Medicare in Delaware

Medicare is a government program providing health insurance in Delaware to people aged 65 and older and those having specific medical conditions. The population is a little over a million as of 2023, and about 21% of these individuals are seniors who qualify for Medicare. Out of all qualified seniors, approximately 233,365 have enrolled in some form of Medicare. This figure includes 70,143 enrolled in Medicare Advantage, about 30% of all eligible individuals compared to 48% across the nation. Delaware spends over $1.9 billion on Medicare each year, which is $11,419 per enrollee.

There are two main paths when it comes to accessing Medicare: Original Medicare (with Part A and Part B) and Medicare Advantage (Part C). Most get automatically signed up for Part A at no cost if they or an eligible spouse has paid enough taxes over the years. Those not eligible should enroll during their initial period to avoid a penalty, which increases year after year. Part A covers hospital or nursing home stays and home health care, while Part B handles outpatient services and medical supplies, with a monthly premium starting at $164.90 for 2023.

Another option, Medicare Advantage, also known as Medicare Part C, bundles the benefits of A and B into a single premium offered by private insurance companies in Delaware. Hospice care, which is exclusive to Part A, is not included. However, these plans often include extras like dental, vision and hearing coverage, and there’s a prescription drug piece. With Original Medicare, services are paid as they are used, but it doesn’t cover everything. Most Advantage Plans will cover prescription drugs (part D), or seniors can also add a Medigap plan to help cover those out-of-pocket expenses. Medicare Advantage Plans in Delaware continue to grow, giving seniors a choice from 33 options in 2023.

This guide is a detailed overview of Medicare in Delaware, making it easier for older adults to find the resources they need and secure coverage that fits their circumstances, all while keeping costs as low as possible.

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 managed by the Centers for Medicare and Medicaid Services (CMS) and is available for seniors 65+ or individuals of any age with certain disabilities. Part A covers inpatient care, skilled nursing at home and hospice support, while Part B pays for medical equipment, mental health and preventative medicine. Unlike private plans, care can be obtained anywhere within the U.S. but not abroad. Seniors pay deductibles for each service received. After this minimum has been paid, Medicare covers 80%, leaving 20% for beneficiaries. This setup provides comprehensive domestic health care, with out-of-pocket cost sharing for optimal coverage. 

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) is provided by private insurers and offers an alternative to Original Medicare with additional benefits. This allows seniors to customize plans and round out their medical coverage to suit their preferences.

Most plans include prescription coverage (Part D), but Part C offers dental and vision care, fitness programs and non-prescription medication coverage — plus an out-of-pocket limit for easier budgeting. There are five plan types: Special Needs (SNPs), Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Private Fee-For-Service (PFFS) and a Medicare Savings Account (MSA) plan. Each has its own eligibility rules, provider networks and cost structure.

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 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 August 2023 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 2023 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.