Medicare in Delaware: 2025 Guide
Delaware, despite being the second-smallest state by area, offers Medicare beneficiaries meaningful state-level supports including the Delaware Prescription Assistance Program (DPAP), expanded Medicaid, and one of the more accessible SHIP programs in the Mid-Atlantic region. About 55% of Delaware's Medicare population is enrolled in Medicare Advantage plans.
Medicare Advantage Plans in Delaware
Delaware's Medicare Advantage market benefits from its location in the Mid-Atlantic corridor, with major national and regional insurers offering plans across all three counties — New Castle, Kent, and Sussex. The Wilmington–Newark metro area (New Castle County) has the most competitive market, typically offering 20 or more plans. Kent County (Dover) and Sussex County (the beach communities including Lewes, Rehoboth Beach, and Milford) generally have somewhat fewer options but still adequate competition.
Major Medicare Advantage insurers in Delaware include:
- Aetna/CVS Health: A strong presence in Delaware across HMO and PPO product lines, with competitive premiums in New Castle County.
- UnitedHealthcare: Offers HMO and PPO options statewide with strong enrollment in the Wilmington area.
- Highmark Blue Cross Blue Shield Delaware: The state's major BCBS affiliate with deep provider relationships across Delaware's health systems including ChristianaCare and Beebe Healthcare.
- Cigna and Humana: Additional options in New Castle and Kent counties.
Sussex County — which has attracted significant retiree migration to its coastal communities — generally has solid MA plan competition despite being more rural than New Castle County. Average MA premiums in Delaware range from $0 to approximately $70/month. All MA enrollees continue to pay the standard Part B premium ($185.00/month in 2025).
Medicare Savings Programs in Delaware
Delaware's Medicare Savings Programs are administered by Delaware Medicaid, under the Division of Medicaid and Medical Assistance (DMMA) within the Department of Health and Social Services (DHSS). Delaware has expanded Medicaid under the ACA, providing broader health coverage to low-income Delawareans under age 65 and well-integrated MSP administration for Medicare beneficiaries.
The three MSP levels in Delaware:
- Qualified Medicare Beneficiary (QMB): Pays Part A and Part B premiums, deductibles, and most cost-sharing. Individual income limit approximately $1,255/month (2025).
- Specified Low-Income Medicare Beneficiary (SLMB): Pays the Part B premium only. Slightly higher income limits than QMB.
- Qualifying Individual (QI): Also pays the Part B premium; highest income limits, first-come, first-served annually.
To apply for an MSP in Delaware, contact Delaware Medicaid/DMMA at 1-800-372-2022 or visit the Division of Social Services at your local DHSS service center in Wilmington, Dover, or Georgetown. Online applications are available through Delaware's benefits portal at assist.dhss.delaware.gov. MSP enrollment automatically qualifies you for Extra Help with Part D drug costs.
State Pharmaceutical Assistance in Delaware
Delaware operates the Delaware Prescription Assistance Program (DPAP), a state-funded pharmaceutical assistance program for Medicare beneficiaries with limited income who need help covering prescription drug costs beyond what Medicare Part D provides.
Key DPAP details for 2025:
- Eligibility: Delaware residents enrolled in Medicare Part D with income below program thresholds (income limits are income-based and subject to annual updates — contact DMAB or DSS for current figures). Applicants must be Delaware residents and enrolled in a Medicare Part D plan.
- What it covers: DPAP helps pay Part D cost-sharing including copays and deductibles for eligible beneficiaries, functioning as a wrap-around program that coordinates with your existing Part D coverage.
- How to apply: Contact the Delaware Department of Health and Social Services or DMAB (Delaware Medicare Assistance Bureau) at 1-800-336-9500 for application information and current income guidelines.
If you do not qualify for DPAP or Extra Help, additional prescription cost resources include pharmaceutical manufacturer patient assistance programs and NeedyMeds.org, which lists drug assistance programs by medication name.
Getting Free Medicare Help in Delaware
Delaware's State Health Insurance Assistance Program is operated by the DMAB — Delaware Medicare Assistance Bureau. DMAB provides free, unbiased Medicare counseling to all Delaware residents with Medicare and is widely regarded as one of the more accessible SHIP programs in the Mid-Atlantic region.
Contact DMAB (Delaware SHIP):
- Phone: 1-800-336-9500
- Website: dhss.delaware.gov/dmab
- DMAB offices are located in Wilmington (New Castle County), Dover (Kent County), and Georgetown (Sussex County), making in-person access available throughout the state.
DMAB counselors can help you:
- Compare Medicare Advantage, Medigap, and Part D plans available in your Delaware county
- Apply for DPAP and Medicare Savings Programs
- Understand your rights as a Medicare beneficiary, including QMB billing protections
- Resolve Medicare billing disputes and file Medicare appeals
- Evaluate employer retiree coverage coordination with Medicare
DPAP (Delaware Prescription Assistance Program) is a state-funded program that helps Delaware Medicare beneficiaries pay Part D drug costs — including copays and deductibles — that Medicare alone doesn't cover. Eligibility is income-based, and you must be enrolled in a Medicare Part D prescription drug plan to participate. To apply, contact DMAB at 1-800-336-9500 or the Delaware DHSS for current income guidelines and an application. DMAB counselors can help you determine whether DPAP, Extra Help, or a combination of resources best meets your prescription cost needs. Because Delaware is a small state with a centralized SHIP program, getting personal help from DMAB is typically quick and straightforward.
Sussex County, including Lewes, Rehoboth Beach, Milford, and the surrounding coastal area, has attracted significant retiree migration and Medicare plan competition has grown accordingly. Major insurers like Highmark BCBS Delaware, UnitedHealthcare, and Aetna offer plans in Sussex County. Beebe Healthcare — the primary hospital system in coastal Sussex County — is in-network for most major plans. However, if you rely on specialists at ChristianaCare (based in Wilmington/Newark), verify network coverage carefully, as some Sussex County HMO plans may require referrals or limit travel to northern Delaware. Beneficiaries who regularly travel between their Sussex County beach home and a residence elsewhere should also consider whether a PPO or Original Medicare provides better flexibility.
Delaware follows federal Medigap standardization rules, meaning supplement plans (A, B, D, G, K, L, M, N) have the same benefits regardless of which insurer you buy from. Delaware requires insurers to offer guaranteed issue rights during the standard 6-month Medigap Open Enrollment Period when you first turn 65 and enroll in Part B. Outside of guaranteed issue periods, insurers in Delaware may use medical underwriting to deny coverage or charge higher premiums based on health status, similar to most states. Plan G is the most comprehensive Medigap option for new enrollees in 2025. Contact DMAB at 1-800-336-9500 to compare current Medigap premiums from all Delaware-licensed insurers before making a decision.