Delaware residents enrolled in both Medicare and Medicaid are called dual eligibles, and the Division of Medicaid and Medical Assistance (DMMA) at the Delaware Department of Health and Social Services runs the Medicaid side of that pairing. In 2026, roughly 30,000 to 35,000 Delawareans fall into one of two dual eligible categories: full-benefit duals, who qualify for complete Delaware Medicaid coverage under the Diamond State Health Plan, and partial duals, who qualify only for a Medicare Savings Program (MSP) that pays some or all of their Medicare costs.
Which category applies depends almost entirely on income and, for some pathways, assets. This guide breaks down Delaware's 2026 income limits by household size for the Medicare Savings Programs, explains exactly what full duals versus partial duals get, and walks through how to apply through Delaware ASSIST or DMMA directly. For general dual eligible rules outside Delaware, see can I have both Medicare and Medicaid.
Direct Answer: Your Dual Eligible Category Decides What You Get
It depends on your dual eligible category in Delaware. Full-benefit duals get complete Delaware Medicaid coverage on top of Medicare, including long-term care, dental, transportation, and personal care Medicare does not cover. Partial duals, who qualify only for a Medicare Savings Program (QMB, SLMB, or QI), get help with the Medicare Part B premium and, for QMB enrollees, deductibles and coinsurance too. Your household income against the 2026 federal poverty level decides which group applies.
What Full Dual Eligibles Get in Delaware
Full-benefit dual eligibles in Delaware receive Medicare as their primary insurance and Delaware Medicaid as a wraparound. Medicaid pays Medicare's Part B premium ($202.90/month in 2026), the Part A inpatient deductible ($1,736 per benefit period in 2026), the Part B deductible ($283 in 2026), and the 20% coinsurance Original Medicare leaves behind. On top of that, Delaware Medicaid covers services Medicare does not, including long-term nursing facility care, home and community-based services through the Diamond State Health Plan Plus waiver, non-emergency medical transportation, adult dental care, and personal care assistance.
Delaware determines full Medicaid dual eligibility for most aged, blind, and disabled applicants through the SSI-linked pathway rather than the MAGI (Modified Adjusted Gross Income) rules used for ACA expansion adults. Anyone approved for Supplemental Security Income automatically qualifies for full Delaware Medicaid. The 2026 SSI federal benefit rate is about $994/month for an individual and $1,491/month for a couple. Delawareans needing nursing home or home and community-based long-term care can qualify at a higher standard, $2,982/month (300% of the SSI federal benefit rate) for a single applicant in 2026, with a $2,000 countable asset limit. Delaware is an income-cap state, so applicants over that limit generally need a Qualified Income Trust (sometimes called a Miller Trust) to become eligible.
What Partial Duals Get: QMB, SLMB, and QI Explained
Delaware DMMA administers three Medicare Savings Programs for residents whose income is too high for full Medicaid but still limited. QMB (Qualified Medicare Beneficiary) is the most comprehensive: it pays the Part B premium plus the Part A and Part B deductibles, coinsurance, and copays, and federal law bars Delaware providers from billing QMB enrollees for those amounts. SLMB (Specified Low-Income Medicare Beneficiary) and QI (Qualifying Individual) pay only the Part B premium, worth $2,434.80 per year in 2026, but do not cover deductibles or coinsurance.
Delaware has eliminated the asset test for all three Medicare Savings Programs, so a partial dual's savings, retirement accounts, or a second vehicle will not disqualify them. Only income against the 2026 federal poverty level matters. QI has one added wrinkle: it is funded through a capped annual federal allocation, so DMMA processes QI applications on a first-come, first-served basis each year and existing QI enrollees get renewal priority over new applicants once the yearly funding is exhausted.
| Program | Income limit (individual, 2026) | What it pays |
|---|---|---|
| QMB | 100% FPL ($1,350/month) | Part B premium, Part A/B deductibles, coinsurance, and copays |
| SLMB | 120% FPL ($1,616/month) | Part B premium only |
| QI | 135% FPL ($1,816/month) | Part B premium only; capped annual federal funding |
| Full Delaware Medicaid | SSI-linked, about $994/month | Everything above plus long-term care, dental, transportation, personal care |
Income limits reflect 2026 federal poverty guidelines plus the $20 monthly disregard applied by DMMA. Delaware has no asset test for QMB, SLMB, or QI.
Source: Delaware DMMA; Medicare.gov Medicare Savings Programs
Delaware Medicaid Managed Care and D-SNP Changes for Dual Eligibles in 2026
Delaware full-benefit dual eligibles typically enroll in a Diamond State Health Plan managed care organization, either AmeriHealth Caritas Delaware, Delaware First Health, or Highmark Health Options, which coordinates the Medicaid wraparound benefits. Many full duals also choose a Medicare Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan built specifically to combine Medicare and Medicaid benefits into one card and one care team.
Effective January 1, 2026, Delaware requires D-SNPs to be exclusively aligned, meaning the Medicare company offering the D-SNP must also hold a Delaware Medicaid managed care contract from the same parent company. Only AmeriHealth VIP Care, Delaware First Health (Wellcare), and Highmark Health Options Duals meet that requirement as of 2026. Aetna, Cigna, and United D-SNPs exited the Delaware market, and enrollees in those plans had to pick a new D-SNP or Original Medicare during the Medicare Annual Enrollment Period, October 15 through December 7, 2025.