Medicare is government managed health insurance that you can get when you turn 65. Medicare in Delaware is also available to people under the age of 65 who meet certain criteria.
Medicare includes five parts:
- Part A – hospital care
- Part B – outpatient care
- Part C – Medicare Advantage (MA)
- Part D – prescription drugs
- Medigap – coverage for out-of-pocket costs
You get different parts of Medicare through different insurance payers (or carriers):
- Part A & Part B (original Medicare) through the federal government
- Part C & Part D through private insurance
- Medicare supplemental insurance (Medigap) through private insurance carriers
What it covers
Each part of Medicare covers different things.
- Part A covers care you receive in a hospital or hospice, and also includes limited coverage for short-term skilled nursing facility (SNF) care, and some part-time home health care services.
- Part B covers outpatient care, such as doctor’s visits, preventive care, and screenings like annual wellness visits or vaccines, and some durable medical equipment.
- Part C bundles your coverage for Part A and Part B into a single plan that may include other benefits, such as dental or vision coverage. These plans often include Part D prescription drug coverage as well.
- Part D covers some or all of your prescription drug costs outside of a hospital (medication you get during a hospital stay is covered under Part A).
- Medigap plans covers out-of-pocket costs like copays and coinsurance that original Medicare plans don’t and are available through private insurance carriers. You may not purchase both Part C and Medigap. You must choose type one or the other.
Medicare plans in Delaware have certain costs that you pay for coverage and care.
Part A is available without a monthly premium as long as you or a spouse worked for 10 or more years in a job and paid Medicare taxes. You can also purchase coverage if you don’t meet eligibility requirements. Other costs include:
- $1,408 deductible each time you are admitted to the hospital
- Additional costs if your hospital or SNF stay exceeds 60 or 90 days
Part B has several fees and costs, including:
- $144.60 monthly premium
- $198 annual deductible
- Copays and 20 percent coinsurance after your deductible is paid
If you cannot afford it, Delaware has financial assistance programs that may help you pay these Part B costs.
Part C plans may have a premium for extra benefits that are available through the plan. You also still pay the Part B premium.
Part D plan costs vary based on coverage.
Medigap plan costs vary based on the plan you choose.
Medicare Advantage and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).
Medicare Advantage plans are approved by the Centers for Medicare and Medicaid Services (CMS) and are available through private insurance companies. Benefits include:
- All your benefits from each part of Medicare are covered under a single plan.
- They offer other benefits that original Medicare does not include, such as dental, vision, hearing, transportation to medical appointments, or home meal delivery.
- They have out-of-pocket maximums of $6,700 (or less). You’ll pay monthly premiums, an annual deductible, and coinsurance until you reach the maximum, then the plan covers the rest of your costs for the year. Original Medicare does not have an out-of-pocket max.
There are five types of Medicare Advantage plans in Delaware:
Health Maintenance Organization (HMO)
- You choose a primary care provider (PCP) who coordinates your care.
- You must use providers and facilities within the HMO’s network.
- Usually you need a referral from your primary care provider (PCP) to see a specialist.
- Care outside the network is usually not covered except in emergencies.
Preferred Provider Organization (PPO)
- Care from doctors or facilities within the plan’s PPO network is covered.
- Care outside the network may cost more, or may not be covered.
- You do not need a referral to see a specialist.
Medical Savings Account (MSA)
- These plans combine a high deductible health plan and savings account.
- Medicare contributes a certain amount of money each year to cover expenses (you can add more).
- MSAs can only be used for qualified medical expenses.
- MSA savings are tax-free (for qualified medical expenses) and earn tax-free interest.
Private Fee-for-Service (PFFS)
- PFFS are plans with no network of doctors or hospitals; you can choose to go anywhere that accepts your plan.
- They negotiate directly with providers and determine how much you owe for services.
- Not all doctors or facilities accept these plans.
Special Needs Plan (SNP)
- SNPs were created for people who need more coordinated care and meet certain qualifications.
- You must be dual-eligible for Medicare and Medicaid, have one or more chronic health conditions, and/or live in a nursing home.
Available plans in Delaware
- Aetna Life Insurance
- Bravo Health Mid-Atlantic
- Sierra Health and Life Insurance
- Humana Insurance
- Cigna Health and Life Insurance
- UnitedHealthcare Insurance
- LIFE at St. Francis Healthcare
Not all plans are available everywhere in Delaware, so your choices may vary depending on where you live.
To be eligible for Medicare, you must be:
- 65 years or older
- a U.S. citizen or a legal resident for five years or more
If you are younger than 65, you can get Medicare plans in Delaware if you:
- have a kidney transplant or end stage renal disease (ESRD)
- have amyotrophic lateral sclerosis (ALS)
- have been receiving Social Security or Railroad Retirement benefits for 24 months
You can use Medicare’s tool to see if you’re eligible.
To receive Medicare or Medicare Advantage you must enroll at the correct time.
- Initial enrollment period (IEP) is a seven-month window around your 65th birthday, starting three months before and continuing for three months after your birthday. If you sign up before you turn 65, your coverage begins in your birthday month. Signing up after this period will mean a delay in coverage.
- Special enrollment periods (SEP) are designated times when you can sign up outside of open enrollment if you lose coverage for various reasons, including losing an employer-sponsored plan or moving outside of your plan’s coverage area.
- General enrollment (Jan. 1-March 31): If you did not sign up for Medicare during your IEP, you can enroll in Part A, Part B, Part C, and Part D plans. You may pay a penalty for signing up late.
- Medicare Advantage open enrollment (Jan. 1-March 31): You may switch to a new plan if you are already on Medicare Advantage or you can continue with original Medicare.
- Open enrollment (Oct. 15-Dec. 7): You may switch between original Medicare and Medicare Advantage, or sign up for Part D if you didn’t sign up during your IEP.
Choosing the right plan for depends on the following factors:
- your healthcare needs
- projected expenses
- which doctors (or hospitals) you want to see for care
You can find answers to your Medicare Delaware questions from these organizations:
Delaware Medicare Assistance Bureau(800-336-9500)
- the state Health Insurance Assistance Program (SHIP), formerly known as ELDERinfo
- free counseling for people with Medicare
- local counseling sites throughout Delaware (call 302-674-7364 to find yours)
- financial assistance to help pay for Medicare
- serves as the official Medicare site
- has trained staff on calls to help answer your Medicare questions
- has a plan finder tool to help you find available Medicare Advantage, Part D, and Medigap plans in your area
Here are your next steps to find the best Medicare coverage to meet your needs:
- Determine whether you want original Medicare or Medicare Advantage.
- Choose a Medicare Advantage or Medigap policy, if applicable.
- Identify your enrollment period and deadlines.
- Collect documentation such as a list of the prescription medications you take and any medical conditions you have.
- Ask your doctor if they accept Medicare, and which Medicare Advantage network they belong to.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline does not recommend or endorse any third parties that may transact the business of insurance.