Background: Prompt and effective treatment of malaria is critical because delays increase the risk for serious illness, disability and death. Objective: To assess determinants of delay in seeking treatment among malaria patients at Dera district, NorthWest Ethiopia. Methods: A case control study was conducted from September 01 to October 15, 2014. A total of 318 malaria patients diagnosed using microscopy or rapid diagnostic test, and who sought treatment in health centers were interviewed. Multivariable logistic regression was done to identify determinants of delay. Results: Delay was high when a patient earned less than 25.0 USD [AOR=15.7, 95% CI: 4.8 - 51.2] and 9.6 times higher if he/she was not a member of community based health insurance [AOR= 9.6, 95% CI: 4.4 - 21.3]. Respondents who travelled for more than 30 minutes to get to a health facility [AOR= 4.4, 95% CI: 1.2 - 15.9] were more likely to be late in seeking treatment for malaria. Conclusion: Income, community based health insurance, previous history of malaria infection, decision making and distance were determinants of delay in seeking treatment for malaria. To reduce the delay, interventions should focus on outreach malaria services and increase enrollment to community based health insurance.