Medicare in Delaware

Delaware residents aged 65 and older can get health insurance from the federal government from Medicare. This program also covers younger adults who have certain disabilities. Delaware had 213,678 people enrolled in Medicare in 2020. That statistic includes 174,919 people who had Original Medicare and 38,759 who were enrolled in Medicare Advantage plans. This means that 21% of the total population of the state was enrolled in some form of Medicare. The state spends $1.9 billion on Medicare each year, which amounts to $10.774 a year per enrollee.

Original Medicare has two parts. Part A is available at no cost provided the individual or their spouse has paid Medicare taxes through their job for enough years. This covers inpatient care at a hospital, hospice care, nursing home care and even some home health care. Medicare Part B covers regular doctor visits and outpatient services as well as testing for diagnostic and health tracking purposes. This part has a minimum monthly premium of $170.10 as of 2022.

Original Medicare provides the same coverage to every person who enrolls, but it does not cover some important things like dental or vision care. Original Medicare users need to enroll in Part D Medicare, if they want coverage for prescription drugs. 

For seniors who want more variety, Medicare Part C, or Medicare Advantage, can provide customized coverage options from private health insurance companies. These plans provide the same benefits of Part A and Part B, except hospice care, and often add other coverage. Most Advantage Plans include prescription drug coverage (Part D). Many Medicare Advantage plans also cover dental, hearing and vision care. 

Finally, Original Medicare users who want a plan to cover the out-of-pocket costs they have can purchase Medigap coverage.

With this guide, seniors in Delaware can learn even more about their options as they seek to choose the right coverage option for their healthcare needs.

Options for Medicare Coverage in Delaware

Original Medicare offers a basic coverage for preventative healthcare, hospital stays, nursing home care and other important services, but many people do not find it sufficient. Delaware residents have the option to build the best Medicare Advantage policy to fit their needs, including programs that they can purchase from private health insurance companies.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage (MA) provides an alternative to Original Medicare that carries the same benefits as Part A and Part B, but with a greater variety of additional plan options. The only exception to this is hospice care, which is not covered by Advantage Plans and remains covered by Medicare Part A. Medicare Advantage, also called Part C, is obtained through private insurance companies. This allows the plans to offer more than just those services of Original Medicare. Most Advantage plans include prescription coverage (Part D) and many seniors also benefit from dental care, fitness programs, non-prescription medication coverage, transportation help and even vision care. These plans usually have limits on their out-of-pocket limits, which can make budgeting easier.

Medicare Advantage gives seniors a wide range of choices, including the choice of one of six plan types. Older adults can often choose from Special Needs Plans (SNPs), Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMO) and Private Fee-For-Service (PFFS) plans. Other less common types of Medicare Advantage Plans that may be available include Health Maintenance Organization with a point-of-service option Point Of Service (HMO-POS) plans and a Medicare Medical Savings Account (MSA) plan. 

Each plan will have its own specific rules about eligibility, which medical providers you can use, and how much you pay out-of-pocket.

Who Should Consider Medicare Advantage

Many seniors can benefit from Medicare Advantage, especially if they are:

• In good health and qualify for lower premiums
• Need coverage not available through Original Medicare
• Could benefit from better control over medical insurance expenses
• Feel comfortable with a managed care plan

The Top 10 Medicare Advantage Plans in Delaware

Delaware has many Medicare Advantage plans for seniors to choose from, and some have risen to the top as excellent choices. The table below shows the top 10 options in the state based on how many people currently choose that plan. It shows the Medicare star rating, cost range as of April 2022 and the plan types it offers. Seniors can find additional information about Medicare Part C here.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Delaware

Enrolling in Medicare can be a complex and confusing process, and the same is true for private options that are available through Medicare Advantage, which vary depending on residents’ location in the state. Several organizations and resources in Delaware help seniors understand the process and get help with the application if they need it.