Medicare Plan Options

Original Medicare provides good basic coverage if your health needs are minimal, but it’s not enough coverage for everyone. Fortunately, you have a few options for customizing your coverage to better fit your needs. Private insurance companies contract with the federal government to provide prescription drug coverage and supplemental plans to give you more control over health care costs. Delaware’s Medicare Advantage program is an all-in-one alternative that provides a broader scope of coverage.

Original Medicare

Original Medicare is the health insurance plan administered by the federal government. With this program, you pay a deductible at the beginning of each year. After you meet your deductible, the plan pays 80% of covered services and you pay the rest, which is known as coinsurance. In most cases, you can go to any health care provider that’s enrolled in Medicare and accepting new patients. You don’t need to choose a primary doctor and you usually don’t need a referral to set up an appointment with a specialist. Most prescription drugs aren’t covered under the base plan, and there are no annual out-of-pocket limits.

Medicare Advantage Plans

Medicare Advantage Plans are an alternate way for you to get the hospital and medical coverage that Original Medicare provides. While Original Medicare is administered by the federal government, private health insurance companies that agree to Medicare’s rules provide Medicare Advantage Plans. These plans provide all the benefits included in Original Medicare, along with additional benefits, such as prescription drug coverage, health club memberships, and vision and dental coverage. You still pay the Part B premium and depending on your plan, you may have an additional premium. Most plans have annual out-of-pocket limits, and many have $0 deductibles.

Medicare Prescription Drug Coverage Plans

Even if you don’t rely on prescription medications when you first sign up for Medicare, it’s generally a good idea to purchase this coverage when you first become eligible for Medicare to avoid late enrollment penalties. These plans are provided by private health insurance companies and pay for medications that your doctor prescribes. When signing up for a prescription drug plan, pay attention to monthly premiums, deductibles, and drug formularies, which determine whether a medication is covered and what portion of the cost you pay out of pocket.

Medicare Supplement Insurance Plans

Medicare Supplement Insurance Plans, also called Medigap, are private health insurance plans that fill in the gap between the health coverage you need and what’s covered under Original Medicare. These plans cover your portion of the cost of the health services you receive, such as coinsurance, copays, and deductibles. There are several policies available but coverage is standardized, making it easy to compare plans. For example, all Plan K policies cover 50% of the Part B coinsurance, and all Plan L plans cover 75% of the coinsurance for skilled nursing services. To get this coverage, you have to be enrolled in Parts A and B.

Medicare in Delaware by the Numbers

People enrolled in Original Medicare Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
174,261 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$9,823 -3.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Delaware

Medicare can help you control your medical costs and ensure that health care expenses aren’t financial setbacks that negatively affect your retirement years. To take the guesswork out of choosing the best policy for your needs, Delaware has several public and nonprofit agencies and programs that can help you compare plans, complete the enrollment process and determine whether you qualify for income-based cost-saving programs.

Delaware Department of Insurance

The Delaware Department of Insurance oversees insurance policies sold in the state and investigates consumer complaints regarding unfair claims processing. The department operates the Delaware Medicare Assistance Bureau, which provides free, impartial health insurance options counseling for those who qualify for Medicare. Through the program, you can speak with a trained volunteer who can answer questions about your Medicare benefits and available Medicare Advantage and Medicare Supplement Plans. Volunteers can also help you find a prescription drug plan that fits your needs and budget, determine whether you qualify for Medicare Savings Programs, or resolve medical or health insurance billing errors.

Contact Information: Website | 800-36-9500

Division of Services for Aging and Adults with Physical Disabilities

The Division of Services for Aging and Adults with Physical Disabilities plans and administers a broad range of programs for Delaware residents aged 60 and over. It provides services through local Aging and Disability Resource Centers, each of which serves a designated region of the state. Through your local center, you can speak with a DMAB advisor for free health care options counseling, which can help you find the right Medicare plan for your needs.

Contact Information: Website | 800-223-9074

The Community Legal Aid Society is a nonprofit legal organization that provides advocacy, advice, and representation for qualifying Delaware residents. Its legal professionals provide one-on-one assistance with obtaining Medicare and Medicare Savings Programs. They can also help you resolve issues regarding your coverage, such as denied claims or canceled policies.

Contact Information: Website | 800-292-7980

Delaware Senior Medicare Patrol Program

The state’s Senior Medicare Patrol program provides you with information on how to protect yourself from Medicare fraud. Its volunteers can help you review your medical bills and identify double charges or charges for services you didn’t obtain.

Contact Information: Website | 800-223-9074

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