Medicare in Delaware

The First State is among states with lowest Part C enrollment

Resources for Delaware beneficiaries

State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.

In Delaware you can reach SHIP at 1-800-336-9500 or online here.

Snapshot of Medicare in Delaware

Total Medicare enrollment in Delaware

As of November 2018, there were 201,488 Medicare beneficiaries in Delaware. That’s nearly 21 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Breakdown of the aged vs. disabled

Individuals who qualify by virtue of their age alone make up 86 percent of Delaware Medicare enrollees. The other 14 are on Medicare as the result of a disability.

In AlabamaKentuckyMississippi, and Puerto Rico, 23 percent of Medicare beneficiares are eligible based on a disability, as opposed to the national average of 16 percent. Hawaii and the Virgin Islands had the smallest percentage of Medicare beneficiares eligible due to disability, at 9 percent.

Medicare spending per recipient

In 2016, Medicare’s per-enrollee spending in Delaware was $9,449. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas like Alaska). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.

Louisiana had the highest per-capita Medicare spending, at $11,399, while Hawaii had the lowest, at $6,846. Nationwide, the average was $9,533, so Medicare spending in Delaware was about 1 percent lower than the national average.

Medigap in Delaware

Medigap plans provide supplemental coverage for Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that enrollees would otherwise have to pay if they only had Original Medicare on its own.

Medigap plans are standardized under federal rules, and federal rules allow enrollees a six-month window (starting when they’re at least 65 an enrolled in Original Medicare) during which they can enroll in a Medigap plan regardless of their medical history. 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. But 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. With this law, Delaware gives disabled Medicare beneficiares the same access to Medigap plans as people who are Medicare-eligible due to age.

Medicare Advantage in Delaware

Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans often offer additional benefits beyond what Original Medicare offers, but they also tend to have fairly limited provider networks, as opposed to Original Medicare’s nationwide network. Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.

There were 19,982 people in Delaware enrolled in Medicare Advantage plans in 2017. That’s about 11 percent of the state’s total Medicare population. Nationwide, 33 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.

Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska has the smallest percentage of enrollees in Medicare Advantage, at just 1 percent.

Stand-alone Medicare Prescription Drug plans

Delaware had 129,754 Medicare beneficiaries — about 64 percent of the state’s total — enrolled in stand-alone prescription drug plans as of November 2018. This is higher than the percentage in most states, but it makes sense given the very small enrollment in Medicare Advantage plans in Delaware. Most Medicare Advantage plans include Part D prescription coverage. But when the majority of the Medicare population is enrolled in Original Medicare — which doesn’t include drug coverage — enrollment in stand-alone Part D prescription coverage will be higher.

In 2019, Delaware has 25 stand-alone Part D plans with premiums ranging from about $14 to $97 per month.

Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.

But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries nationwide, including those who have Part D coverage as part of their Medicare Advantage plan.

For those under 65 in Delaware

Are you under 65 years of age? We have information on Delaware health insurance and the Delaware health insurance marketplace at our health insurance site.