Medicare Advantage Plans in Delaware
Key Takeaways
- With a 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). plan, you can enjoy the same benefits as Original Medicare plus additional benefits like dental, vision and hearing coverage.
- Medicare Advantage plans may be more cost-effective than Original MedicareOriginal 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). . Costs vary between plans.
- If you’re enrolled in Original Medicare, you’re eligible for a Medicare Advantage plan.
- Most Medicare Advantage plans in Delaware have prescription drug coverage.
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.
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Delaware Medicare Advantage Plan Coverage
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
- Medically necessary treatment and care
- Preventative services
- Lab tests and screenings
- Doctor’s visits
- Outpatient hospital care
- Ambulance services
- Durable medical equipment
- Vision coverage
- Dental coverage
- Hearing coverage
- Prescription drug coverage
- Transportation services
- Fitness memberships
DE Medicare Advantage Plan Costs
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.
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Types of Medicare Advantage Plans
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.
Medicare Advantage Plan Eligibility & Enrollment in Delaware
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.
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.
Are there Delaware Medicare Advantage Plans with Prescription Drug Coverage?
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.
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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.
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
Sources
- FACT SHEET. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.