Medicare Advantage Plans in Delaware

Delaware may be one of the smallest states, but it earned its nickname “The First State” by being the first state to ratify the U.S. Constitution in 1787. Delaware also is a leader when it comes to offering quality healthcare coverage options to its residents.

As of 2024, 100% of Delaware residents with Medicare have access to a Medicare Advantage plan.

Medicare Advantage plans, also called Medicare Part C, give Medicare beneficiaries all the same benefits as Original Medicare Part A and Part B, plus additional benefits such as prescription drug coverage. Here’s what’s covered by Medicare Advantage plans in Delaware:

Part A hospital coverage, including:

• Inpatient hospital care
• Skilled nursing facility care
• Home health care
• Hospice care

Part B medical coverage, including:

• Medically necessary treatment and care
• Preventative services
• Lab tests and screenings
• Doctor’s visits
• Outpatient hospital care
• Ambulance services
• Durable medical equipment

Medicare Advantage plans may include even more benefits, such as:

• Vision coverage
• Dental coverage
• Hearing coverage
• Prescription drug coverage
• Transportation services
• Fitness memberships

Medicare Advantage plans are offered by private insurance companies under guidance from the federal Medicare program. Each plan provider can set their own additional benefits, so before enrolling in a Medicare plan be sure to check exactly what’s covered. A GoHealth licensed insurance agent can help you compare the plans that are available in your ZIP code.

Let’s take a closer look at the cost of Medicare Advantage plans.

Original Medicare has set monthly premiums, copayments and deductibles. These costs are the same across all 50 states. Costs with Medicare Advantage plans vary. That’s because Part C plans are offered by private insurance agencies, and each can set their own cost.

Typical costs include:

• A monthly premium: Among the 39 Delaware-based Medicare Advantage plans available in 2024, the average monthly premium is $17.80. All Medicare enrollees in Delaware also have access to a Medicare Advantage plan with a $0 premium.
• An annual deductible: Just like Original Medicare, Medicare Advantage plans have deductibles you have to pay out of pocket.
• Copayments and coinsurance: Each time you access healthcare, you may be responsible for a copayment or coinsurance for that service. Original Medicare has a 20% copayment on most covered services. Medicare Advantage plans may have lower copayments.

In-Network Providers

To make the most of your plan and access care with lower out-of-pocket costs, you should access in-network doctors and specialists. You’ll have low coinsurance and copayments when you get in-network care. Some Medicare Advantage plans even offer doctor’s visits with no copayments.

However, if you need to access out-of-network care, your out-of-pocket costs usually will be much higher. For example, seeing a specialist that’s outside your plan’s network could get pricey.

Your Medicare costs depend on what type of Medicare plan you choose. There are four main types of Medicare Advantage plans in Delaware. Each plan has different costs and coverage.

Health Maintenance Organization (HMO) Plans

One of the most common types of Medicare Advantage plans are HMO plans. When you enroll in an HMO plan, you’ll choose a primary care physician who will be your main healthcare partner. Whenever you want to visit a specialist, you first need a referral from your doctor.

Preferred Provider Organization (PPO) Plans

Medicare Advantage PPO plans offer flexibility. You don’t need to have a primary doctor, and you can visit specialists and other providers without a referral. You can get healthcare from any in-network provider and your coverage will apply.

Private Fee-for-Service (PFFS) Plans

PFFS plans provide more flexibility but often at a higher cost. You can access care in- or out-of-network, as long as the provider accepts your coverage. Just like a PPO plan, you don’t need to choose a primary doctor or get a referral to see specialists.

Special Needs Plans (SNPs) Plans

Special Needs Plans limit membership to people who have specific needs or illnesses. For example, some SNP plans cover people who live in a nursing home, people who have chronic health conditions such as heart failure or end-stage renal disease, or people who qualify for both Medicare and Medicaid. These plans are tailored to the needs of that group, with prescription drug coverage that matches their healthcare needs.

Do you have Original Medicare? Then you’re eligible for a Medicare Advantage plan. There are just two eligibility criteria:

• You need to be enrolled in Original Medicare Part A and Part B.
• You need to live in the area that’s covered by your new Medicare Advantage plan.

It’s that simple! Once you’re enrolled in Original Medicare and you have your Medicare number, you’re eligible to switch to a Medicare Advantage plan in your area.

Medicare Advantage plan enrollment

There are a few times each year when you can enroll in a Medicare Advantage plan in Delaware.

If you enroll in Original Medicare when you’re first eligible, you can switch to a Medicare Advantage plan right away. You can first enroll in Original Medicare during the Initial Enrollment Period (IEP). This is a seven-month period that starts three months before the month you turn 65. You’ll have lots of time to enroll in Original Medicare, and then switch to a Medicare Advantage plan before the period ends three months after your 65th birthday month.

If you’ve had Original Medicare for a while, there are several times throughout the year when you can enroll in a Medicare Advantage plan:

• Medicare’s Annual Enrollment Period is from October 15 to December 7 each year. Also known as the Annual Enrollment Period, this period allows you to make changes to your Medicare coverage, like enrolling in a Medicare Advantage plan or switching between plans.
• The Medicare Advantage Open Enrollment Period is from January 1 to March 31 every year. If you’re already enrolled in a Medicare Advantage plan, you can use this period to switch to a new Medicare Advantage plan or switch back to Original Medicare. You can’t switch to Medicare Advantage during this time.
• A Special Enrollment Period (SEP) is triggered by life events. For example, if you move outside the range of your current plan, you’ll qualify for a SEP so you can find a plan in your new city.

If you’re enrolled in Original Medicare, you don’t have prescription drug coverage. You’ll need to enroll in Medicare Part D or a Medicare Advantage plan to get medication coverage.

Many Medicare Advantage plans in Delaware include prescription drug coverage. You won’t need to pay multiple monthly premiums or keep track of several Medicare cards. Instead, you’ll get comprehensive healthcare coverage all in one plan.