Medicare in Delaware

While it may be known for its small size, you can still get big-time medical coverage with Medicare in Delaware. The key is being able to answer some important questions. For example, do you know the different Medicare plans in Delaware or what they cost? When do you need to enroll? Can you get Medicare Advantage in Delaware?

Once you know the facts, you’ll see The First State is second to none regarding Medicare coverage and options. To help you find the answers you need, this is GoHealth’s guide to Medicare in Delaware.

Medicare provides several ways for older Americans to enroll and start receiving benefits. If you or a loved one is looking to enroll in Medicare in Delaware, you’ll need to sign up through the Social Security Administration. Depending on the assistance you need, there are several ways to enroll, including:

• Online on the Social Security website
• Over the phone at 1-800-772-1213 (TTY: 1-800-325-0778)
• In person at a local office

When am I eligible for Medicare in DE?

Eligibility for Medicare in Delaware begins for all legal U.S. citizens at the age of 65. If this is your first chance to enroll, you’ll need to sign up during your Initial Enrollment Period (IEP). This is a seven-month window that starts three months before your birth month.

There are times you may be eligible to enroll in Medicare before you turn 65. These include:

• You’ve received disability-based Social Security or Railroad Retirement Board benefits for 24 months
• You’re living with End Stage Renal Disease
• You’re living with Amyotrophic Lateral Sclerosis (ALS)

Technically speaking, Medicare is not required when you turn 65. If you’re still working when you turn 65, you may be able to delay enrollment past 65. But because you’ve paid into your coverage through taxes, it may be the most cost-effective option for health insurance when you need it. If you enroll after you’re first eligible for Medicare in Delaware, you may have to pay some hefty enrollment penalties when you do sign up.

Do you get free Medicare when you turn 65?

You may get a portion of your Medicare (Part A) at no cost when you turn 65. Still, you’ll probably pay something for your Medicare coverage, whether it’s monthly premiums or out-of-pocket copays, coinsurance and deductibles. Your final cost will come down to your needs, income and other details.

Are you looking to budget for Medicare plans in Delaware? Here are some standard costs for Medicare Parts A, B and D in 2022.

Medicare in DE: Part A 

Premium

• $0 if you or your spouse worked 10 or more years

• $274 to $499 if you or your spouse worked fewer than 10 years

Deductible

• $1,556 per plan period

Copayments & coinsurance

• Hospital stays: $0 for first 60 days (after the deductible above is met); daily charges after

• Skilled nursing facility stays: $0 for first 20 days (after the deductible above is met); daily charges after

Medicare in DE: Part B

Premium

• Starting at $170.10 per month (income-based)

Deductible

• $233 per plan period

Copayments & coinsurance

• $0 for most preventive services; 20% coinsurance for other Medicare-approved services

Medicare in DE: Part D

Premium

• Income-based and varies by plan

Deductible

• Capped at $480

Copayments & coinsurance

• Based on plan and medication

There are several ways to get Medicare in Delaware. You’ll need to start by making an essential decision: do you want Original Medicare (Parts A and B) or Medicare Advantage (Part C)?

Here’s a primer on how they work:

Original Medicare (Parts A and B)

This is the Medicare you enroll in through Social Security. Original Medicare has two parts: A and B.

• Part A: helps cover hospital stays, including some home health care and limited inpatient services at nursing homes and skilled nursing facilities
• Part B: The medical portion of your Medicare coverage helps pay for medically necessary and preventive care

If you have Original Medicare, you may also consider adding Part D coverage for your prescription drugs. Many Original Medicare beneficiaries also choose to enroll in Medicare Supplement Insurance (Medigap) to help cover their out-of-pocket costs.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Which Medicare Supplement plan is the best?

Medicare Supplement Insurance, or Medigap, is a group of different policies meant to work with your Original Medicare policy to help cover your out-of-pocket costs. While some Medigap plans cover more than others, finding the right fit comes down to your personal needs and budget. Keep in mind that all Medigap plans must offer at least a portion of the following benefits:

• Part A coinsurance and hospital costs

• Part B coinsurance and copays

• Part A coinsurance and copays for hospice care

• The first three pints of blood

Medigap in Delaware consists of 10 plans, starting with A and ending with N. All Medigap plans must be the same from one insurance company to another. In other words, a Plan A from one company in Delaware must be the same as another company’s Plan A.

For some, having a provider network through Medicare Advantage is a downside when compared to Original Medicare. Those that don’t travel may value the extra benefits and cost-effectiveness of Medicare Advantage in Delaware.

To help you make up your mind, here are the four main types of Medicare Advantage in Delaware and how they work:

Health Maintenance Organization (HMO)

HMO plans feature local provider networks and use primary care physicians to manage your overall care.

Preferred Provider Organization (PPO)

PPO plans offer the freedom to see out-of-network doctors and providers without a referral, but you still have a primary care physician.

Private Fee-for-Service (PFFS)

PFFS plans pay your providers for every Medicare-approved service you receive

Special Needs Plans (SNP)

SNPs are designed for beneficiaries living with certain illnesses or conditions. D-SNP helps dual-eligible individuals, and C-SNP is for people with chronic diseases.

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.