Delaware has approximately 215,000 Medicare beneficiaries statewide, which makes it a smaller market than nearly any of the neighboring mid-Atlantic states.1 The structural consequence is fewer competing Medicare Advantage plans, narrower provider networks within those plans, and a market where Original Medicare paired with Medigap is often the more practical default.
What Medicare covers, and what it doesn’t
The biggest misconception in caregiving: Medicare is health insurance, not long-term care insurance. Medicare covers short rehab after a hospital stay. It does not cover ongoing custodial care — assisted living, memory care, or long-term nursing home placement — once skilled rehabilitation ends.
What Medicare does cover:
- Part A (Hospital).Inpatient stays, skilled nursing rehab up to 100 days post-hospital (full for first 20 days; copay approximately $204/day for days 21–100 in 2025), hospice, limited home health.
- Part B (Medical). Doctor visits, outpatient procedures, durable medical equipment, mental health, preventive care, ambulance.
- Part D (Drugs). Prescription drug coverage, standalone or bundled into Medicare Advantage.
What Medicare does not cover:
- Assisted living (any state, any setting)
- Memory care
- Custodial nursing home beyond the 100-day rehab window
- Long-term in-home aide hours for personal-care support
- Dental, vision, hearing (Original Medicare; some MA plans add these as extras)
Original Medicare vs. Medicare Advantage in Delaware
Every Medicare-eligible person chooses between two structures: Original Medicare (Parts A and B, usually with a Medigap supplement and a standalone Part D plan) or Medicare Advantage (Part C, a private plan that bundles A, B, and usually D plus extras).
Delaware’s Medicare Advantage penetration is below the national average — approximately 40-45% of Delaware Medicare enrollees are on Advantage in 2025, compared with roughly 54% nationally.2Fewer plans, narrower networks. Some Sussex County Delaware residents face MA networks that exclude major Philadelphia or Baltimore academic medical centers — a meaningful issue if your parent has been managing a serious condition with a regional specialist.
When Original Medicare + Medigap usually beats Advantage in Delaware
- Your parent spends part of the year out of state. Original Medicare works with any Medicare-accepting provider nationwide; Advantage plans have networks.
- Your parent has a complex condition and wants specialist access without referrals or prior authorizations.
- Your parent values predictable out-of-pocket costs and can afford a Medigap monthly premium (approximately $150–$300 for Plan G in Delaware).
When Advantage may beat Original Medicare
- Your parent lives in one Delaware county year-round and is generally healthy.
- The total monthly cost of Original Medicare Part B + Medigap + Part D exceeds your parent’s budget, and a low-premium Advantage plan is available.
- Your parent values the extras — dental, vision, hearing, gym, sometimes meal delivery — that some Advantage plans bundle in.
Medigap in Delaware
Medigap (Medicare Supplement) plans are federally standardized — Plan G in Delaware offers the same benefits as Plan G anywhere else — but Delaware’s pricing rules have specifics.
- Delaware is an age-rated state.Premiums rise as your parent ages. (Connecticut, New York, Massachusetts, and Vermont require community rating — where premiums don’t rise with age. Delaware does not.)
- Guaranteed issue applies during the 6-month Initial Enrollment Period when your parent turns 65 or first enrolls in Medicare Part B. Outside that window, insurers can use medical underwriting to deny or surcharge.
- Delaware does not have an annual switching window. Unlike California, Washington, or Oregon, Delaware doesn’t guarantee an annual Medigap switch with no underwriting. Once your parent picks a plan, switching can require medical requalification.3
Medicare Savings Programs in Delaware
If your parent has limited income, they may qualify for one of the federal Medicare Savings Programs (MSPs), administered in Delaware by DMMA:
- QMB (Qualified Medicare Beneficiary). Pays Part A and Part B premiums, deductibles, and coinsurance. Income limit approximately $1,255/month individual (2026) .
- SLMB (Specified Low-Income Beneficiary). Pays Part B premium only. Income limit approximately $1,506/month individual.
- QI (Qualifying Individual). Pays Part B premium. Income limit approximately $1,695/month individual. First-come first-served annual funding.
Many Delaware seniors who qualify never apply because the application is unfamiliar and DMMA outreach is uneven. A DMAB / ELDERinfo counselor can walk your parent through the application for free.
Annual Enrollment Period (AEP) in Delaware
Medicare AEP runs from October 15 through December 7 each year. During this window your parent can:
- Switch from Original Medicare to Medicare Advantage (or vice versa)
- Switch from one Advantage plan to another
- Add, drop, or change a standalone Part D plan
Delaware sees less aggressive AEP marketing than Florida or California, but the choice still matters. Use Medicare.gov’s Plan Finder to compare plans by total annual cost — not by the size of the dental or grocery benefit being advertised.4
There is also a Medicare Advantage Open Enrollment Period (MA OEP) from January 1 through March 31 each year, during which a member already on Advantage can switch to a different Advantage plan or back to Original Medicare with a Part D plan.
Where to get free help in Delaware
Delaware Medicare Assistance Bureau (DMAB) — also known as ELDERinfo— is Delaware’s federally-funded State Health Insurance Assistance Program (SHIP). DMAB is housed within the Delaware Department of Insurance. Counselors don’t sell plans, take commissions, or represent insurers. Call 1-800-336-9500.5
For Delaware Medicaid questions where Medicaid and Medicare interact, see our Delaware Medicaid guide.