All Medicare beneficiaries in Delaware have the option to get prescription drug coverage from Medicare. It’s best to get this drug coverage soon after becoming a Medicare beneficiary even if you don’t need it right away. This is because waiting too long to enroll in an insurance providing drug coverage can result in late enrollment fees (link) that will make your plan cost more. Should your needs change, having prescription drug insurance early will also prevent you from having to pay out of pocket for medications while you’re waiting to enroll in Part D.
Medicare Part D vs. Medicare Advantage
There are two avenues for obtaining prescription drug coverage with Medicare. One is to enroll in Medicare Part D as a supplement to Original Medicare. The other is to enroll in a Medicare Advantage Plan (link), which provides all the same coverage Original Medicare does, and potentially other services, like prescription drug coverage or dental insurance. Even though Delaware has so few counties, in any given area there are at least three Medicare Advantage plans to choose from, in addition to 22 Medicare Part D plans.
Both Medicare Part D and Medicare Advantage are administered by private insurance companies. But while Medicare Part D plans are available in all counties in Delaware, Medicare Advantage plans are generally restricted to certain regions and counties. Should you move to a different area within your state, you may lose your drug coverage with Medicare Advantage.
If you’re already in a Medicare Advantage Plan, you may be interested in switching to Medicare Part D for your prescription drug coverage. Or if you’re on Medicare Part D, you may find a Medicare Advantage plan offers you a better deal. Switching plan types doesn’t just change your drug coverage, though. If you’re in a Medicare Advantage Plan with drug coverage and enroll in Part D, you will lose all Medicare Advantage benefits and be returned to Original Medicare. Similarly, if you have Original Medicare and take a Medicare Advantage Plan for drug coverage, you will no longer have Original Medicare.
Before you decide to take prescription drug coverage with Part D, you should understand how Medicare drug coverage will work with your current insurance. Enrolling in Medicare Part D may disqualify you from getting insurance from your union or employer. You should contact your previous insurance and visit this article (link) on how Medicare Part D works with other insurance before making a decision.
When to sign up
There are three main time windows to enroll in Medicare Part D. The first of these windows is the Initial Enrollment Period (IEP). This is the only period you can sign up for Medicare Part D without risking late enrollment fees, regardless of your previous insurance or financial status. The IEP lasts for a total of seven months, beginning three months before the month you’re eligible to become a Medicare beneficiary.
Your next opportunity to enroll in Medicare Part D is the Annual Election Period (AEP). This lasts from October 15th to December 7th every year. Even if you don’t need to enroll in Medicare Part D during this period, it’s a good time to review your prescription drug insurance and decide whether you would benefit from switching to another plan.
You can also potentially get a Special Election Period (SEP) allowing you to change your prescription drug insurance at other times of the year. There are several circumstances that could entitle you to this, including moving out of your previous coverage zone. For more information on SEPs, visit our article here (link).
What are my choices?
Shown below is a table including the Medicare Part D plans available in Delaware. There are five plans which offer extra drug coverage in the donut hole (link). The cheapest plan with a deductible has an $18.40 monthly premium, and the cheapest plan without a deductible has a $27.00 premium. For an explanation on the various benefit types, visit our article here (link).
|Organization Name||Plan Name||Plan ID||Benefit Type||Total Premium||Drug Deductible||Gap Coverage
|Aetna Medicare||Aetna Medicare Rx Saver (PDP)||39||Actuarially Equivalent Standard||$28.50||$360.00||No|
|EnvisionRx Plus||EnvisionRxPlus Silver (PDP)||5||Actuarially Equivalent Standard||$33.00||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Value (PDP)||107||Actuarially Equivalent Standard||$30.30||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Choice (PDP)||208||Enhanced Alternative||$72.00||$360.00||No|
|First Health Part D||First Health Part D Value Plus (PDP)||128||Enhanced Alternative||$33.40||$0.00||Yes|
|First Health Part D||First Health Part D Premier Plus (PDP)||164||Enhanced Alternative||$86.80||$0.00||Yes|
|Humana Insurance Company||Humana Enhanced (PDP)||4||Enhanced Alternative||$68.30||$0.00||Yes|
|Humana Insurance Company||Humana Preferred Rx Plan (PDP)||103||Actuarially Equivalent Standard||$28.60||$360.00||No|
|Humana Insurance Company||Humana Walmart Rx Plan (PDP)||151||Enhanced Alternative||$18.40||$360.00||No|
|Magellan Rx Medicare||Magellan Rx Medicare Basic (PDP)||3||Actuarially Equivalent Standard||$32.40||$360.00||No|
|SilverScript||SilverScript Choice (PDP)||10||Basic Alternative||$27.00||$0.00||No|
|SilverScript||SilverScript Plus (PDP)||11||Enhanced Alternative||$87.10||$0.00||Yes|
|Stonebridge Life Insurance Company||Transamerica MedicareRx Classic (PDP)||4||Actuarially Equivalent Standard||$83.50||$360.00||No|
|Symphonix Health||Symphonix Value Rx (PDP)||6||Actuarially Equivalent Standard||$28.70||$360.00||No|
|Symphonix Health||Symphonix PrimeSaver Rx (PDP)||51||Enhanced Alternative||$40.30||$200.00||No|
|United American Insurance Company||United American – Enhanced (PDP)||8||Enhanced Alternative||$79.00||$100.00||Yes|
|United American Insurance Company||United American – Select (PDP)||76||Actuarially Equivalent Standard||$63.40||$360.00||No|
|United American Insurance Company||United American – Essential (PDP)||110||Enhanced Alternative||$39.50||$230.00||No|
|UnitedHealthcare||AARP MedicareRx Preferred (PDP)||4||Enhanced Alternative||$57.50||$0.00||No|
|UnitedHealthcare||AARP MedicareRx Saver Plus (PDP)||350||Actuarially Equivalent Standard||$33.60||$360.00||No|
|WellCare||WellCare Classic (PDP)||142||Basic Alternative||$32.60||$360.00||No|
|WellCare||WellCare Extra (PDP)||177||Enhanced Alternative||$66.70||$0.00||No|
Plans are subject to change as contracts are finalized.
Includes contracts/plans as of April 22, 2016. The data does not reflect information for Employer sponsored plans, Part B only plans, or plans not offering a Part D drug benefit.
There is also information not on this chart that could help you in deciding on a drug plan. Before signing up for a plan, you should consider plan whether they have a pharmacy network, so you don’t get