As you get older, it’s normal to think about retirement and how you will manage your medical care. Medicare provides important health coverage for those over age 65 and those with specific health conditions.
It can be challenging to understand how to choose a Medicare plan, what the costs are, and how to enroll. This guide will answer the most common questions about Medicare in Delaware and help you determine what the best plan is for you.
Medicare is a nationwide federal program, so every state has Medicare plans. Original Medicare does not vary from one state to another, but other plans like Medicare Advantage can be quite different.
In Delaware, there are more than 500,000 people enrolled in a Medicare Advantage plan and over 1.2 million enrolled in a prescription drug plan.
It’s important to carefully compare your Medicare options, especially during your initial enrollment period. You have special benefits during your initial enrollment, such as automatic acceptance into a Medigap plan, that are not available later on.
There are a variety of different Medicare plans available in Delaware. They fall into two categories: Original Medicare and Medicare Advantage.
Original Medicare consists of Medicare Part A and Part B. Part A covers hospital inpatient stays, and Part B covers doctor’s appointments, medical equipment, and other needs. You can also add Medicare Part D for prescription drug coverage.
Medicare Advantage, which is Medicare Part C, replaces Original Medicare. The coverage is sold by private insurance companies and often includes additional benefits that Original Medicare does not. However, you do need to get your care from the medical network the plan includes, which means you do not have national coverage as you do with Original Medicare.
It’s important to compare plans so you ensure you get the coverage that makes sense for you at a price you can afford. Many Medicare Advantage plans don’t cost more than Original Medicare, but some do. And you’ll need to ensure your doctors are part of the network of the plan you choose.
The cost of Medicare is different for each part. The plan you choose will have one or more parts, and your out-of-pocket costs will be based on those coverages.
For example, with Original Medicare, Part A is premium-free for most recipients. However, there is a deductible, and a daily copay for inpatient hospital care if your stay is longer than 60 days. Part B has a monthly premium of $170.10 in 2022, and there is a deductible each year. After the deductible, you pay 20% of the Medicare-approved costs of care and Medicare covers the rest.
Medicare Part D, prescription drug coverage, has a monthly premium as well. The cost will depend on which plan you choose since each one is different. There is also a deductible and a per-prescription copay for your medication.
Medicare Part C, Medicare Advantage, often has the same monthly premium as your Medicare Part B coverage in Original Medicare. However, sometimes there are additional costs. Your deductible, copayments, and coinsurance will be different depending on the plan you choose. That’s why it’s so important to compare your options.
As you can see, each plan has different costs. It’s important to choose the plan that makes the most sense for your needs.
Most people who are eligible for Medicare are automatically enrolled, especially if they are already receiving Social Security benefits or Railroad Retirement benefits. However, the automatic enrollment is in Original Medicare — if you want a different plan, or want to add Part D, you’ll need to enroll in those separately.
If you are not automatically enrolled during your initial enrollment period, you’ll need to apply by doing one of the following:
After your initial enrollment period, you can only change your Medicare coverage once a year, so it’s essential that you choose the right plan from the beginning. If you need help choosing a plan, you can talk to a licensed insurance agent for assistance.
Medicare Advantage plans are available in every state, including Delaware. These plans replace Original Medicare and can give you extra benefits like vision and dental coverage, or discounts on gym memberships.
However, it’s important to pay attention to the medical network each plan includes. In general, non-emergency care isn’t covered outside the medical network, so before you sign up ensure that your doctors are included. Also, if you travel frequently outside of your local area, Medicare Advantage in Delaware may not be the right choice for you.
Choosing the right Medicare Advantage plan means comparing all of the options available in your local area. Some will cost the same as Original Medicare each month, and for others, the premium will be different. Many seniors appreciate the certainty of having specific copays, instead of facing an undefined “20% of costs” each time they need care.
After you choose a plan, it’s still important to compare your options every year during annual enrollment. There could be a new Advantage plan that’s a better deal, or the costs in your plan might change. Nothing stays the same, so be sure to review your coverage options every year.
Hopefully, this guide answered most of your questions about Medicare in Delaware. However, it’s likely you still have a few questions or concerns about Medicare. Talking to one of our licensed insurance agents can help. Contact us for more information today!
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