Medicare Advantage in Delaware

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Delaware Medicare Advantage enrollment by the numbers

There were more than 20,000 people in the state of Delaware with a Medicare Advantage plan in 2017.¹  

There are several major types of Medicare Advantage plans. In the state of Delaware, there are eight different Medicare Advantage plans available as of 2018.² But not every plan is available in each county, so it's important to find out which ones are offered where you live.

The state of Delaware displays a nearly even split among HMO plan enrollment (50 percent of all Delaware Medicare Advantage plan enrollees) and local PPO plans (49 percent). The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans. Enrollment in these plans makes up around 1 percent of all MA plan enrollment in Delaware.

Total number of Medicare Advantage enrollees in Delaware: 20,739 as of 2017¹

Delaware's Medicare Advantage enrollees by plan type:

Plan type Percentage of Delaware enrollees (2017)
HMO 50%
Local PPO 49%
Regional PPO 0%
PPFS 0%
Cost Plans 0%
Other Plans 1%

Data reflects Medicare Advantage enrollment in the state of Delaware as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

Delaware Medicare Assistance Bureau (DMAB)

Delaware Medicare Assistance Bureau (DMAB) is a free program in Delaware that provides health insurance counseling and assistance to people with Medicare. The DMAB helps to empower Medicare recipients to better understand their options and benefits in order to make the most of their coverage. The DMAB can be reached at 1-800-336-9500 or 302-674-7364.


You can also explore more information about the insurance industry in Delaware by visiting the state’s Department of Insurance website.

 

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

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Last Updated: 4/24/2018