very low-cost coverage. No premiums, no deductibles.
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 | $15,960 | $22,025 | $63,840 |
| 2 | $21,640 | $29,863 | $86,560 |
| 3 | $27,320 | $37,702 | $109,280 |
| 4 | $33,000 | $45,540 | $132,000 |
| 5 | $38,680 | $53,378 | $154,720 |
| 6 | $44,360 | $61,217 | $177,440 |
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.
About Diamond State Health Plan
Who Qualifies for 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 You're Near the Income Line
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 $691 per month, 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.
What Diamond State Health Plan Covers
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.
Tips for Applying
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 and CHIP Income Limits for Children and Pregnancy
Children and pregnant women qualify for coverage in Delaware at higher incomes than other adults. Children under 19 are covered up to 217% of the federal poverty level, through Medicaid at lower incomes and Delaware's separate CHIP program above that (CHIP may charge a small premium). Pregnancy coverage runs up to 217% FPL.
| Household | Children 217% FPL |
Pregnant 217% FPL |
|---|---|---|
| 1 | $34,633 | — |
| 2 | $46,959 | $46,959 |
| 3 | $59,284 | $59,284 |
| 4 | $71,610 | $71,610 |
| 5 | $83,936 | $83,936 |
| 6 | $96,261 | $96,261 |
Annual income limits for 2026, including the standard 5-point income disregard. A pregnant woman counts as at least two people, so the one-person row does not apply. Limits as of January 2026, from KFF's annual survey of state Medicaid and CHIP eligibility rules.
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 $691/month for a 40-year-old (2026 average; 2027 rates are published shortly before open enrollment begins November 1).
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 for a Silver plan after subsidies under the 2027 premium tax credit rules, based on the $691/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$86/mo | $605/mo |
| 200% FPL | $31,920 | ~$180/mo | $511/mo |
| 250% FPL | $39,900 | ~$288/mo | $403/mo |
| 300% FPL | $47,880 | ~$408/mo | $283/mo |
| 400% FPL | $63,840 | ~$544/mo | $147/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in Delaware. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. Delaware uses the federal marketplace at HealthCare.gov.
How to Apply for Diamond State Health Plan
Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:
- Online: Apply through HealthCare.gov — the system automatically checks your Diamond State Health Plan eligibility when you enter your income. Or apply directly through Diamond State Health Plan.
- Phone: Call Delaware's Medicaid helpline for guided help with your application.
- In person: Visit your local human services office or a certified application counselor.
You'll need proof of income (pay stubs or tax returns), proof of Delaware residency, and Social Security numbers for household members.
Calculate Your Subsidy in Delaware
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Delaware.
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: $22,025 per year for an individual, $29,863 for a household of 2, $37,702 for 3, and $45,540 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?
Delaware residents with household income between 100% and 400% FPL ($15,960 to $63,840 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 ($22,025 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 near-free with no premiums or deductibles. Marketplace plans in Delaware average $691/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.