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Medicare Part D in Delaware


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Prescription drug coverage for Medicare beneficiaries in Delaware is available through Medicare Part D. Medicare Part D in Delaware, as in other states, is offered through private insurance companies approved by Medicare. According to the Centers for Medicare and Medicaid Services (CMS) there are over 196,000 Medicare beneficiaries in Delaware. About 75% of those beneficiaries are enrolled in Medicare Part D in Delaware.

How much will I pay for Medicare Part D in Delaware?

According to CMS, $12.60 is the lowest monthly premium for a stand-alone Medicare Prescription Drug Plan in Delaware in 2018. The plan may have a deductible, which is an amount you pay out-of-pocket before the plan begins to pay. Medicare determines a maximum deductible that plans can have. You may also pay a copayment (a set dollar amount) or coinsurance (a percentage) when you fill a prescription. Different prescription drugs may have different copayments and coinsurance depending on the “tier” they are on. For example, a “tier 1” generic prescription drug may have a much lower copayment or coinsurance than a “tier 5” specialty prescription drug.

Why would I need Medicare Part D in Delaware?

Original Medicare (Part A and Part B) covers hospital and medical insurance, but this does not generally include coverage for most prescription drugs you take at home. If your medications could cost you hundreds or even thousands of dollars out-of-pocket, you may want to add prescription drug coverage to your Part A and Part B benefits.

You can get Medicare Part D in Delaware through either a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug Plan. The stand-alone plan only works together with Original Medicare. Medicare Advantage is another way to get your Part A and Part B benefits from a private insurance company that contracts with Medicare. Medicare Advantage plans must cover everything Original Medicare covers, with the exception of hospice care, which is still covered by Part A. Most Medicare Advantage plans in Delaware offer prescription drug coverage.

With a Medicare Advantage plan with prescription drug coverage, you may have a monthly premium as low as $0. (You must continue to pay your Medicare Part B Premium.) With a Medicare Advantage plan you may also have to pay a deductible, coinsurance, or copayment.

How do I enroll in Medicare Part D in Delaware?

You are eligible for Medicare Part D in Delaware if you:

  • Have Medicare Part A and/or Part B and
  • Live in the service area of a Medicare plan that covers prescription drugs

Like other parts of Medicare, you’re only allowed to enroll in or make changes to your Medicare prescription drug coverage during specific times. These periods include:

  • Initial Enrollment Period for Part D: This is the seven-month period when you’re first eligible to sign up for Medicare Part D, and it typically coincides with the period that you’re first eligible for Medicare coverage. If you get Medicare because of age, this period starts three months before you turn 65, includes the month you turn 65, and ends three months later. If you get Medicare because of disability, this period starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board, includes the 25th month, and ends three months later.
  • Annual Election Period(AEP) (October 15 to December 7): Also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. This is your yearly opportunity to enroll in a Medicare plan or make changes to your coverage. During this period, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch plans, or disenroll from a Medicare plan.
  • Medicare Advantage Open Enrollment Period(OEP) (January 1 to March 31): During this period, you can disenroll from a Medicare Advantage plan and return to Original Medicare. If you use this period to disenroll from your Medicare Advantage plan, you’ll also have the chance to enroll  in a stand-alone Medicare Prescription Drug Plan.  During this period you can also switch from one Medicare Advantage plan to another.
  • Special Election Period: Outside of the above periods, you can only make changes to your Medicare prescription drug coverage in certain situations that qualify you for a Special Election Period. This may include (but isn’t limited to) a change of address, losing your Medicaid eligibility, or living in a nursing home. A Special Election Period can occur at any time of the year that you have a qualifying situation.

What else should I know about Medicare Part D in Delaware?

Although Medicare Part D in Delaware is offered through private insurance companies, it is regulated by Medicare. Medicare has determined six classes of medications that Medicare plans with prescription drug benefits must cover “all or substantially all drugs.”

These categories are:

  • HIV/AIDS treatments
  • Antidepressants
  • Antipsychotics
  • Anticonvulsive treatments for seizure disorders
  • Immunosuppressant medications
  • Anticancer medications unless covered by Medicare Part B.

The plan has a formulary which outlines the other medications it covers. The formulary could change at any time, but you will be given notice when necessary.

To start comparing plans in Delaware just enter your zip code in the “zip code” box on this page.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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