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Delaware Medicare Guide

Medicare doesn’t have to feel overwhelming
Speak with a Licensed Advisor

We’re here to help you:

Explore your options

Compare options, including Medicare Advantage, Medicare Supplement, and prescription plans.

Enroll in Medicare

Get the help you need to enroll in Medicare, from Original Medicare to supplemental coverage.

Use your coverage

Receive extended support to help you use your plan effectively, find doctors, and get savings.

This Delaware Medicare guide will help you understand when to enroll, how to enroll, what your options are, and how to get the most from Medicare.


We’re here to help! Get free, personalized advice from independent Delaware Medicare agents who care. Schedule a free consultation or give us a call at (888) 604-0055 to get started.


Use this table of contents to jump to specific sections:


Snapshot of Medicare in Delaware

There are 223,000 Medicare beneficiaries in Delaware, making up 22% of Delaware’s total population. While most people age into Medicare, about 11% are on Medicare because they have a disability. 15% of Delaware’s Medicare beneficiaries also receive support from Delaware Medicaid. When it comes to Original Medicare vs. Medicare Advantage, 77% of Delaware residents choose Original Medicare and 23% choose Medicare Advantage.


Delaware Medicare Advantage Plans

There are 23 Medicare Advantage (MA) plans available to all Delaware residents in 2023. These plans replace Original Medicare, and therefore must provide at least the same coverage. To attract customers, Medicare Advantage plans often provide more. They almost always include prescription drug coverage and can also include extra benefits, like:

  • Dental, vision, and hearing care

  • Flex cards

  • Meal services

  • Fitness perks

  • Transportation services


These added benefits often come with low or no added premium (Medicare Advantage enrollees must still pay their Original Medicare premiums). Medicare Advantage plans also have their disadvantages though. People often complain about:

  • Limited provider networks

  • Prior authorization requirements

  • High out-of-pocket costs 


Original Medicare doesn’t cover about 20% of costs for covered services. It also doesn’t have an out-of-pocket maximum. This means that if you only have Original Medicare, you could owe thousands of dollars for covered services—with no upward limit! To avoid sky-high healthcare expenses, many Medicare recipients choose to either replace Original Medicare with a Medicare Advantage plan or add Medicare Supplement to their Original Medicare coverage.


Delaware Medicare Supplement Plans

There are ten types of Medicare Supplement (also called Medigap) plans, labeled by letters A through N. These plans help to significantly reduce your out-of-pocket costs, saving you money and making your budget more predictable. Every plan of the same type (e.g., every Plan K) is identical, even though pricing may vary. 


Compared to Medicare Advantage plans, Medigap plans have some big benefits, like:

  • No networks - you can see any doctor who accepts Medicare nationwide

  • No prior authorization requirements for covered services

  • Lower out-of-pocket costs - for example, if you have a Plan G, you owe nothing else once you’ve met your Part B deductible


It’s best to enroll in a Medigap plan during a guaranteed issue period. During guaranteed issue periods, you are guaranteed acceptance into any Medigap plan. Furthermore, insurance companies cannot ask you questions about your health history and cannot charge you more based on your health history during these periods. Everyone has a guaranteed issue period called your Medigap Open Enrollment Period for the first six months that they have Part B coverage. Outside of the Medigap Open Enrollment Period, there are a handful of other guaranteed issue periods based on specific scenarios. 


Delaware Prescription Drug (Part D) Plans

Original Medicare does not include prescription drug coverage. Most Medicare Advantage enrollees receive prescription coverage from their plans. Delaware Original Medicare beneficiaries can enroll in a stand-alone prescription drug plan. There are 24 Delaware Part D plans ith an average monthly premium of $30.65.


If you aren’t taking prescriptions when you first enroll in Medicare, we recommend that you enroll in a low-cost drug plan. This will help you avoid the Medicare Part D penalty later!


If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Delaware Medicare Advisors or give us a call at (888) 604-0055. 


Get help paying for Medicare in Delaware

There are three government programs that can help Medicare beneficiaries with low incomes pay for their health-related expenses. 


Medicaid

Medicaid works with Medicare to provide access to care for low-income Americans. Delaware provides low-income seniors with:


The three Medicare Savings Programs that Delaware offers are:

  1. The Qualified Medicare Beneficiary (QMB) Program pays for Medicare Part A and B premiums, deductibles, and coinsurance. To qualify, your income must be at or below 100% of the Federal Poverty Level (FPL). 

  2. The Specified Low Income Medicare Beneficiary (SLMB) Program pays for members’ Part B premium. To qualify, your monthly income must be at or below 120% of the FPL.

  3. The Qualified Individual-1 (QI-1) Program pays for members’ Part B premium. To qualify, your monthly income must be at or below 135% of the FPL.


Learn more about getting help from Delaware as a Medicare beneficiary here. And reach out to us if you need help determining if you’re eligible and applying for any Delaware programs.


Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.


You automatically qualify for Extra Help if you:

  • Receive full Medicaid coverage from Delaware

  • Delaware pays your Part B premium

  • Are eligible for Supplemental Security Income (SSI)


If you don’t automatically qualify for Extra Help, you may still be eligible. Talk to one of our licensed Delaware Medicare Advisors to get free support with your application.


Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:


You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.


Delaware Medicare Eligibility and Enrollment Steps

Medicare eligibility is the same across the US. You’re eligible for Medicare if you’re a US citizen who meets one of the following criteria:

  • You’re 65 or older

  • You have certain disabilities, like End-Stage Renal Disease or ALS


Three key steps for Delaware Medicare enrollment:

  1. Enroll in Original Medicare (Part A & Part B)

  2. Choose your supplemental coverage options

    1. Medicare Supplement (Medigap)

    2. Medicare Advantage (Part C)

    3. Part D (drug coverage)

  3. Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.


Due to its multiple parts and supplemental options, Medicare can feel overwhelming, but it doesn’t have to! One of our Delaware Medicare Advisors would be happy to answer any questions you have, help you understand and compare your options, and guide you through enrollment. Get started by scheduling your free consultation or calling us at: (888) 604-0055.


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