Medicare in Delaware

Most Delaware Medicare Beneficiaries select Original Medicare; state law protects access to Medigap plans for people who are under 65

At a glance: Medicare enrollment in Delaware

How high is Medicare enrollment in Delaware?

As of July 2020, there were 213,668 people enrolled in Medicare in Delaware. That’s nearly 22 percent of the state’s total population, compared with a little less than 19 percent of the United States population enrolled in Medicare.

Delaware is in the top ten states in the US in terms of the percentage of elderly residents. Although Medicare enrollment in Delaware covers both aged and disabled populations (including people with ALS or end-stage renal disease), 86 percent of enrollees attain Medicare eligibility in Delaware due to being at least 65 years old, versus just 14 percent who are eligible due to a disability.


Medicare options

Medicare beneficiaries can chose among several options to access Medicare coverage. The first choice is between Medicare Advantage plans, where coverage is through private Medicare Advantage plans or Original Medicare, where coverage is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.

Original Medicare includes Part A (also called hospital insurance, which helps pay for inpatient stays, like at hospitals, skilled nursing facilities, or hospice centers) and Part B (also called medical insurance, which helps pay for outpatient care like doctor appointments or a preventive healthcare services, such as most vaccinations). Medicare Advantage plans bundle Parts A and B under a single monthly premium and often include other services like prescription drug and vision coverage. There are pros and cons to either option, and the “right” solution is different for each individual.

Medicare Advantage in Delaware

By mid-2020, enrollees with Medicare Advantage Medicare coverage enrollment stood at 40,569, which was about 19 percent of the state’s Medicare population.

Nationwide, about 40 percent of Medicare beneficiaries had private coverage at that point. Nearly all of those beneficiaries had Medicare Advantage plans, but there were also some enrollees with Medicare Cost plans, which are another type of private Medicare coverage available in some areas (there are no Medicare Cost plans in Delaware). Medicare Advantage enrollment has been increasing steadily since the early 2000s, but Original Medicare remains much more popular in Delaware than it does in many other states, with more than four out of five Delaware Medicare beneficiaries opting for Original Medicare.

While most eligible Medicare beneficiaries opt into Original Medicare, there is widespread availability of Medicare Advantage plans in Delaware. Residents can choose from among 17 or 19 different Medicare Advantage plans for 2020, depending on where they live.

Medicare Advantage enrollment is available when people are first eligible for Medicare benefits, and also during the annual open enrollment period in the fall (October 15 to December 7). During the Medicare Advantage open enrollment period (January 1 to March 31) people who are already enrolled in Medicare Advantage plans can change Medicare Advantage plans or switch to Original Medicare.

Medigap in Delaware

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

There are 33 insurers offering Medigap plans in Delaware as of 2020. The state has a Medigap shopper’s guide that provides a variety of useful information about Medigap plans.

Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. But federal rules do not guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability. States can set their own rules, however, and Delaware enacted a law in 2013 that grants a six-month guaranteed issue window for Medigap when people become eligible for Medicare as a result of a disability.

Under the terms of the legislation, Medigap insurers in Delaware that sell plans to people who are 65+ must make all of their plans available to people who are under 65 and enrolled in Medicare due to a disability. But the legislation allows insurers to charge higher premiums for people under age 65, and specifically prohibits insurers from increasing premiums for the 65+ population in order to cover the additional risk involved in providing coverage for disabled Medicare beneficiaries. The legislation requires insurers to have two separate risk pools (and thus separate pricing) for under-65 enrollees who are eligible due to end-stage renal disease (ESRD) versus under-65 enrollees who are eligible due to all other disabling conditions.

But due to this provision, Medigap premiums are dramatically higher for under-65 Delaware residents with ESRD. In many cases, premiums for an under-65 enrollee with ESRD exceed $20,000 per year, while under-65 enrollees without ESRD are generally charged premiums in the range of $4,000 to $7000 per year, and people who are age 65 typically pay somewhere in the range of $1,000 to $2,500 per year (premiums vary considerably from one insurer to another; these ranges cover most plans, but not all of them).

The separate risk pool and sharply higher Medigap premiums for under-65 enrollees with ESRD is particularly important given that prior to 2021, ESRD is also the only condition that prevents a person from enrolling in most Medicare Advantage plans (there are some Medicare Advantage plans that are set up as Special Needs Plans for people with ESRD, but most Advantage plans will not accept a new enrollee with ESRD; nationwide, there are only ten SNPs for people with ESRD in 2020, and none of them appear to be available in Delaware). As of 2021, however, under the terms of the 21st Century Cures Act, people with ESRD will no longer be barred from enrolling in Medicare Advantage plans nationwide.

Under federal Medigap rules, all Medicare beneficiaries have a guaranteed-issue open enrollment period when they’re at least 65 years old and enrolled in Medicare Part B. So enrollees in Delaware who are under-65, including those with ESRD, have the option to get a new plan with standard age-65 rates when they turn 65.

Most Medigap insurers in Delaware use attained-age rating, which means that premiums increase as the enrollee gets older. Some insurers use issue-age rating, which means premiums are based on the age the person was when they initially enrolled. United Healthcare uses community rating (ie, rates don’t vary based on age) for enrollees who are age 75 or older.

Delaware Medicare Part D

Original Medicare does not cover outpatient prescription drugs. Medicare beneficiaries can get needed prescription coverage via Medicaid,  an employer-sponsored plan, or Medicare Part D — which is available as part of most Medicare Advantage plans or as a stand-alone plan prescription drug plan (PDP).

As of July 2020, 131,080 of those receiving Medicare benefits in Delaware were enrolled in stand-alone Medicare Part D prescription drug plans. That’s 61 percent of the state’s total Medicare beneficiaries (for comparison, about 40 percent of all Medicare beneficiaries nationwide are enrolled in stand-alone Part D plans). In areas where Medicare Advantage enrollment is lower, enrollment in stand-alone Medicare Part D plans tends to be higher.

For 2020 Medicare Part D enrollment, there are 27 stand-alone Part D plans providing service in Delaware, with monthly premiums ranging from $13 to $80.

Medicare Part D enrollment is available during the annual open enrollment period in the fall (October 15 to December 7). The plan you select during this window will take effect January 1. It’s recommended that all Medicare beneficiaries review their Part D coverage during open enrollment and consider switching policies if a different plan will better meet their needs (keeping in mind that covered drug lists, in-network pharmacies, and out-of-pocket drug costs can all change from one year to the next, in addition to any changes to a person’s own prescription needs).

Medicare spending in Delaware

In 2018, average per beneficiary spending for Medicare in Delaware was $9,823 (the spending analysis did not include costs for Medicare Advantage enrollees, but it did standardize the data to eliminate differences in payment rates from one area to another). The national average that year was $10,096 per enrollee, so costs were only slightly lower than average in Delaware.

How does Medicaid provide financial assistance to Medicare beneficiaries in Delaware?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Delaware includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Helpful resources for Medicare beneficiaries and their caregivers

If you need assistance with Medicare enrollment in Delaware or have questions about Medicare eligibility in Delaware, here are some resources for you. They are available free of charge.

  • You can contact the Delaware Medicare Assistance Bureau (formerly called Elderinfo) with any questions related to Medicare in Delaware. Visit the website or call 1-800-336-9500 or (302) 674-7364 for help over the phone or to arrange an in-person visit.
  • The Delaware Prescription Assistance Program can help low-income seniors afford their medications. Download an application from their website or call 1-844-245-9580 for assistance.
  • The Delaware Aging and Disability Resource Center (ADRC) can provide various assistance to elderly and disabled Delaware residents. The phone number is 1-800-223-9074.
  • Visit the Medicare Rights Center. This nationwide resource provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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