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Advantage Plans

Medicare Advantage (Part C) Plans in Delaware

Medicare Advantage plans are another health insurance option for Medicare beneficiaries. Medicare Advantage plans (HMOs, PPOs, PFFS plans and/or MSAs) are available in our state and provide all Medicare Part A and Part B benefits and possibly some extra benefits. Members may be required to utilize a network or group of preferred providers. Check with your doctors and hospital to see if they accept the insurance plan you are considering joining. All four plan options may not be available in the county in which you reside. If you join a Medicare Advantage Plan, you are in the Medicare Program but receive your Medicare benefits from the private carrier. Your benefits will now be administered by the private carrier. You may enroll in a Medicare Advantage plan during your Initial Enrollment Period during the Annual Election Period from Oct.15 through Dec. 7.

There are several different types of Part C plans available in Delaware:

  • Health Maintenance Organization (HMO) Plans must cover all Part A and Part B health care. Most require you to go to doctors, specialists, or hospitals on the plan’s list, except in an emergency.
  • Preferred Provider Organization (PPO) Plans are available in a local or regional area and you may pay less if you use doctors, hospitals, and providers in their network, but pay additional costs for outside network visits.
  • Medical Savings Account (MSA) Plans combine a high deductible health plan with a Medical Savings Account that beneficiaries can use to manage their healthcare costs.
  • Private Fee-for-Service (PFFS) Plans allow you to go to any doctor or hospital that accepts the plan’s payment. The plan decides how much it will pay—and what you will pay for the services you receive.
  • Medicare Special Needs (SNP) Plans are specially designed to meet the needs of people who live in certain institutions, are eligible for both Medicare and Medicaid, and/or have one or more chronic conditions.

It is important for people who now have Original Medicare and are considering enrolling in any Medicare Advantage Plans to understand:

  • The Plan will provide your primary health coverage instead of Original Medicare.
  • Original Medicare will no longer pay your health care claims once you enroll in the plan.
  • You will be given a new Plan card, which will replace your Medicare card (though you should keep your Medicare card in a safe place, in case you decide to switch back at a later point).
  • You will continue to pay your Part B premium even if you enroll in a Medicare Advantage Plan.
  • The plan is not a Medicare Supplement Plan. It does not replace Medicare Supplement Insurance (Medigap).
  • You may be charged extra co-payments or cost-sharing expenses for Medicare services.