Delaware Medicare Supplement Plans (Medigap)
Let’s say Don has Medicare only and no supplement coverage. Don goes to the emergency room in an ambulance because of a heart attack; Don is an inpatient in the hospital for 6 days where he receives coronary artery bypass surgery.
Then, since he was inpatient status at the hospital he’ll pay the Part A deductible of $1,364 per benefit period. Don must also cover 20% of his hospital bill after the deductible is met.
Now, Medicare doesn’t have a Maximum Out Of Pocket and you can pay 20% of several hundred thousand if the bills get that high. Medigap coverage protects beneficiaries from outrageous medical expenses.
Delaware Medicare Plans Broken Down
Original Medicare consists of two parts; Part A activates when your status in inpatient, Part B benefits are for outpatient status. Durable Medical Equipment (DME) is an outpatient coverage item.
Medigap fills the gaps in Part A and Part B. So, instead of paying the Part A deductible and Coinsurance, the insurance company pays those fees. Then, some plans cover Part B coinsurance. Policies with more coverage generally have a higher premium.
The alternative to Medigap is a Medicare Advantage policy; MA plans replace Medicare, giving you new copayments, coinsurance, and doctor networks. Some MA plans include prescriptions, although these policies aren’t always the most cost-effective.
Part D covers prescription drugs, these policies go great with Medigap coverage. The lowest cost Part D plan in Delaware is $14 and the most expensive policy is $97.20.
The best coverage for your neighbor likely isn’t the best coverage for you, talking with a broker can ensure you get the most suitable option for your situation.
Medicare Eligibility for the Disabled, Under 65 in Delaware
State laws require Delaware offer Supplement insurance to beneficiaries under the age of 65. Additionally, Delaware state law requires insurers to offer at least one plan for those under 65 that have End-Stage Renal Disease (ESRD).
The most commonly available policy is Plan A; this coverage is the most basic of all the options and the premium is typically astronomical for someone under 65. There are options if you’re currently living in Delaware with a disability, under 65 or have ESRD.
Some beneficiaries will find financial protection through a Medicare Advantage policy until eligible for Medigap at 65. Medicare Advantage policies are Part C of Medicare and sometimes include Part D.
Delaware Medicare Advantage Plans
Medicare Advantage plans usually have a low premium in exchange for higher out of pocket expenses. In 2015, only 15 plans were available in the state of Deleware.
MA plans require beneficiaries to follow a provider network, leaving the network can result in higher out of pocket costs.
These Medicare replacement plans replace medicare benefits; the federal government delegates a portion of your Part B premium to the insurance company, and the insurance company becomes responsible for your claims (approval and denial).
The benefits usually include Part D coverage, routine dental, basic vision, and hearing exams. While this can seem like a one-stop-shop, the coverage isn’t adequate for comprehensive care needs.
Beneficiaries under 65 may find the MA plan is more cost-effective due to the high cost for supplemental coverage before age 65.
Part D Prescription Drug Plans in Delaware
Medicare Part D is a stand-alone Prescription Drug Plan (PDP) that provides coverage for medications. There is a network on the policy that tells you which pharmacy to use for the best rates. Mail-order pharmacy options can save beneficiaries time and money.
The cheapest monthly premium is $14 and the most expensive costs $97.20 monthly. Choosing coverage is more than just choosing premiums though. Not all medications are found on all formularies.
When you work with a broker, they can input your medications and find the cheapest cost for the year basing the policy on the medications you currently take. For example, if you take 2 brand name medications the $14 plan might not cover them and you’d pay outrageous out of pocket fees.
However, a $40 or $50 policy could provide you with adequate coverage and low out of pocket expenses.
Top Delaware Medicare Supplement Plans
Medicare Supplement Plan benefits are the same regardless of the carrier. The major difference is the premium costs will vary.
The top 3 of the 10 letter plans are Plans G, N, and F.
- Medigap Plan G only requires beneficiaries to pay the Part B deductible, the Part B premium, and the policy premium.
- Plans N is popular because it’s one of the more affordable Medicare Supplement Plans.
- Medicare Supplement Plan F is first dollar coverage; however, in 2020 Plan F won’t be available to new beneficiaries.
Since Plan F, C, and High Deductible Plan F are retiring, Medicare Supplement High Deductible Plan G will make its release in 2020. Also, you can’t use your Medigap plan to pay for Medicare Advantage out of pocket expenses.
Delaware Medicare Supplement Plans Criteria for Eligibility
To be eligible for Medigap in Delaware, you must already be 65 years of age and have Part B. You’re given a six-month Open Enrollment Period (OEP), which is the best time to obtain a Medicare Supplement.
Your OEP begins the first day your Part B is effective. Medicare beneficiaries can enroll in coverage with an effective date the same day as Part B; enrolling into a policy well before coverage starts to ensure your premium is locked into the best rates.
The OEP gives beneficiaries Guarantee Issue (GI) rights; this means no matter how unhealthy a person, the policy must receive approval at the lowest rate. Make sure to enroll during your OEP to avoid any unwanted added expenses.
Although it’s better to enroll during the OEP, it’s not necessary. Many seniors enroll in Medicare after the OEP; however, the unfortunate reality is some wait too long and don’t medically qualify when they need it most.
Delaware Medicare Supplement Plan Premiums
Age, sex, and location play a big part when deciding the cost. For example, insurance premiums for someone living in Wilmington may find Aetna offers the lowest premium. Then, a person living in Long Neck might find coverage with Mutual of Omaha is more suitable.
The insurance companies use 3 different methods to figure out costs and rate increases. Most companies in Delaware don’t charge an application fee; although, some do.
Prices range from $90-$250 or more depending on age, policy, health status, and location. Our brokers are highly capable of assisting you with all your Medigap enrollment questions, they can even walk you through the process. This will save you time and money.
Medicare Savings Programs in Delaware
Medicare beneficiaries can contact Centers for Medicare and Medicaid or the state assistance program SHIP for more information. Qualified Medicare Beneficiaries can receive assistance paying for Medicare premiums, deductibles, and coinsurances.
The Extra Help program can help low-income beneficiaries with the cost of drugs.
Find and Compare Delaware Medicare Rates Online
We make comparing Medicare Supplement Plans online easy for you! Eligibility, guidelines, and enrollment can be overwhelming; however, our agents can help you identify the best policy for you.
Coverage available in New Castle won’t be the same premium as in Sussex. Give us a call at the number above and start working with one of our licensed insurance brokers today!
If you can’t call, fill out an online rate form to have an agent help you with your best premium quote.