Medicare Advantage Plans in Delaware

Buying a Medicare Advantage plan in Delaware is a popular choice for Medicare beneficiaries interested in having all parts of Medicare under one health insurance policy. Medicare Advantage (MA) plans, also known as Medicare Part C, include Medicare Part A and Part B.

A Medicare Advantage plan in Delaware can encompass Part D too. These are known as Medicare Advantage Prescription Drug (MAPD) plans.

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Features of MA plans:

  • Available through a Medicare-approved private insurance company
  • Benefits linked to use of plan’s network healthcare providers
  • Extra benefits often extended to vision, dental, hearing and wellness programs

When you join a Delaware Medicare Advantage plan, you are not giving up your Original Medicare coverage, but most of the Part A and Part B benefits you receive will come through your MA plan. The MA plan serves as administrator, claims processor and customer service contact.

Top-rated Medicare Advantage Providers in Delaware

  • Humana: Humana has earned about eight percent of the market share. Humana’s Gold Plus HMO has good quality ratings in some Delaware counties.
  • Cigna: Delaware residents tend to favor Cigna, as it has almost 40 percent of the market in this state.
  • Aetna: Aetna has also attracted about 40 percent of Medicare Advantage plan members. They have offered both PPO and HMO Medicare Part C plans with good star ratings.

Popular Medicare Advantage Plan Types in Delaware

Best for network flexibility: Medicare Advantage PPO

Preferred Provider Organization (PPO):

  • Go to any doctors or facilities accepting Medicare, though benefits are typically higher when using out of network providers
  • Usually includes Medicare Part D
  • Choosing a primary care physician not required
  • Referrals to see specialists not required
  • Zero-premium for some PPO plans, but others can cost up to $100 monthly

Best for reducing out-of-pocket costs: Medicare Advantage HMO Plan

Health Maintenance Organization (HMO):

  • Generally, must use network providers except in emergencies or dialysis outside service area
  • Usually incorporates prescription drug plans
  • Must select primary care physician in most cases
  • Referrals required for most specialist services
  • Zero-premium not uncommon for HMO plans

Best for limited income or certain health care needs: Medicare Advantage D-SNP

Dual-Eligible Special Needs Plan (D-SNP):

  • Synchronized Medicare and Medicaid benefits to lower costs for dually eligible beneficiaries
  • Customized plan based on specific health conditions
  • Benefits, provider pool and formularies tailored to groups served by Special Needs Plan (SNP)

Delaware Enrollment Facts

1. Number of enrollees in Medicare Advantage in Delaware: 26,644

2. Number of enrollees by type of Medicare Advantage plan:

  • Local HMO: 11,952
  • Local PPO: 12,692
  • Regional PPO: 0

3. Number of enrollees in Medicare Advantage nationwide: 19,838,319

4. Percentage of enrollees in Medicare Advantage nationwide: 42%

How much does Medicare Advantage in Delaware cost?

In most states, you can find a zero-premium HMO. PPOs may also be available for $0 premium, but a trend is emerging that indicates more PPOs are charging premiums.

Premiums and availability vary from one county to another.

The average 2021 monthly premium for a Delaware Medicare Advantage plan with prescription drug coverage is $22.80.

This is in addition to the Part B premium you pay to Medicare.

PPO Plan $0.00 to $22.80

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

  • First sign-up period for Original Medicare
  • Begins three months preceding the month of your 65th birthday
  • Ends three months after the month of your 65th birthday

Open Enrollment Period – aka Annual Election Period

  • Can join, change or end your MA plan
  • October 15 through December 7
  • Effective coverage date: January 1

Medicare Advantage Open Enrollment Period

  • Exclusive for existing MA plan members
  • January 1 through March 31
  • Can switch to another MA plan
  • If dropping an MAPD plan, can revert to Original Medicare and sign up for a Medicare drug plan

Special Enrollment Periods – Special Circumstances

  • Applies to certain situations, such as relocation or termination of other insurance plans
  • Timing depends on special circumstance

5-star Special Enrollment Period

  • Tied to star ratings awarded by Medicare for MA and Medicare prescription drug plans
  • Can switch to a 5-star plan from a lower-rated plan
  • December 8 through November 30

Special Enrollment Periods if you get “Extra Help”

  • Accessible to people in the Medicaid or Extra Help program
  • One change allowed during January through March, April through June, and July through September, effective first day of following month
  • Medicare coverage changes also allowed during open enrollment period (October 15 through December 7)

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.    

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