I can still help you get a nationwide PPO in Delaware. Let's look at a Middletown couple who own a swim school and how they can choose coverage for their family as marketplace options get smaller this year.
Hi, I'm Sam Jaber. I hold health insurance licenses in 36 states, and I work with Delaware small-business owners over the phone to help them find coverage for their families.
Think about a family that owns a swim school in Middletown. Business picks up when spring arrives and stays busy through summer, with some indoor classes keeping things moving during winter. They employ six part-time instructors, mostly students in high school or college. At home, they're raising three children, including a youngest child with asthma who sees pediatric specialists in Wilmington. Since the business doesn't provide a group health plan, they purchase family insurance themselves through HealthCare.gov. They went with the lowest-priced silver plan last year, but now they've found out that they'll have to shop for coverage all over again.
Delaware's 2026 marketplace has 40 individual medical plans offered by three insurance companies statewide. Each company handles a different network type: EPO, PPO or HMO. Looking at the two types that will remain available next year, the PPO carries the higher price. For a 40-year-old before applying any credit, the lowest-priced silver PPO is 6% more expensive than the lowest-priced silver HMO.
I can also help Delaware families purchase a private nationwide PPO. Pricing depends on each applicant's medical history, so having a child with an existing condition makes the details especially important. Rather than tell you whether it'll work without knowing your situation, I'll run the numbers and let you see.
For 2027, the Delaware Department of Insurance approved marketplace rates from just two insurers, including average rate increases of 17.20% and 13.94%. The insurer that offered all 17 EPO plans in 2026 doesn't appear among those approvals. That leaves families currently enrolled in an EPO needing to compare the HMO and PPO choices during this fall's enrollment.
What really separates these plans is what happens when you see a doctor outside the network. With an HMO, those visits generally aren't covered unless it's an emergency. A PPO can still contribute toward that care, although you'll pay more yourself. When your family relies on specialists, I'd check the doctors first and worry about the premium second.
For marketplace coverage, your household's net income during the year determines the credit. In a swim school, that's the lesson revenue after paying for the pool rental, instructors, insurance and equipment. When the result falls from 100% to 400% of the federal poverty level, the credit is available. That usually makes HealthCare.gov the more affordable choice for covering everyone in the family.
Next, find out which plan includes your child's specialists. If both the asthma doctor and your preferred hospital participate in the HMO network, that plan will probably give you better value once the credit is applied because the PPO is more expensive. But if those providers participate only in the PPO company's network, paying the difference is often worthwhile to keep the medical team familiar with your child.
Next step: Give me the names of your kids' doctors along with last year's business figures. I'll compare what your family would actually pay for the 2027 HMO and PPO once the credit is factored in.
Once household income goes beyond four times the poverty level, the credit disappears, leaving a family of five responsible for the entire premium. That's when I'd also examine a private nationwide PPO, whether for the whole family or just certain members. Each applicant goes through medical questions, and the insurer may approve coverage, leave out a particular condition, or reject an application. Your child's asthma matters in that review, but the outcome depends on the details. You might qualify together for private coverage, or it may make more sense to keep one person on a marketplace plan. We won't know which arrangement costs less until I calculate both.
Next step: Give me a call with your family's ages and doctors. I'll compare private PPO coverage with full-price marketplace plans for everyone.
When business income falls particularly low, Delaware's Medicaid expansion may become relevant. According to KFF, Delaware has adopted and implemented expanded Medicaid, with adult eligibility reaching 138% of the federal poverty level. There's also a federal requirement for states to begin, generally by January 1, 2027, checking whether certain adults ages 19 to 64 complete 80 hours per month of work or other qualifying activities. Before relying on Medicaid, make sure you understand how those requirements would affect someone running a business.
Next step: If business is looking slow this year, give me a call ahead of renewal. We'll review the income picture and figure out where that puts everyone in your household.
Straight answers, no sales pitch.
I wouldn't expect it. The insurer isn't among the two companies on Delaware's approved 2027 rate list. Be ready to compare replacement plans when open enrollment arrives.
For the two insurers included in its 2027 approvals, the Delaware Insurance Department reported average rate increases of 17.20% and 13.94%.
For 2026, it's the HMO. At age 40, the lowest-priced silver PPO comes in 6% above the lowest-priced silver HMO.
Yes, provided the family members qualify after medical underwriting. I can quote that coverage and compare its cost with marketplace alternatives.
Give me the ages of everyone needing coverage, the doctors your kids see, and an estimate of what your business brought home last year. I'll put Delaware's 2027 HMO and PPO prices after the credit alongside a private nationwide PPO so you can compare.
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