Medicare Plans in Delaware – Coverage and Benefits

Medicare is a federal government health care plan which all citizens 65 years of age or older are eligible to join. The basic plan that most people refer to when they talk about Medicare actually comes in two parts: Medicare Part A, and Medicare Part B. You may also hear them referred to as “Traditional” or “Original” Medicare. While both parts A and B are intended to cover most of your health care needs, there are sometimes gaps in the plan which may require additional coverage.

There are some basic costs associated with Original Medicare. Part B requires a monthly premium, regardless of your circumstances. Part A might require a premium also, but that depends largely on your employment history. If you have worked for at least ten (10) years or at least forty (40) quarters, Part A is free. If your employment history is shorter than that, you may have to pay an additional charges. Click here for more information on Part B costs.

You’re practically guaranteed Medicare benefits if you apply within your specific window after turning 65 years old. Once you qualify, you will start receiving – and be required to pay a premium for – your Part A benefits. But you don’t have to accept Part B benefits (or pay for them) right away. In some situations, Part B maybe completely optional. But if you don’t accept Part B, you will have to find another way to pay for doctor visits, medical supplies, and outpatient treatment.

Medicare Part C is 100% optional. However, if you choose to accept Medicare Part C instead of Medicare Parts A & B, There are some benefits which you cannot opt out of. Medicare Part C plans automatically come with the exact same benefits that you would get from Original Medicare (Parts A & B). Aside from optional coverages like prescription drugs, dental, or vision, you cannot choose to accept fewer benefits than the base package. Similarly, if you decide to stick with Original Medicare and decide to add Part D coverage, you must also accept Part B benefits. You cannot have only Part A and Part D benefits at the same time.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Delaware Medical Plans: A Breakdown

Within the state of Delaware, there are 157,289 residents currently enrolled in the Medicare benefits program. Of those, a meager 7% (11,010) of people have instead chosen a Medicare Advantage plan. However, 32,593 people – nearly three times the number of Medicare Advantage enrollees – have chosen to supplement their Medicare benefits with a Medigap policy instead. But these popular Medicare supplement policies are only protecting 27% of the Delaware population in total. The remaining 73% are either relying on alternative sources for health care coverage, such as an employer plan, or risking their financial future by relying on Original Medicare by itself to cover their health care needs. Keep in mind that these numbers only represent seniors 65 and over who are currently enrolled in Medicare.

Delaware may be a relatively small state, but healthcare costs are far from diminutive – especially when it comes to senior care. Understandably, this becomes extremely problematic when you are no longer working and instead getting by on a fixed income. Medicare benefits do a great job of helping seniors cut their healthcare costs down to a manageable level. But there are other supplements out there which can assist seniors like you even further.

The two most popular options for supplementing Medicare Parts A & B are either Medicare Part C, or a Medicare supplement insurance policy. Medicare Part C is also sometimes referred to as a Medicare Advantage plan; likewise, Medicare supplement insurance policies are also known as Medigap policies. Unfortunately, the confusion doesn’t end there.

We know what you might be thinking: why is it so important to get a Medicare health insurance supplement? Doesn’t Medicare cover all of my needs? Unfortunately, the answer to that question is no. There are some little-known gaps in both Part A and Part B coverage which can cost you thousands if you aren’t careful. That’s where Medicare supplements come in. They help share that burden with you so that your savings and finances are protected. If you have yet to enroll, click this link to learn more about Federal Medicare benefits.

If you are unfamiliar with Medicare supplements, you have come to the right place. It’s important to understand the distinction between these two types of coverage. For starters, Medicare Advantage is a private health insurance plan which you purchased from an independent company. Your health care will no longer be managed by the government. Medicare supplement plans, on the other hand, do not usurp Medicare; they simply add a little bit of private health insurance coverage onto your federal Medicare benefits. They work with the government, not in place of them.

How Important Are Medicare Supplement Policies?

Depending on your circumstances, they can be essential to managing your health care needs at the most affordable cost. If something unfortunate were to happen, such as an extended hospital stay or months of rehab from a physical injury, you might be required to pay some hefty out-of-pocket prices which Traditional Medicare won’t cover. Such as:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

For many, especially those who are well into their golden years and living on a fixed income, leaving their health care coverage to chance is a gamble they cannot afford to make. Obtaining supplemental health insurance helps protect them from the gaps in Medicare, and eases their worries. There are two main options for supplementing Medicare which we will get into presently: Medicare Advantage, and Medigap.

Medigap Coverage: Pros and Cons

Medigap is the shorthand term for Medicare Supplement plans. It’s a sort of nickname used to reflect the fact that these policies are designed to cover the “gaps” in Original Medicare. The federal government, with Medicare gaps in mind, has designed and continues to regulate these plans to work optimally with existing Medicare coverage options. The plans are organized alphabetically: A, B, C, D, F, G, K, L, M, and N. During the summer of 2010, plans E, H, I, and J were phased out of the program due to the Medicare Modernization act. By law, each plan provides the same benefits and coverages in every state; meaning that what you get for plan A in Delaware will be the same as California or Texas. The only difference will be in how much you pay for the policy.

Below is a handy chart which explains the benefits of each individual plan:

The Pros and Cons of Medicare Advantage

Medicare Advantage (also Medicare Part C) acts more like a replacement of Original Medicare than a supplement plan. This is because, with Part C, a private insurance company takes over responsibility for paying out your claims; they are no longer paid for by the federal government. However, there are laws in place to protect you. These laws mandate that whatever private company underwrites your coverage offers you the exact same benefits as Traditional Medicare (or better). They are not legally permitted to offer you anything less.

Some companies take advantage of this and dress up their Medicare Advantage policies to include enticing extras, such as prescription drug coverage or dental. Such a policy will likely cost more than Original Medicare, but could save you thousands in the long run. However, in order to provide affordable extras, Medicare Advantage plans tend to have limited networks. The risk of losing your current doctor (or doctors) by switching to Medicare Part C is a significant one that you will have to consider before signing the dotted line.

A Side-by-Side Comparison of Medigap vs. Medicare Advantage

One important distinction between Medicare Advantage and Medigap is the process by which claims are handled. With a Medigap policy, your supplement provider doesn’t step in or pay for any costs until after Medicare has handled their share of the expenses. Any remaining costs are then dealt with via your Medicare supplement insurance before you even see a bill – If you ever see one at all.

Medigap supplements and Medicare Advantage are both issued and underwritten by private businesses. However, unlike Medicare Part C, Medicare supplement insurance is highly standardized and streamlined. this helps get your costs covered more efficiently and helps you understand what your plan provides. No matter where you are in the country, your plan will cover the same benefits as it would in any other state. The only variable is your monthly premium.

Medicare Advantage plans are much larger, more cumbersome, and can be a little confusing at times. But they offer more benefits then a Medicare supplement insurance policy. They completely replace Medicare Parts A & B to start with. Next, your insurance company may give you the option to choose riders like vision, dental, or even prescription drug coverage. There may be even more additions than that if you choose to add them.

Pricing tends to be simpler with Medicare supplement insurance when compared with Medicare Advantage. Medigap supplements require one affordable monthly premium, and that’s it. On the other hand, because Medicare Part C is basically a private health insurance policy, your provider can change pricing and benefits at almost any time. This includes your monthly premium. Granted, the federal government will be paying most if not all of your premium directly to your healthcare provider. Leftover premium costs, co-pays, car insurance, and deductibles will be passed on to you.

But that really only skims the surface of the differences between Medicare Advantage and Medigap. We have a list of frequently asked questions below, along with some helpful information to help you get through the confusion. But you can learn even more if you contact one of our representatives today and let them assist you in finding a policy.

Everyone’s medical needs are different. While Original Medicare may be more than enough for some, there are others out there who could really benefit from a Medigap or a Medicare Advantage policy. It is up to you and your insurance agent to analyze your specific needs and figure out what type of supplement coverage you need.

 

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? Your provider estimates average costs based on your location, age, and overall health. They charge you a monthly premium based on that info. The US government pays most of that premium, and you pay the rest With a comprehensive plan, you pay your premium once a month, and that’s it. Plans that don’t cover coinsurance or co-pays may leave you paying some of those extra costs
Will I still have to pay for Part B? Yes Yes
What will it cost me? Because Medicare Part C plans are so large and complicated, it can be difficult to estimate how much you can expect to pay for premiums, regular care, and emergency treatment For most seniors, all you need to do is budget for your monthly premium; almost all other costs will be covered
What will the plan cover? A Medicare Advantage plan will cover exactly what you want it to cover, starting with benefits that are identical to Medicare Parts A & B Medigap supplements are smaller, simpler policies which cover the gaps in Original Medicare coverage. you get to choose whether you want a policy which covers some or all of these coverage gaps
Is it easy to budget my health care expenses? The less care you receive on a regular basis, the easier it is to budget with Medicare Advantage. But receiving frequent scare makes your costs much less predictable If you have a comprehensive plan such as F, you only need to budget your monthly premium. Some plans don’t cover costs like coinsurance or co-pays, so you may need a budget for those, too
Is my plan guaranteed? Or can it be cancelled? There are very few guarantees with Medicare Advantage. Like any other private company, they can change your terms or drop your coverage if they have the legal ability to do so You get the same guarantees as you would with your Medicare benefits. You will only run into problems if your provider goes bankrupt or you don’t pay your premiums
Do I have to clear a pre-approval or pre-certification process? Just like with a private health insurance policy, you will go through some sort of pre-approval or pre-certification process for a Medicare Advantage plan – it is not as easy to qualify for as Medicare is Qualifying for Medicare automatically qualifies you for a Medicare supplement insurance policy
Am I limited to specific doctors or hospitals? Unfortunately, there are restricted medical networks with Medicare Advantage plans – but this can keep costs low and affordable in certain areas You will have access to the same doctors and Facilities as you will with regular Medicare
What type of plan is best for me? Medicare Advantage plans are the most affordable for younger seniors in big cities with many doctor and hospital options to choose from. it also helps if you are in relatively good health Older seniors with health conditions and fewer providers to choose from will save more money with Medigap. It also helps those who are living on a tighter budget

More Useful Information

You can use the directory search tool below to directly contact Deleware Medicare experts who will have more information. This article is only a primer to get your started on your journey for affordable health care. With a little digging, you can find out which options are best for you.

Useful Contacts


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Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

 

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