Medicare Advantage (MA) is an easy way to supplement your Medicare coverage. Also known as Medicare Part C, the option has nearly doubled in popularity over the past decade. Over 22 million people enrolled in a Medicare Advantage plan in 2019. This page explains Medicare Advantage plans in Delaware to help you understand your options to get the best plan for your particular needs.
What Is Medicare Advantage in Delaware?
Medicare Advantage plans must provide the same coverage you get with Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance. However, most Medicare Advantage plans provide additional benefits as well. The most common is prescription drug coverage, which is found in around 90 percent of MA plans.
Delaware Medicare Advantage Plans with Prescription Drug Coverage
Medicare Advantage Prescription Drug plans (MA-PD) are also known as all-in-one plans, because they combine Original Medicare benefits with Medicare Part D prescription drug coverage.
Please note that you cannot have both standalone Part D and an MA-PD plan.
Who Is Eligible for Medicare Advantage in Delaware?
If you have Medicare Parts A and B, you qualify for Medicare Advantage in Delaware.
American citizens aged 65 and older are eligible for Medicare. You may also qualify for Medicare before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months.
When Can You Sign Up for a Medicare Advantage Plan in Delaware?
You can first join a Medicare Advantage plan in Delaware during your Initial Enrollment Period (IEP). This begins 3 months before the month you become eligible and lasts for a full 7 months. So, if your 65th birthday or 25th month of collecting disability benefits occurs in October, your IEP begins on July 1 and ends on January 31.
If you miss your IEP, you can sign up for Medicare Part A and/or Part B during the General Enrollment Period from January 1 through March 31. Once this ends, you have from April 1 until June 30 to join an Advantage plan.
The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7. Current beneficiaries may use this 8-week window to make any coverage changes they want, including joining a Medicare Advantage plan.
If you already belong to a Part C plan, you may participate in the Medicare Advantage Open Enrollment Period from January 1 through March 31. Your only options are switching to a different MA plan or returning to Original Medicare. However, if the change you make means you lose your prescription drug coverage, you may also join a standalone Medicare Part D plan.
There are also Special Enrollment Periods (SEPs) for people who experience certain life changes, such as moving or losing their current coverage. There are dozens of qualifying special circumstances. Find the full list of Medicare.gov.
Types of Medicare Advantages Plans in Delaware
The four most popular types of Medicare Advantage plans in Delaware are:
- Health maintenance organizations: HMO plans account for more than half of all MA options. Members choose a primary doctor who manages their care and provides specialist referrals. HMOs also have a provider network that may include doctors, hospitals, labs, and more. Out-of-network services are usually not covered by the plan.
- Preferred provider organizations: PPO plans are similar to HMOs in that they have a provider network. However, plan members may visit an out-of-network provider for a higher out-of-pocket cost. There is also no requirement for a primary doctor or referrals.
- Private fee-for-service: PFFS plans set limits on what the plan and the beneficiaries pay for services. Most use a provider network, but like PPOs, allow members to go outside the network for a higher share of the cost.
- Special needs plans: SNPs are limited to Medicare beneficiaries who have certain chronic conditions (e.g. diabetes, ESRD, HIV/AIDS, etc.), live in an institution or require home healthcare, or who are dual eligible (i.e. qualify for both Medicare and Medicaid).
How to Choose a Medicare Advantage Plan in Delaware
To be sure you get the best Medicare Advantage plan for your unique needs and budget, you should look at these four metrics:
- Coverage (including drug formulary if it's an MA-PD plan)
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Delaware. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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