Medicare Advantage in Delaware

Medicare Advantage was established in 1997 as an alternative to Original Medicare. It provides the same benefits as Part A and B in a single plan also known as Medicare Part C. These plans often cover other health products and services such as dental, vision, hearing and prescription drugs to provide greater value to Delaware seniors. Medicare Advantage Plans are managed by private companies and partly funded by the federal government. The government regulates the companies that provide this insurance. However, they do have a certain amount of control over costs such as copays, premiums, deductibles and other out-of-pocket expenses. The total amount that seniors are responsible for will depend on their plan and the type of coverage they prefer.

From 2022 to 2023, Delaware experienced a 17% surge in Medicare Advantage enrollees. This increase far surpasses the nationwide growth of 10%, indicating significantly higher enrollment in Delaware. Despite this, the state has one of the lowest Medicare Advantage enrollment rates, which may be due to its small population. Medicare Part C makes up 30% of all Medicare enrollments in Delaware. This is a slight increase from the 2022 figure of 27% but is significantly lower than the national average of 48%, a figure that has been growing steadily since the program began. 

This guide can help seniors in Delaware determine if Medicare Advantage is the right choice for their health care needs. It has information about coverage options, eligibility requirements, potential costs and how to enroll. 

The Top 5 Medicare Advantage Plans in Delaware

There are a number of companies that provide Medicare Advantage to seniors in Delaware. The top five providers based on total enrollments are listed below. Companies often have more than one plan available, so the minimum and maximum costs are listed. The table also shows the Medicare star ratings based on satisfaction surveys. These ratings range from 0 to 5 stars and change each fall before open enrollment for Medicare Advantage begins. This information is current as of August 2023. Seniors can visit Medicare.gov for the latest information about Part C plans in Delaware. 

How Medicare Advantage Plans Work in Delaware

Medicare Advantage plans are unique in every state, so it’s important for Delaware seniors to understand how Part C works for them. Private companies offer four types of plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS) and Special Needs Plans (SNP). Each plan type has a different balance of provider options, out-of-pocket costs and covered services to account for the needs of as many seniors as possible. 

What Medicare Advantage Plans Cover in Delaware

The Centers for Medicare and Medicaid Services will only certify a Medicare Advantage plan if it covers the same benefits as Original Medicare Parts A and B, except for hospice care. This includes inpatient hospital care, preventative screenings, durable medical equipment, home health care and more. Some seniors prefer Medicare Advantage because it bundles these benefits with additional coverage, such as vision, dental, prescription drugs, transportation and specialized health and wellness programs. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Delaware

Like Original Medicare, Medicare Advantage requires its members to be aged 65 or older or have a qualifying disability. Beneficiaries must also be U.S. citizens or documented immigrants. While some plans may be available statewide, other plans may only provide coverage for seniors in specific counties. Applicants will need to live in their provider’s service area to qualify, but some companies offer provisions for beneficiaries who live outside the service area for parts of the year. Delaware seniors will need to already have Parts A and B to switch to Medicare Advantage. Enrollment in these plans is only available during certain periods, which seniors can find listed below. 

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Delaware

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources