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) and Medicare Advantage in Delaware
Those with Original Medicare can add Medicare Supplement Insurance and Part D prescription drug coverage 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.
Find a local Medicare plan that fits your needs
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)
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.
Are you eligible for cost-saving Medicare subsidies?
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.
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
- $0 if you or your spouse worked 10 or more years
- $274 to $499 if you or your spouse worked fewer than 10 years
- $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
- Starting at $170.10 per month (income-based)
- $233 per plan period
Copayments & coinsurance
- $0 for most preventive services; 20% coinsurance for other Medicare-approved services
Medicare in DE: Part D
- Income-based and varies by plan
- Capped at $480
Copayments & coinsurance
- Based on plan and medication
What extra benefits and savings do you qualify for?
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.
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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.
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.
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.
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.
What should I know about DCVA?
If you are a veteran and have a question or concern about veterans’ health care benefits, contact DCVA.
Speak with an insurance agent that is licensed in Delaware about your Medicare questions.
Mon-Fri, 8am-6pm CT
Centers for Medicare and Medicaid Services
If you have general questions about Medicare in DE, or need help with current Medicare benefits.
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status