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Medicare Options in Delaware

Medicare is a government-run health insurance program that provides coverage for a wide range of medical costs. Medicare and Medicaid are administered by the Department of Health and Human Services (HHS) in CMS.

The elderly population of Delaware is among the ten highest in the country. Delaware’s Medicaid program provides coverage for both the elderly and the disabled (including people with ALS or ESD). More than 86% of Delaware residents are eligible for Medicare because they are at least 65 years old, compared to just 14% who qualify because of a disability.

To keep up with escalating healthcare costs, it is essential that you choose an insurance plan that is both affordable and comprehensive. Learn more about different Delaware Medicare plans and how a licensed Medicare insurance agent can help you find the right one.

An elderly couple holding insurance documents

Original Medicare

This is the standard Medicare that is governed by federal law. Original Medicare includes Parts A and B. Medicare Part A focuses on hospital coverage. This includes inpatient care, hospice care, and some home care and specialist nursing homes.

Medicare Part B deals with medical coverage. It covers outpatient care, preventive care, doctor’s appointments, and medical equipment. Immunization and screening that help you stay healthy and stave off disease are also part of this plan.

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Since the early 2000s, Medicare Advantage membership has seen a steady increase. Even though Original Medicare is less popular in many states, it is still the preferred plan for Delaware residents. Four out of every five Medicare enrollees in Delaware choose Original Medicare.

Medicare Supplement (Medigap) Plans in Delaware

There is no cap on out-of-pocket expenses under Original Medicare, so most beneficiaries choose to carry supplemental coverage. Medicare Supplement or Medigap plans in Delaware are designed to cover some or all the out-of-pocket payments that Medicare members would otherwise bear.

Medicare Advantage plans are widely available in Delaware, even if most eligible Medicare enrollees do end up choosing Original Medicare. As of 2028, you can select from 28 different Medicare Advantage plans, depending on where you reside.

There are 33 Medigap insurers in Delaware. To help consumers make informed decisions about Medigap insurance, the state has a Medigap shopper’s guide that includes a wealth of information. Alternatively, you can discuss your options with a Medicare insurance agent.

Delaware Medigap for People Younger than 65

Even if you’re disabled and under 65 and qualified for Medicare, federal rules don’t guarantee that you’ll be able to enroll in a Medigap plan. States, on the other hand, are free to enact their own laws. Delaware passed a law in 2013 that allows a six-month guaranteed Medigap window for people eligible for Medicare due to a disability, regardless of their age.

Under Senate Bill 42, Delaware health insurers who provide Medicare supplement policies for 65+ people must also offer those policies to people younger than 65. Premiums for persons younger than 65 tend to be more expensive.

Since most beneficiaries younger than 65 are enrolled due to a health condition, carriers increase their rates to account for the higher loss ratio. This makes Medicare supplement plans more expensive and explains why many people in Delaware prefer Medicare Advantage plans.


Delaware Medigap for People Younger than 65

Delaware Medicare Advantage Plans (Part C)

Though Delaware Medicare Supplement plans offer the most extensive coverage; beneficiaries can also go for Medicare Advantage plans in Delaware. Medicare Advantage plans are offered by private organizations that contract with Medicare. The best copays are only available if you agree to use the plan’s network of physicians and hospitals.

There are four types of Medicare Advantage plans in Delaware:

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Health Maintenance Organization (HMO)

Most HMOs mandate that you use only in-network providers for all healthcare services:

  • You require a PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions.
  • Plans typically provide drug coverage.
  • You can’t purchase separate drug coverage.
  • Costs are lower if you stick to the provider network.

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended network of providers, but you can always choose out-of-network doctors or healthcare facilities for a higher price.

  • No PCP or specialist referral requirement.
  • Most plans cover prescriptions.
  • You cannot purchase drug coverage separately.
  • Higher out-of-network charges and premiums.

Private Fee-For-Service (PFFS)

PCPs and specialist referrals aren’t necessary under PFFS programs:

  • You can consult any Medicare-approved doctor or healthcare facility, provided that they agree to the plan’s terms.
  • Drug coverage may be included or purchased separately.
  • You’ll pay more to consult a provider who doesn’t agree with the plan’s terms.

Special Needs Plan (SNP)

SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:

  • You require a PCP and specialist recommendations.
  • Plans always include drug coverage.
  • Anybody who meets the eligibility criteria can join SNPs at any point in time.

Delaware Medicare Part D

Medicare Parts A and B do not cover outpatient prescription medication. Medicare enrollees can obtain prescription coverage through Medicaid plans, their employer, or through Medicare Part D.

As of 2018, there were 158,715 Delaware residents enrolled in Medicare Part D. Stand-alone Medicare Part D enrollment tends to be higher in locations where Medicare Advantage membership is lower.

Note: You don’t have the option of enrolling in Medicare Part C and Part D at the same time. You must choose one of them.

Delaware Prescription Assistance Program (DPAP)

Low-income residents of Delaware can get up to $3000 in annual prescription drug assistance through the Delaware Prescription Assistance Program. Those who qualify for the program will incur a small copay and must be enrolled in Part D.

Part D drug coverage can be purchased from a wide range of providers. Our Medicare insurance agents can help you compare Part D plans to ensure that you get the best deal possible.


A Medicare insurance agent talking to a client
An elderly person talking to a Medicare insurance agent

Comparing Medicare Advantage Plans in Delaware

By 2020, 38,759 Delaware residents had enrolled in Medicare Advantage, accounting for nearly 21% of the state’s total population. With so many options available, you want to make sure you choose one that covers all your healthcare needs.

Consider the following factors when evaluating your Medicare options:

Provider Network

Some Medicare plans mandate that you only use the providers in the plan’s network. Otherwise, you’ll pay for your own medical care and those expenses may be higher than if you stuck to the provider network. To avoid high medical expenses, check if your doctors and hospitals are in the network.

Amount of Coverage Required

Do you have any specific goals in mind for your Medicare plan? Medicare Advantage and Medigap plans often include additional dental, vision, and hearing benefits that aren’t covered by the original Parts A and B. Try keeping a list of benefits ready so that you can choose a plan that meets all your requirements.

Check Plan Ratings

With the dozens of plans with similar coverage and prices on the market, comparing plans can get overwhelming. The Centers for Medicare & Medicaid Services (CMS) releases Part C and Part D performance data every year. Make sure you check these ratings before open the enrollment period begins.

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Out-of-Pocket Expenses

These are the expenses that you are responsible for. Out-of-pocket costs include deductibles, copayments, and coinsurance. This is the most you’ll have to pay if you stay within the service provider network. You can use our plan finder tool to learn more about the costs of different plans in your area.

Monthly Premium

Medicare Advantage and Supplement plan premiums are an additional expense because you’re required to pay the Part B deductible even if you don’t use your benefits. So, having at least one zero-premium plan with reasonable prescription coverage in your area is essential to keeping your costs down.

For beneficiaries under 65 years of age, this is a key consideration when you’re deciding between Medicare Part C and Medigap plans. Since the latter have higher premiums, you might want to discuss with your Medicare insurance agent which one is better for you.

Drug Coverage

Take a look at the policy’s formulary to find out if your prescriptions are covered and how much they will cost. Ask your doctor if they can advise an alternative or generic option for a medicine that is not on the list.

Deductibles, Coinsurance & Copays

You pay these costs when you use your Medicare benefits. Make sure you are aware of all your plan’s hospital and medical coverage details before enrolling. This includes everything from doctor’s visits to medicines.

Freedom to Travel

Delaware residents who frequently travel outside of the state prefer travel plans that offer travel courage. Medicare plans often require that you stick to their provider network, while Medigap policies allow you to receive treatment anywhere you are. Find out how much travel coverage you need before deciding on a plan.

Medicare Eligibility in Delaware

You must be at least 65 years old to be eligible for Medicare benefits. In Delaware, people under 65 can also apply for Medicare supplement policies. Patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), also qualify for Medicare at any age.


An elderly person holding Medicare insurance document

Medicare Enrollment in Delaware

Medicare will register you automatically if you have received at least four Social Security or Railroad Retirement Board payments before your 65th birthday. Otherwise, you can apply online or mail your application to your local Social Security Office. We recommend going the online route since it is a much quicker process.

Enrollment in Medicare is open during the following time frames:

Initial Enrollment

This is a 7-month window beginning three months before your 65th birthday and ending three months after it. If you enroll before 65, your coverage will begin during your birthday mon

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Note: If you fail to enroll in Part D within this period and don’t have creditable prescription drug coverage, you will be subject to a lifetime Part D late penalty. Late enrollment in Part D can result in a penalty, even if it is optional.

General Enrollment

From January 1 to March 31, you get another chance to sign up for Original Medicare, Medicare Advantage, and Part D Plans. If you enroll later than the deadline, you may be charged a late fee.

Open Enrollment

You get a 3-month window from October 15 to December 7 each year when you can switch between Original Medicare and Medicare Advantage Plans or make changes to your current plan. You can also sign up for a Part D plan during this period.

Special Enrollment

If you lose your insurance coverage or your eligibility changes due to unforeseen circumstances (such as job loss, moving to an out-of-coverage location, etc.), you may be eligible for a special enrollment period.


How to protect your retirement income in Delaware Annuity

An annuity is an important tool for protecting your retirement income in Delaware. Whether you’re close to or far from retirement, an annuity can help ensure that your money lasts as long as you do. Annuities are investments that provide a steady stream of income for as long as you live, with no risk of outliving your savings. They come in a variety of forms and types, so it’s important to find the one that best suits your individual needs. 

The first step in choosing the right annuity is to understand your options. Traditional fixed-rate annuities are a popular choice because they offer stability and predictable returns without much volatility or risk. Variable rate annuities allow you to invest in different underlying securities, but the returns are not guaranteed and they are very expensive. Finally, fixed-indexed annuities offer the potential for growth while providing downside protection and a guaranteed minimum return. 

Once you understand your options, it’s important to compare annuity providers and their features. It is also essential that you understand all of the terms and conditions associated with each provider before signing an agreement. Be sure to consider factors such as fees, commissions, guarantees, and surrender charges when making your decision.

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To protect your retirement savings in a fixed-indexed annuity, it’s important to monitor the performance of your investments on a regular basis. Make sure to review any changes in fee structures or investment strategies over time to ensure that they are still suitable for your needs. Additionally, you should look for features such as downside protection and a guaranteed minimum return. This will ensure that your investments are secure in the event of any market volatility or downturns. 

Finally, it is important to understand how accidental death benefits work with fixed-indexed annuities. These benefits provide additional security for you and your family, offering financial support if something were to happen to you. Be sure to inquire about this feature when shopping for an annuity provider and make sure that the terms are clearly outlined in the contract before signing. 

By being well-informed of your options and understanding all of the terms associated with investing in a fixed-indexed annuity, you can protect your retirement savings while also maximizing long-term returns. Investing in a fixed-indexed annuity can offer peace of mind, security, and stability for you and your family’s financial future.


Why Should You Choose Medicare Hope Insurance Agents?

The Medicare Insurance Agents at Integrity Now Insurance Brokers are certified annually by America’s Health Insurance Plan (AHIP). Our years of experience and expertise allow us to take care of all your Medicare Insurance needs. We work with the elderly, youth with disabilities, and others who need help taking care of their healthcare expenses.

Insurance plans for seniors are constantly being added to the Medicare marketplace. Existing plans also see updates and reductions. You don’t have to worry about keeping track of all these changes. We’ll handle it for you.

A Medicare insurance agent in Delaware will review your healthcare needs and weigh all your options. This includes figuring out if a Medicare Supplement Plan or a Medicare Advantage Plan is best for you.

A senior enrolling for Medicare online

With our guidance, you can compare quotes and find the best Medicare insurance plan for your needs. We have all the information you need to get started on debt-free and stress-free living.

Call us to speak with one of our representatives and get started today!

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