Medicare in Delaware: Plans and Coverage (2026)

Medicare plans in Delaware run on federal rules, with free counseling from the DMAB at the Delaware Department of Insurance and a Medicare Savings Program through DMMA.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage Plans in Delaware (Part C)
• Medicare Part D: Prescription Drugs
• Medicare Supplement (Medigap) Plans in Delaware
• Help Paying for Medicare in Delaware
• Medicare Enrollment Periods
• Free Medicare Help: DMAB
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, so check the current year's figures on medicare.gov. To talk to a person about your own coverage, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.6 In Delaware, a DMAB counselor will also take your Medicare questions free of charge at 1-800-336-9500.5

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Delaware and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025.1 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.1,7

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)1
• Annual deductible: $2831
• After the deductible: you pay 20% of the Medicare-approved amount for most services1

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.8

Medicare Advantage Plans in Delaware (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.9

What matters in Delaware is that Medicare Advantage is sold locally. Plans set their own service areas, networks, and prices, and they redraw them every year, so what a neighbor in New Castle County is enrolled in may not be sold in Kent or Sussex at all. Never assume a plan someone recommended is available to you; check it against your own ZIP code first.

How These Plans Work

• You keep paying your Part B premium ($202.90)1 on top of any plan premium. CMS estimates the average Medicare Advantage premium at about $14 a month for 2026, and many plans charge $0 extra. Some plans go further and help pay all or part of your Part B premium.9
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.9
• Plans may require prior authorization (plan approval before a service is covered), which Original Medicare generally does not.9
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap on its own. CMS's sentence adds the condition: no yearly limit on what you pay out of pocket unless you have supplemental coverage, like Medigap, Medicaid, employer, retiree, or union coverage. What each covers varies by policy.9

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. A DMAB counselor can walk through the results with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.2 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).10
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.2

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.2 People who qualify for Extra Help often pay much less, sometimes nothing.

Medicare Supplement (Medigap) Plans in Delaware

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.9

Delaware uses the federally standardized plans, labeled A-D, F, G, and K-N, regulated by the Delaware Department of Insurance.11 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G covers the same benefits as Plan F apart from the Part B deductible, and unlike Plan F it is still open to newly eligible beneficiaries: it pays the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.12,1

Your first window is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer can't refuse to sell you any policy it offers, can't use medical underwriting against you, and can't charge you more because of your health. One limit survives: the insurer may still decline to pay your out-of-pocket costs for a pre-existing condition for up to six months, unless you had at least six months of continuous creditable coverage beforehand.11 Outside that window, Delaware insurers may use medical underwriting for some purchases.

Delaware also has a Medigap birthday rule (Senate Bill 71, effective January 1, 2026): each year, a current Medigap policyholder gets a Special Enrollment Period that begins 30 days before their birthday and lasts at least 30 days after, to switch to a plan with the same or lesser benefits, with no medical underwriting. The Delaware Code sets that window and the same-or-lesser-benefits limit, but names no carrier; the statement that you may buy from your current or a different carrier comes from the Delaware Department of Insurance, not the statute. Insurers must notify you of these rights 30 to 60 days before that window opens, so the letter should arrive a couple of months before your birthday.3

Medigap or Medicare Advantage?

You can't use both at once. A Medigap policy can't pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.9 Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. The lock isn't permanent. If you join an Advantage plan for the first time and go back to Original Medicare within 12 months, federal law gives you a trial right to buy a Medigap policy and a separate drug plan.9 For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Delaware

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Delaware runs its Medicare Savings Programs through the Delaware Division of Medicaid and Medical Assistance (DMMA), part of Delaware Health and Social Services (DHSS). DMMA sets the three tiers at 100% (QMB), 120% (SLMB), and 135% (QI-1) of the Federal Poverty Level, and labels the third one "QI-1" rather than simply "QI." You have to be entitled to Medicare Part A to qualify for any of them.4

Apply even if you are a little over. Those are the countable-income figures DMMA publishes. The federal limits Medicare.gov lists for 2026 run about $20 a month higher per person ($1,350 for a QMB individual and $1,824 for a couple, $1,616 and $2,184 at SLMB, $1,816 and $2,455 at QI), and Medicare.gov notes that some states don't count certain types or amounts of income, so a state can qualify you when the published number says otherwise. Only DMMA can tell you which of your income it counts.4

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.13 On assets, DMMA's QMB section states flatly that "your assets are not considered"; its SLMB and QI-1 sections give an income limit and say nothing at all about assets, so ask DMMA how resources are treated before you rule yourself out of those two.4 QI-1 is the one tier you must reapply for every year; qualifying once does not carry you into the next year.13 Apply through DMMA at dhss.delaware.gov/dmma; a DMAB counselor can walk you through the application at no charge.4 Enrolling in QMB, SLMB, or QI-1 automatically qualifies you for Extra Help with Part D.13

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.14 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses14
• If you qualify for QMB, SLMB, or QI-1, you're enrolled in Extra Help automatically13
• QDWI, the Medicare Savings Program for people who lost premium-free Part A after returning to work, pays the Part A premium but does not carry Extra Help with it, so a QDWI enrollee has to apply to Social Security for Extra Help separately13,14

Apply through Social Security at ssa.gov or call SSA at 1-800-772-1213 (TTY 1-800-325-0778).15 A DMAB counselor can help with the application at no charge.14

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Delaware as everywhere else.16

Changes you make during Annual Open Enrollment take effect the following January 1. If you start Social Security at least four months before you turn 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through the Social Security Administration.16

If you're working past 65 with employer coverage and plan to delay Part B, you get an 8-month Special Enrollment Period counted from the month that job or its coverage ends, whichever comes first. COBRA and retiree coverage don't count for this purpose, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. Miss that window and you'll wait for the General Enrollment Period and may owe a permanent late penalty. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17

Free Medicare Help: DMAB

You don't have to figure this out alone, and you don't have to pay a broker. Delaware runs the Delaware Medicare Assistance Bureau (DMAB), the state's federally funded State Health Insurance Assistance Program (SHIP). DMAB is administered by the Delaware Department of Insurance and delivers free, unbiased Medicare counseling through trained volunteers. Counselors serve adults with Medicare including those under 65 on disability.5

A DMAB counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• Work out coordination of benefits if you have other coverage

Learn More

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.