Medicare in Delaware: Plans and Coverage (2026)

Medicare in Delaware runs 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 in Delaware (Part C)
• Medicare Part D: Prescription Drugs
• Medigap 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. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or DMAB at 1-800-336-9500.

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.

The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. 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.

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage 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.

Medicare Advantage 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.

Delaware's Medicare Advantage market is modest in size. Plan availability concentrates around the Wilmington and Dover metro areas, where residents tend to have the widest choice of carriers and plan types. Kent and Sussex Counties, which are more rural, have fewer competing plans, so the options available in southern Delaware look different from those in New Castle County. Plan options, networks, and prices change every year and differ by county, so compare what's actually available at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) 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.
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll.
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.
• 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.

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. 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).
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.

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. People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Delaware

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

Delaware uses the federally standardized plans, labeled A through N, regulated by the Delaware Department of Insurance. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the most popular choice for newly eligible beneficiaries: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.

Your strongest 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 must sell you any Medigap plan at the standard rate regardless of your health. Outside it, Delaware insurers may use medical underwriting, meaning they can review your health history, charge you more, or decline your application.

Delaware does not have a birthday rule or year-round guaranteed-issue protections beyond the federal window. If you missed your Medigap Open Enrollment Period and don't qualify for a special guaranteed-issue right, you'll likely need to pass medical underwriting to switch plans. DMAB counselors can help you identify whether any guaranteed-issue rights apply in your situation.

Medigap or Medicare Advantage?

You can't hold both. 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. 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). Delaware uses the standard federal income tiers and Delaware labels the QI-1 tier "QI-1" rather than simply "QI."

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. For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. The income figures are tied to the Federal Poverty Level and update each year. Apply through DMMA at dhss.delaware.gov/dmma or call DHSS at 302-255-9500. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.

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. 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
• Resource limits: $16,590 for an individual, $33,100 for a married couple
• If you qualify for QMB, SLMB, or QI-1, you're enrolled in Extra Help automatically

Apply through Social Security at ssa.gov or call 1-800-772-1213. A DMAB counselor can help with the application at no charge.

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.

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

If you're working past 65 with employer coverage and plan to delay Part B, you get an 8-month Special Enrollment Period once that coverage ends. COBRA and retiree coverage don't count for this purpose. Miss that window and you'll wait for the General Enrollment Period and may owe a permanent late penalty.

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.

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

Call 1-800-336-9500 (toll-free) or 302-674-7364 to reach a counselor.

Learn More

• Medicare: The National Guide
• Original Medicare vs. Medicare Advantage
• How Medigap Works
• Medicare Part D Drug Coverage
• Medicare Savings Programs
• Medicare Enrollment Periods

Find personalized help with Medicare in Delaware at brevy.com.

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.