Ranked as the fifth state in the United States with the highest proportion of retirement-age residents, there’s no wonder why more than 22% percent of Delaware’s total population is enrolled in Medicare. Medicare plays a key role in providing health and financial security to beneficiaries residing in Delaware. With more than 212,600 Delaware beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Delaware. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Delaware?

Medicare covers most Delaware residents who are 65 or older, and it also covers disabled Delaware residents. In general, Medicare enrollment in Delaware works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Delaware Medicare Enrollments

172,591

Original Medicare Plans
(Part A and B)

40,012

Medicare Advantage & Other Health Plans

161,173

Stand-alone Medicare
Part D (Drug plans)

212,603

Total Medicare Beneficiaries
in Delaware

Delaware Medicare Advantage Plans (Part C)

Only 16% of Delaware Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Delaware who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 19 Medicare Advantage plans are available in Delaware. The average monthly Medicare Advantage premium in Delaware changed from $26.61 in 2020 to $21.64 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Delaware. 100% of people with Medicare have access to a Medicare Advantage plan.

According to CMS, as of May 2020, there are 40,012 beneficiaries enrolled in Medicare Advantage and other plans in Delaware. This figure equates to about 16% of Delaware’s Medicare population, so Original Medicare seems to be much more popular for beneficiaries in the state.

Delaware Medicare Supplement (Medigap) Insurance Plans

Most Medigap insurers in Delaware use attained-age rating, which means that premiums increase as beneficiaries get older.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

According to the Delaware Medicare Assistance Bureau, as of 2020, there are currently 23 insurers in Delaware that offer Medigap plans.

Trinidad Navarro, Insurance Commissioner at the Delaware Medicare Assistance Bureau says, “Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. As a result, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.”

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B

During this period, an insurance company can’t use medical underwriting.

Delaware Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, there are 130,836 Medicare beneficiaries in Delaware enrolled in stand-alone Part D plans and 30,918 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 27 stand-alone Part D plans available in Delaware, with premiums ranging from about $13 to $80 per month. Nearly 95% of people with a stand-alone Medicare prescription drug plan have access to a plan with a lower premium than what they paid in 2019. About 23% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different.

Delaware Prescription Assistance Program (DPAP)

The Delaware Prescription Assistance Program (DPAP) helps pay for prescription medications for elderly and/or disabled individuals who cannot afford the full cost of filling their doctor’s prescriptions. The program is designed to aid eligible individuals who have no prescription insurance other than Medicare Part D, and whose income is at or below 200% of the Federal Poverty Level (FPL), or whose prescription costs exceed 40% of their income.

DPAP provides eligible individuals with up to $3,000 per year toward medically necessary prescription drugs and Part D premiums. The program doesn’t pay for diabetic supplies for Medicare recipients. Medicare provides this coverage under the Medicare Part B benefit. Clients must make a co-payment of 25% of the cost of the prescription, or a minimum of $5. The copay is collected by the dispensing pharmacy. The pharmacy submits a claim to DPAP and is reimbursed directly. Learn how you can save money on out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Medicare Health Plan Resources in Delaware

  • Delaware Medicare Assistance Bureau (DMAB): DMAB, formerly known as ELDERinfo, provides free health insurance counseling for people with Medicare, including those under 65 years of age, including counseling and assistance on questions and problems related to Medicare, Medicaid, Medigap (Medicare supplement insurance), Medicare Part D, long-term care insurance and other types of health insurance. There is no charge for the service.
    Contact: Call 1-800-336-9500 or (302) 674-7364 to set up a free counseling session with a trained volunteer at a convenient site near you.

  • Delaware Prescription Assistance Program (DPAP): DPAP is funded by tobacco settlement money. The goal of DPAP is to help pay for prescription medications for elderly and/or disabled individuals who cannot afford the full cost of filling their doctor’s prescriptions. The program is designed to aid eligible individuals who have no prescription insurance other than Medicare Part D, and whose income is at or below 200% of the Federal Poverty Level (FPL), or whose prescription costs exceed 40% of their income.
    Contact: Call (800) 996-9969 or visit www.dhss.delaware.gov/dhss/dmma/dpap.html

  • Delaware Senior Medicare Patrol Program is a program that provides public information to encourage Medicare beneficiaries to carefully read their Medicare summary notices and ask questions if they do not think the information is correct.
    Contact: The Delaware Senior Medicare Patrol Program can be accessed through the department website.

  • Delaware Aging and Disability Resource Center (ARDC): ARDC The Delaware Aging and Disability Resource Center (ADRC) is a one-stop access point for information and services for older persons and adults with physical disabilities throughout the State. The ADRC, operated by the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD), was established in October 2010 through a grant from the Administration on Aging. It is part of a nationwide network of ADRC’s. DSAAPD receives a great deal of support in the operation of the ADRC from partner organizations.
    Contact: Call 1-800-223-9074 or email [email protected]

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Delaware. Our process makes it easier for you to access your Medicare eligibility in Delaware so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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