Medicare Advantage Plans in Delaware

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical) coverage and often include Part D (prescription drug coverage). Many plans also offer additional benefits such as routine dental, vision, hearing care, and fitness memberships.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65. However, those with certain disabilities, ALS, or ESRD may qualify earlier.

Enrollment is available during specific windows:

• Initial Enrollment: Starts 3 months before your 65th birthday month and ends 3 months after.
• General Enrollment: Jan 1 – Mar 31 (if enrolling in Medicare Part B during this time).
• Special Enrollment Periods: Triggered by events like moving, losing other coverage, or health condition changes.

What Types of Medicare Advantage Plans Are Available in Delaware?

Delaware offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require use of in-network providers and referrals for specialists.
• Preferred Provider Organizations (PPOs): Offer out-of-network care at higher cost, with no referrals typically needed.
• Private Fee-for-Service (PFFS) Plans: May allow any doctor who accepts plan terms; some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like cancer, diabetes, HIV/AIDS, or ESRD.
  • I-SNPs: For individuals living in institutions or needing nursing-level care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid; often include additional support and low/no costs.
• Medical Savings Accounts (MSAs): Pair a high-deductible MA plan with an insurer-funded savings account.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, some plan types differ:

• MSAs and some PFFS plans do not include Part D coverage, but allow purchase of a separate Part D plan.
• HMOs and PPOs without Part D generally do not allow you to buy a separate drug plan.
• If you delay drug coverage without other creditable insurance, you may owe a late enrollment penalty.

How Do You Choose a Medicare Advantage Plan?

Be sure to understand Medicare Advantage costs and review plan details including:

• Premiums: Many plans have $0 premiums, but all require you to pay your Medicare Part B premium.
• Deductibles, Coinsurance & Copays: You’ll need to pay a share of medical costs depending on your services.
• Out-of-Pocket Maximums: This yearly cap limits how much you’ll spend on covered services.
• Extra Benefits: Look for plans offering dental, hearing, vision, telehealth, gym memberships, and OTC allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment Period: 3 months before and after your 65th birthday
• Annual Open Enrollment (Oct 15–Dec 7): Switch, join, or drop a plan
• General Enrollment (Jan 1–Mar 31): For those who start Part B during this time
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch plans or return to Original Medicare
• Special Enrollment Periods: Triggered by:
  • Changing residence outside your plan’s service area
  • Losing employer/union coverage
  • Qualifying for Medicaid or a chronic condition plan
  • Your plan being terminated by Medicare

What If You Want to Change Your Medicare Advantage Plan?

You may change your plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

What Are Medicare Resources in Delaware?

Delaware provides the following helpful programs:

• Delaware Medicare Assistance Bureau (DMAB): Offers free Medicare counseling. Call 1-800-336-9500 for guidance.
• Delaware SMP Program: Educates beneficiaries on healthcare fraud prevention.
• Delaware Department of Insurance: File insurance-related complaints.
• Delaware Medicaid: Assists low-income individuals. Apply online or call 1-866-843-7212.

Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also known as Medigap, help cover deductibles, copays, and coinsurance from Original Medicare.

• You must be enrolled in Medicare Parts A and B to buy a Medigap plan.
• The best time to enroll is during your six-month Medigap Open Enrollment Period, when coverage is guaranteed.
• Plans do not cover prescription drugs—you’ll need a separate Part D plan.
• There are 10 standardized plans. Medicare Supplement Plan G is the most popular in 2023.
• Plan F is no longer available to those newly eligible for Medicare.
• Medigap plans offer predictable costs and access to Medicare providers nationwide without referrals.

Learn more about Medicare Supplement plans in Delaware.

Next Steps

If a Medicare Advantage plan in Delaware seems right for you, compare available plans in your ZIP code. Look at provider networks, out-of-pocket costs, prescription drug coverage, and added benefits. Be prepared to enroll during your next eligible window.