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.

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
  • Run 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. If you have yet to enroll, click this link to learn more about Federal Medicare benefits.

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:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $125 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $124 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $134 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $96 $0 $147 Not Covered Not Covered Not Covered Request Info
N $83 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $95 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $72 $1 $147 Not Covered Not Covered Not Covered Request Info
L $72 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $43 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $124 $608 $147 Not Covered 100% Covered 100% Covered Request Info

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.

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$456 Aetna Medicare Standard Plan (HMO) Health and Drug $38.00 $0
$1464 Aetna Medicare Premier Plan (HMO) Health and Drug $122.00 $0

Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$2172 Aetna Medicare Premier Plan (PPO) Health and Drug $181.00 $0
$744 HumanaChoice H5041-015 (PPO) Health and Drug $62.00 $0

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

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 the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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.

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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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