You can still purchase a nationwide PPO in Delaware. But if you're a western Sussex County HVAC owner currently enrolled in a marketplace EPO, you really need to review your coverage this fall. I'll explain what's changing and how to choose.
Hi, I'm Sam Jaber. I'm licensed to broker health insurance in Delaware, and that's the only type of insurance I handle. Everything is done over the phone, which makes things easier when you own an HVAC business and spend much of your working day in crawl spaces rather than sitting at a desk.
Picture a husband and wife in their fifties who own a heating and cooling company in Seaford and employ one technician. They take service calls throughout Seaford, Laurel, Bridgeville and Delmar. Some days they're installing heat pumps in newer houses; others they're repairing oil furnaces in older farmhouses. Summer brings calls from retirement communities expanding west of the beaches. Their regular family doctor practices in Seaford, but when they need more involved care, they travel to Salisbury, Maryland, rather than Dover because Salisbury is closer. Last fall, they enrolled in a marketplace EPO after seeing that it had the lowest premium among their choices.
For this Seaford couple, nationwide PPO coverage remains available in Delaware. I can put together a household quote.
The timing matters because Delaware's marketplace is changing. In 2026, there are 40 medical plans from 3 insurers. One insurer provides all 17 EPOs, another provides all 15 PPOs, and the remaining company offers all 8 HMOs. But the state's approved Plan Year 2027 rate announcement names only two insurers. One has 16 comprehensive plans plus a catastrophic option, while the other has 9 plans. The insurer selling the 2026 EPOs doesn't appear in that announcement. So if you're currently covered by a Delaware marketplace EPO, you'll need to prepare to select a different plan for 2027 rather than count on keeping your existing one.
Don't rely on an automatic replacement or wait until your notice arrives. The 2027 open enrollment period begins November 1 and ends January 15. For coverage effective January 1, make your choice by December 15. Premium increases add another reason to compare carefully. KFF reports Delaware's average benchmark premium increased 29.4% between 2025 and 2026.
Your premium tax credit reflects estimated household net income during the coverage year. For the shop, calculate receipts after deducting technician wages, vans, equipment, parts, refrigerant, licensing and insurance.
When your Seaford doctors participate in a network available for 2027, I'd generally start with marketplace coverage because that's the only place you can use the premium credit. Among the remaining 2027 plans, look for one with a lower premium that includes those doctors. If most of your care happens locally, paying extra for another plan may not help, especially since your credit won't increase just because the premium does. Once the 2027 rates become available, we'll review the actual costs together. In the meantime, contact your Seaford doctor's office and ask which 2027 networks they expect to accept. That answer is more important than price alone.
Next step: Give me your doctors' names and last year's return. Once the 2027 rates are available, I'll compare your premiums after the tax credit.
When a household earns beyond the credit limits, marketplace coverage comes at full price, which can be significant for a couple in their fifties. If both of you are healthy, let's also price a medically underwritten nationwide PPO. Each applicant answers medical questions, and the insurer can accept the application, exclude an earlier condition, or decline coverage. Healthy applicants often find lower premiums than unsubsidized marketplace plans. The nationwide network includes Maryland and Delaware, so bring the names of your Salisbury specialists.
Next step: Call with your birth years and medical histories for both of you. I'll compare a nationwide PPO quote against the 2027 marketplace premiums.
Straight answers, no sales pitch.
Yes, you should prepare for a change. The insurer providing every 2026 EPO is missing from Delaware's 2027 rate filing list.
Two marketplace insurers, compared with three in 2026.
Yes. KFF reports that Delaware's average benchmark premium increased 29.4% between 2025 and 2026.
Choose by December 15 to begin coverage January 1. The full enrollment period extends from November 1 through January 15.
Send your current policy details, everyone covered, your Seaford and Salisbury doctors, and last year's net earnings. I'll compare the available 2027 marketplace plans after credits with a nationwide PPO.
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