Speak to a Licensed Insurance Agent 1-855-792-0088 TTY 711
Mon - Sun, 7am - 10pm
Menu

Medicare in Delaware

Learn more about coverage, costs and enrollment for Medicare in Delaware

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Delaware is for all legal citizens aged 65 and older, and some under 65

  • You can choose between Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Delaware

  • Those with Original Medicare can add Medicare Supplement InsuranceMedicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. and Part D prescription drug coverageMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. separately. Many Medicare Advantage plans bundle Part D coverage

 

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.

How Do I Apply for 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 [1]
  • Over the phone at 1-800-772-1213 (TTY: 1-800-325-0778)
  • In person at a local office [2]

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)

Is Medicare Portable From State to State?

If you’re enrolled in Original Medicare (Parts A and B), your Medicare can be used with any doctor or provider in the nation that accepts Medicare. Parts A and B are federal programs, and the benefits are largely the same nationwide.

Part D prescription drug plans and Medicare Supplement Insurance (Medigap) both work with Original Medicare but are provided by private insurance companies. To see if your Part D and Medigap plans can be used in a state other than Delaware, call your health insurer.

Can Medicare Advantage be used out of state?

Yes, but only in emergencies. Private insurance companies provide Medicare Advantage (Part C). While it must provide at least the same benefits as Original Medicare, Part C plans are often built around local provider networks. Depending on the type of plan you have, seeing an out-of-network doctor could cost you the full amount of your visit.

Is Medicare Accepted in all States?

Yes — whether you’re looking for Medicare plans in Delaware or anywhere else in the United States, you’ll find coverage if you meet the eligibility requirements. The benefits you’ll get from Original Medicare (Parts A and B) largely won’t change across the country. As we mentioned above, Medicare Advantage in Delaware uses provider networks and seeing out-of-network doctors can cost a lot more. Also, Medigap and Part D plans are based on where you live, so check with your insurance carriers to see what restrictions you’ll need to know about if you’re out of state.

What Medicare Plans Are Required at 65?

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 2021.

Medicare in DE: Part A

Premium

  • $0 if you or your spouse worked 10 or more years
  • $259 to $471 if you or your spouse worked fewer than 10 years

Deductible

  • $1,484 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 $148.50 per month (income-based)

Deductible

  • $203 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 $445 in 2021

Copayments & coinsurance

  • Based on plan and medication

What Plans do Medicare Offer?

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. [3] 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.

What is the Downside to Medicare Advantage Plans?

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. [4] D-SNP helps dual-eligible individuals, and C-SNP is for people with chronic diseases.

Medicare in Delaware by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 191,667 people are enrolled in Medicare in Delaware. The total number of beneficiaries enrolled in Medicare Advantage in Delaware is 30,248. The previous year, 24,702 enrolled in Medicare Advantage. Medicare Advantage participation in Delaware went from 13.36% to 15.78% year over year. If you’d like to dive deeper into how Medicare in Delaware breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Delaware
191,667
Beneficiaries with Part A & Part B
30,248
Medicare Advantage Beneficiaries
15.78%
Medicare Advantage Participation Rate
55.53%
% Female
44.47%
% Male
0.97
Average HCC Score
$10,770.42
Actual Per Capita Costs
15.34%
% Eligible for Medicaid
30.53%
% of Beneficiaries with an Emergency Department Visit
17.11%
Hospital Readmission Rate
79.10%
% Non-Hispanic White
14.44%
% African American
2.32%
% Hispanic
4.14%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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.

Delaware Medicare Resources & Contacts

Beneficiaries spend an average of $10,770.42 each year on Medicare in Delaware. To be sure you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Delaware-based resources, like these, may be able to help:

Delaware Commissioner and Department of Insurance

302-674-7300

https://insurance.delaware.gov/

What should I know about the CSIDE?

If you have questions about the health insurance you’ve bought, or you want to file a complaint, contact the Department of Insurance.

Delaware Medicaid & Health and Human Services

302-255-9500

1-800-372-2022

https://dhss.delaware.gov/dhss/dmma/

What should I know about DEHHS and Medicaid?

If you have questions about health coverage eligibility or are having a hard time affording coverage, contact Delaware’s Department of Human Services.

Delaware Medicare Assistance Bureau

302-674-7364

1-800-336-9500

https://insurance.delaware.gov/divisions/dmab/

What Should I Know about DMAB?

DMAB is Delaware’s State Health Insurance Assistance Program (SHIP); Contact DMAB if you are on Medicare or have a disability or End Stage Renal Disease.

Delaware Commission of Veterans Affairs

302-739-2792

1-800-344-9900

https://vets.delaware.gov/

What should I know about DCVA?

If you are a veteran and have a question or concern about veterans’ health care benefits, contact DCVA.

Nationwide Resources

Speak with an insurance agent that is licensed in Delaware about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in DE, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

Previous Next

New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.