Medicare Advantage Plans in Delaware

If you don't like the coverage provided by Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., the alternative is a private health plan through the Medicare Advantage program. In most areas of Delaware there are multiple options to choose from, but options vary between each Delaware County. As a result, you can only choose a plan that's available where you live.

You can compare all the available plans in your area by using our zip code lookup tool above or by clicking on your county below. Continue reading to find out more about Delaware's Medicare Advantage program and how it compares to other options.

Compare the Best Medicare Advantage Plans in Delaware by County

Delaware Medicare Advantage Plans Explained

The advantages of Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are found in what they can cover that Original Medicare cannot. Specifically, the MA plans (aka, Part C of Medicare) available in Delaware can include minor healthcare benefits such as prescription drug coverage, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services. To join a plan you must first be enrolled in both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services..

While it is nice to have coverage for minor medical costs, such as a prescription drug plan, you must understand exactly what you get when you join a Medicare Advantage plan in Delaware. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care insurance plan (HMO, PPO, etc.) through an employer, you already know what to expect.

Original Medicare vs. Medicare Advantage in Delaware

The best way to understand the differences between Medicare Advantage and Original Medicare (Medicare Part A and Part B) is to evaluate the pros and cons of each type of coverage.

The Pros and Cons of Medicare Advantage Plans vs Original Medicare

• When you have Original Medicare, you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Delaware providers.
• If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Delaware Medicare Advantage plans, which are only required to cover you if you have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death..
• With Original Medicare, there are no limits on your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. However, all Delaware Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. , the plan picks up the tab for the remainder of the year.
• If you want prescription coverage and have Original Medicare, you must purchase a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan. However, most Medicare Advantage plans include a Delaware Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
• In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system, deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
• There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

Delaware Medigap Coverage vs. Medicare Advantage

Most Delaware seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans?
• Is it better to have Medicare Advantage or Medigap?

Let's take a minute or two to compare and contrast, shall we?

Why Delaware Medicare Advantage Plans are Bad

People that say Medicare Advantage plans are bad simply misunderstand them and don't know how they work. Over 42 percent of all Medicare beneficiaries choose Medicare Advantage enrollment and like their care. However, these plans are not suitable for everyone living in Delaware.

In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. believes that Medicare Advantage is the best option for healthy people, people with Medicare Advantage retiree benefits, and for people who qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..

Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , even when they are well.

You can check out supplemental Medicare insurance in Delaware on our Delaware Medicare supplements page.

The Disadvantage of Medicare Advantage Plans if You Live in Delaware

We have already highlighted the issue of doctor choice in Medicare Advantage. If this is not an issue for you, then consider the financial differences. These are the same regardless of the type of plan you're evaluating (e.g., HMO, PPO, PFFS, Cost, or HSA).

With Medicare Advantage, you pay a little each month (with some plans, you pay nothing). This is the monthly premium. But you also pay copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.

However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.

When Should I Consider Medigap Instead of Medicare Advantage?

1. If your budget allows, keep your Original Medicare benefits and a Medicare Supplement Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N. These are the top 3 best Medigap plans that can help you manage your out-of-pocket costs the best, giving you complete peace of mind.
2. If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and pay just a little to see your doctor (up to $25 per visit).
3. If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
4. If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
5. If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
6. If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
7. With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
8. With Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
9. Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or return to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on July 2, 2022.