Medicare beneficiaries in Delaware may have the option to sign up for coverage under the Medicare Advantage (Medicare Part C) program, under which you would receive your Medicare benefits through a Medicare-approved private insurance company rather than through the federal government. Availability of Medicare Advantage plans may vary within the state of Delaware.
How Medicare Advantage works in Delaware
Medicare Advantage plans in Delaware are required to provide and administer your Original Medicare, Part A and Part B, benefits (except for hospice care, which Part a covers. This requirement applies to the rest of the United States as well. Some Medicare Advantage plans in Delaware may also offer additional benefits, like routine vision, hearing, and dental services, and in some cases even fitness programs. Many Medicare Advantage plans in Delaware offer prescription drug coverage as well.
To enroll in a Medicare Advantage plan in Delaware, you must already be enrolled or be eligible to enroll in Original Medicare, Part A and Part B. As a Medicare beneficiary in Delaware, you can enroll in Original Medicare during your Initial Enrollment Period – or you might get enrolled automatically. If you’re not automatically enrolled and don’t sign up when you’re first eligible, you may enroll in Original Medicare at a later date, during the General Enrollment Period, which runs from January 1 to March 31 each year, but you might have to pay a late-enrollment penalty.
You are able to switch Medicare Advantage plans in Delaware (as in any state) during the Annual Election Period, also called the Fall Open Enrollment Period, which runs from October 15 to December 7. Your new coverage then goes into effect on January 1 of the following year. You may also be able to switch Medicare Advantage plans in Delaware during Special Election Periods, if you qualify due to certain events. Those events include the loss of your current coverage, qualifying for other coverage, experiencing changes in your current plan that affect your health benefits, or moving to a new address where your old plan may not be available.
If you want to switch from Medicare Advantage back to Original Medicare, Part A and Part B, you may do so during the Medicare Advantage Open EnrollmentPeriod, which runs from January 1 to March 31 each year in Delaware and the rest of the United States. During this period you also can enroll in a stand-alone Part D Prescription Drug Plan if you dropped your Medicare Advantage coverage. You also can switch from one Medicare Advantage plan to another.
Types of Medicare Advantage Plans in Delaware
Before selecting a Medicare Advantage policy, it may be a good idea to review the types of Medicare Advantage plans available in Delaware. Here’s a look at the main types of existing health plans:
- Health Maintenance Organizations (HMOs): An HMO typically requires you to visit doctors, health-care providers, and hospitals listed in your plan’s network. You may also have to get a referral from your primary doctor to receive coverage for certain health services.
- HMO Point-of-Service (HMO-POS): An HMO-POS plan is usually more flexible than an HMO, sometimes letting you go out-of-network for a number of health services, but generally at a higher cost.
- Preferred Provider Organization (PPO)*: Under a PPO, you can generally benefit from even more flexibility than you would under an HMO-POS plan, by choosing doctors, health-care providers, and hospitals outside of your plan’s network, but usually at a higher out-of-pocket cost.
- Private Fee-for-Service (PFFS): A PFFS plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account, which you generally use to pay for your health-care expenses.
- Special Needs Plan (SNP): A Medicare SNP limits enrollment to people with special health needs, those living in institutions, and those who qualify for both Medicare and Medicaid. SNPs are generally tailored to suit the specific needs of each beneficiary, and they may include plans for patients with certain chronic illnesses such as (but not limited to) HIV/AIDS, chronic heart failure, or dementia.
- Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage into a single insurance plan.
You must still pay your Medicare Part B premium along with any premium the Medicare Advantage plan may charge.
Comparing Medicare Advantage plans available in Delaware
As a Medicare beneficiary living in Delaware, it may be a good idea for you to compare all Medicare Advantage plans available in your area.
The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. You may find that some Medicare Advantage plans in Delaware offer premiums as low as $0; but always keep in mind that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, in order to keep your Medicare insurance coverage.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, such as prescription drug coverage and routine dental services. With all these plan options in Delaware, you can see why it can be smart to compare plans with the benefits and costs suited for your individual health requirements. Note that not every type of Medicare Advantage plan may be available in your part of Delaware.
To start comparing Medicare Advantage plans in Delaware today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.
Access the following resources in order to get more information about Medicare insurance plans in Delaware:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.