Medicare Advantage Plans in Delaware

Established in 1997 as a private alternative to Original Medicare coverage, Medicare Advantage is a type of health insurance that provides the same benefits as Part A and B in a single plan. It may also cover other health products and services that are important to the well-being of Delaware seniors, such as dental, vision and hearing. In most cases, Part C coverage will include prescription drug benefits. Private insurance companies manage Medicare Advantage plans. They can cover the same benefits as Original Medicare because the federal government partly funds them.

Of the Delaware residents enrolled in Medicare Advantage plans, close to 60,000 people accounted for 18% of All Medicare users in the state in 2020. This is one of the lowest Part C enrollment rates in the United States, which likely reflects the small size of the state. The national average is 42%, which has been growing steadily since the program’s inception. The federal government regulates Delaware insurance companies that offer Medicare Advantage plans, but they have a certain amount of autonomy regarding member costs, such as deductibles, copays, premiums and other out-of-pocket expenses. Each senior’s specific costs will depend on the type of coverage they prefer. 

With the help of this guide, Delaware seniors can learn if Medicare Advantage is the right option for their health needs. They can learn about coverage options, potential costs, eligibility requirements and how to enroll. 

The Top 10 Medicare Advantage Plans in Delaware

Several companies provide Medicare Advantage plans for Delaware seniors. The table below lists the top 10 providers by total enrollment. Since many of these companies offer more than one plan, the column for costs presents them in a range, usually from $0 to an affordable monthly figure. The table also lists the Medicare star ratings given to each company, which range from 0 to 5 stars. This rating, based on satisfaction surveys, changes each fall before the open enrollment period for Medicare Advantage begins. The information in the below table is current as of April 2022. For the latest information about Part C plans in Delaware, seniors can go to Medicare.gov.

How Medicare Advantage Plans Work in Delaware

Medicare Advantage plans are unique in every state, so it’s important for Delaware seniors to understand how Part C works for them. Private companies offer four types of plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS) and Special Needs Plans (SNP). Each plan type has a different balance of provider options, out-of-pocket costs and covered services to account for the needs of as many seniors as possible. 

What Medicare Advantage Plans Cover in Delaware

The Centers for Medicare and Medicaid Services will only certify a Medicare Advantage plan if it covers the same benefits as Original Medicare Parts A and B, except for hospice care. This includes inpatient hospital care, preventative screenings, durable medical equipment, home health care and more. Some seniors prefer Medicare Advantage because it bundles these benefits with additional coverage, such as vision, dental, prescription drugs, transportation and specialized health and wellness programs. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Delaware

Like Original Medicare, Medicare Advantage requires its members to be aged 65 or older or have a qualifying disability. Beneficiaries must also be U.S. citizens or documented immigrants. While some plans may be available statewide, other plans may only provide coverage for seniors in specific counties. Applicants will need to live in their provider’s service area to qualify, but some companies offer provisions for beneficiaries who live outside the service area for parts of the year. Delaware seniors will need to already have Parts A and B to switch to Medicare Advantage. Enrollment in these plans is only available during certain periods, which seniors can find listed below. 

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Delaware

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources