Know your options for Medicare Advantage Plans in Delaware and find out how to enroll.
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Medicare is a federal program to provide health insurance for people aged 65 and over or younger people with a qualifying disability or illness. When you become eligible for Medicare, you can choose to get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
Medicare Advantage Plans, also referred to as Medicare Part C, are bundled plans designed to be an all-in-one alternative to Original Medicare. MA Plans provide the same coverage as Medicare Parts A and B, and often include Part D prescription drug coverage as well as other benefits Original Medicare does not provide, such as hearing and dental coverage. Offered by private, Medicare-approved insurance companies, the benefits and cost will vary among Medicare Advantage Plans.
Read this guide to learn everything you need to know about Medicare Advantage Plans in Delaware.
Compare ratings of insurance companies offering Medicare Advantage Plans in Delaware:
Insurance company | Medicare rating | A.M. Best rating | BBB rating | J.D. Power ranking |
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Aetna | 4 stars | A | A+ | 6th out of 9 |
Cigna | 4 stars | A- | Not rated | 8th out of 9 |
Humana | 4 stars | A- | A+ | 2nd out of 9 |
UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
Original Medicare | Medicare Advantage Plans |
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Original Medicare covers your Part A hospital insurance and Part B medical insurance. | Medicare Advantage Plans combine Part A, Part B, and additional benefits. |
You can add Part D prescription drug coverage. | Prescription drug coverage is usually included. |
You’re able to use any medical provider in the U.S. that accepts Medicare. | You’ll usually need to use doctors in your plan’s network. |
You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance. | Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare. |
Vision, hearing, dental, and other benefits aren’t covered. | Your plan may offer additional benefits, including vision, hearing, and dental. |
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Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
Hospital and skilled nursing facility inpatient care | Home health care | Prescription drug coverage (if included in your plan) |
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Medically necessary outpatient services, such as:
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Preventive services, such as:
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Additional benefits (depending on your plan), such as:
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With 33 Medicare Advantage Plans available in Delaware, you likely have a few options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With only 22% of Delaware residents choosing a Medicare Advantage Plan, Plan C isn’t as popular in the state as it is elsewhere in the country. This may be because there are fewer plans available in Delaware than in many other states, but these plans are still an option worth exploring.
Number of Medicare Advantage Plans available | Medicare Advantage Plan types available | Medicare Advantage Plans rated 3.5 or higher by NCQA |
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33 |
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In Delaware, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs | HMOs typically require that you receive all services from in network providers:
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PPOs | PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
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PFFS Plans | PFFS plans don’t require a primary care physician or referrals for specialists:
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SNPs | SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
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You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
Enrollment period | When it happens | Medicare plans you can choose | What you can do |
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Initial Enrollment Period | Three months before you turn 65, the month you turn 65, and three months after | Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan | Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty. |
General Enrollment Period | January 1 – March 31 | Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June. | Sign up for Medicare if you missed your IEP |
Open Enrollment Period | October 15 – December 7 | Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan | Join, switch, or drop a plan |
Medicare Advantage Open Enrollment Period | January 1 – March 31 | Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan | If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare |
Special Enrollment Period | When you have a qualifying event | Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan | Make changes to your plan |
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Delaware Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
Resource | Contact | How they help |
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Delaware Division of Services for Aging and Adults with Physical Disabilities | (800) 223-9074 [email protected] |
The Delaware Division of Services for Aging and Adults with Physical Disabilities seeks to improve the quality of life for Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations |
Delaware Aging and Disability Resource Center | (800) 223-9074 [email protected] |
The Delaware Aging and Disability Resource Center (ADRC) is a one-stop access point for information and services for older persons and adults with physical disabilities throughout the State |
Delaware Medicaid & Medical Assistance | [email protected] | This website is a guide to Medicaid and medical assistance programs in Delaware |
Delaware Medicare Assistance Bureau | (800) 336-9500 | The Delaware Medicare Assistance Bureau (DMAB), formerly known as ELDERinfo, provides free health insurance counseling for people with Medicare, including those under 65 years of age |
Delaware Insurance Department | (800) 282-8611 [email protected] |
The Delaware Insurance Department protects Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public |
Resource | Contact | How they help |
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Brandywine Senior Center | (302) 798-5562 [email protected] |
Brandywine Senior Center offers a mix of formal activities, classes, and trips, as well as informal activities such as cards, billiards, and BINGO |
Mid-County Senior Center | (302) 995-6728 [email protected] |
Mid-County Senior Center aspires to be the primary resource for aging well in the heart of New Castle County, providing a warm and vibrant environment for individuals 50+, their friends and families, and where members are inspired to help each other and contribute to the community |
Newark Senior Center | (302) 737-2336 [email protected] |
The Newark Senior Center enhances the lives of the 50+ community by providing resources and opportunities for growth in body, mind and spirit |
New Castle County Senior Services | (302) 395-5613 | New Castle County Senior Services is committed to providing residents 50 and older with a variety of options for better living, including activities, discounts, and safety programs |
Sussex County Elderly & Disabled Services | (302) 855-7700 | This website is a guide to the services available to those in Sussex County who are elderly or disabled |
Wilmington Senior Center | (302) 651-3400 [email protected] |
The Wilmington Senior Center offers a variety of activities programs, exercise classes, educational presentations, and trips to places near and far |
Resource | Contact | How they help |
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American Hospital Association – Medicare Advantage | (800) 424-4301 | The AHA provides education for health care leaders and is a source of information on health care issues and trends. |
CMS.gov – Medicare Advantage Applications | N/A | This page provides important information on the application process for Part C Medicare Advantage plans. |
Medicare.gov – Medicare Advantage Plans | (800) 633-4227 | This government website provides information on the Medicare Advantage program. |
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.